From Trump's Budget Proposal

     From Donald Trump's budget proposal for Fiscal Year (FY) 2018 (page 111), which begins on October 1, 2017.

Reform Disability Programs. Currently, people with disabilities have low rates of LFP [Labor Force Participation]-20 percent-which is less than a third of the LFP rate of the overall working age population. There is a common expectation that receipt of disability insurance benefits results in a permanent exit from the labor force. The Budget challenges this assumption by evaluating alternative program designs that will help individuals with disabilities remain attached to the labor force and individuals with temporary work disabilities return-to-work.

As part of this reform effort, the Administration would call on the Congress to establish an expert panel that would identify specific changes to program rules that increase LFP and reduce participation on disability programs based on the results of successful demonstrations and other evidence. This panel would be responsible for making recommendations to reduce participation levels that would be directly tied to reaching a 5 percent reduction in Disability Insurance (DI) and Supplemental Security Income (SSI) projected outlays by 2027.

To maximize the potential of success, the Administration would simultaneously test a variety of strategies. The Administration is calling on the Congress to mandate participation by applicants and program beneficiaries in these projects including:

1) Test "time limited benefits" for beneficiaries for a period when they would be more likely to return to work;

2) Require applicants to engage in job-seeking activities before their application is considered;

3) Push existing State vocational rehabilitation offices to intervene earlier with individuals on a track to end up on DI;

4) Replicate welfare-to-work strategies in State TANF offices to provide wellness care and vocational services to welfare applicants that cannot work due to a short-term or uncontrolled health condition; and

5) Mandate that lower back pain and arthritis sufferers engage in rehabilitation traditionally used in occupational health treatment services before receiving benefits.

On a separate track, the Office of Disability Employment Policy (ODEP) at the Department of Labor would lead the implementation of a demonstration project to test the effectiveness of Washington State's Centers of Occupational Health and Education (COHE) program to improve labor force participation and attachment of individuals with temporary injuries and disabilities. While COHE is focused on workers' compensation related injuries, the demonstration will test the effects of implementing key features of the model in other States or municipalities, and/or for a broader population beyond workers' compensation. Some of the key features include care and service coordination, population screening and monitoring, increased access and targeted vocational rehabilitation and work supports, workplace accommodations, and technical assistance to healthcare providers and employers.

Reduce 12 month retroactive DI benefits to six months. New DI beneficiaries are eligible for up to 12 months of benefits before the date of their application, depending upon the date they became disabled. This proposal would reduce retroactivity for disabled workers, which is the same policy already in effect for Medicare eligibility.

Create sliding scale for multi-recipient SSI families. Currently, families receive an equal amount for each SSI child recipient. However, economies of scale in some types of consumption — housing, in particular — reduces per capita living expenses and therefore means that two children generally do not need twice the income as one child. Federal poverty guidelines and other means-tested benefits take into account these efficiencies. The Budget proposes to create a sliding scale for SSI disability benefits that considers the number of additional family recipients. It would keep the maximum benefit for one recipient the same as in current law but reduce benefits for additional recipients in the same family.

Offset overlapping unemployment and disability payments. The Budget proposes to close a loophole that allows individuals to receive Unemployment Insurance (UI) and DI for the same period of joblessness. The proposal would offset the DI benefit to account for concurrent receipt of UI benefits. Under current law, concurrent receipt of DI benefits and unemployment compensation is allowable. UI is intended to compensate individuals for short-term bouts of unemployment while they look to return to work while DI is intended to compensate individuals who cannot return to work on a long-term basis due to a disability, allowing double dipping that is unnecessary and wasteful.

Reinstate the reconsideration review application stage in 10 States. The Budget proposes reinstating reconsideration in 10 States, conforming these States with the practices used in the rest of the Nation. This reform requires a second review by the State Disability Determination Services (DDS) before an appeal goes to an Administrative Law Judge (ALJ). Other States already require disability applicants to have their claim "reconsidered" before they can appeal to an ALJ.

Eliminate Workers' Compensation (WC) Reverse Offset. The Budget proposes to eliminate reverse offsets in 15 States where WC benefits are offset instead of DI benefits. Currently, in most States, the combination of benefits from WC and DI is limited to 80 percent of the recipient's earnings before they were disabled. If necessary, DI benefits are usually offset to meet the limit. However, 15 States currently reduce the benefit from WC rather than DI in order to achieve the 80 percent limit, creating an unjustified inequity across States. This option would eliminate the reverse offsets in these States.

Create a probationary period for Administrative Law Judges. The Budget proposes to create a probationary period for ALJs. This option would create a one-year probationary period, similar to the Senior Executive Service, to ensure an ALJ is performing at a satisfactory level. Following the one-year probation, the ALJ would convert to a lifetime appointment. individuals receiving retirement benefits. This proposal will not modify retroactivity for Medicare eligibility.

Don't Get Excited But Trump Wants $72 Billion In "Disability" Cuts

     The White House budget proposal for Fiscal Year (FY) 2018, which begins on October 1, 2017, is due out at 11:00 today. The New York Times is reporting that the budget includes $72 billion in cuts for "disability." I have no idea what this means other than that it would be over 10 years. 

     All reports indicate that this budget proposal is outlandish even by the standards of the preposterous Trump administration. There is every reason to believe it will have almost no influence on what Congress actually does.
     Update: This is from Vox:

The budget would also cut $72.5 billion over 10 years to programs for disabled people, including Social Security Disability Insurance (violating Trump’s promise to not cut Social Security benefits) and Supplemental Security Income, which provides support for desperately poor disabled and elderly people without enough earnings to qualify for poverty-level Social Security benefits.

The biggest disability cut is vaguely labeled, “Test new approaches to increase labor force participation,” implying that the budget will require that SSDI test a number of new approaches to get beneficiaries back into the workforce. It budgets $100 million a year in the first five years for testing, but then assumes that the approaches they choose will save more than $49 billion in the final five.

We don’t know what exact measures will be introduced to try to promote work. But many ideas that would increase work among disabled Americans — like increased access to long-term supports and services, subsidized jobs, more funding for vocational rehab programs, and a partial disability benefit available for those who can work part time — would cost more money to the federal government, not less.

Trump Budget For FY 2018 Due Out On Tuesday

     On Tuesday the Trump Administration will release its proposed budget for Fiscal Year (FY) 2018, which begins on October 1, 2017. Some details are starting to leak out but in considering them be aware that Congress completely ignored the Trump budget proposals for FY 2017. 

     From the Washington Post:

President Trump’s first major budget proposal on Tuesday will include massive cuts to Medicaid and call for changes to anti-poverty programs that would give states new power to limit a range of benefits, people familiar with the planning said, despite growing unease in Congress about cutting the safety net.

For Medicaid, the state-federal program that provides health care to low-income Americans, Trump’s budget plan would follow through on a bill passed by House Republicans to cut more than $800 billion over 10 years. The Congressional Budget Office has estimated that this could cut off Medicaid benefits for about 10 million people over the next decade. ...

Leaked budget documents, obtained by the think tank Third Way, suggested other ways the White House plans to change anti-poverty funding. These documents show a change in the funding for Social Security’s Supplemental Security Income program, which provide cash benefits for the poor and disabled. It’s unclear, though, what those changes might look like. A White House official said the Third Way document was out-of-date and would not comment on specifics in their files. ...

Trump has instructed his budget director, former South Carolina congressman Mick Mulvaney, that he does not want cuts to Medicare and Social Security’s retirement program in this budget, Mulvaney recently said, but the plan may call for changes to Social Security Disability Insurance, seeking ideas for ways to move people who are able out of this program and back into the workforce. ...

Annual Statistical Supplement Issued

     The Social Security Administration has issued its Annual Statistical Supplement for 2016. As always, it's crammed full of all the statistics about Social Security that you could want except that it includes only limited information on Social Security Administration operations, such as wait times at field offices, length of backlogs to obtain a hearing, Administrative Law Judge reversal rates, etc. I've always found this odd since otherwise these Annual Statistical Supplements are incredibly comprehensive. Want to know how many people are receiving U.S. Social Security widows and widowers benefits who live in Serbia and Montenegro? What about the percentage distribution of persons receiving both a retired-worker and a secondary benefit with and without reduction for early retirement, by sex and primary insurance amount? They're all there in the Annual Statistical Supplement. 

     It does include this table which may be of interest to readers of this blog:

Table 2.F3 Number of work years, fiscal years 1995–2016

Year	Full-time permanent staff a	Total work years b
1995	62,504	67,063
1996	62,133	66,726
1997	61,224	69,378
1998	59,943	67,210
1999	59,752	66,459
2000	60,434	65,521
2001	61,490	65,562
2002	61,914	65,742
2003	63,569	65,343
2004	63,186	c 66,154
2005	63,696	d 68,026
2006	61,692	66,878
2007	60,206	63,939
2008	61,920	64,358
2009	65,203	67,170
2010	67,548	70,758
2011	64,744	69,936
2012	62,943	67,208
2013	59,823	64,601
2014	62,956	64,006
2015	63,466	67,004
2016	62,685	65,798
SOURCE: Social Security Administration's Payroll Reports.
a. On duty at end of fiscal year; includes seasonal employees.
b. Includes full-time, part-time, and temporary employees; employees in special programs; and overtime hours worked.
c. Includes 178 work years for activities related to Medicare Modernization Act.

We're Number Nine!

     Social Security ranks 9th on the list of best large federal agencies to work for in 2016, which is the middle of the pack. NASA ranks first. DHS ranks last. Social Security suffered the largest decline in rating between 2015 and 2016 of any large agency. In fact, it looks like Social Security has been in a fairly steady decline since 2010. While Senior Executive Service (SES) employees at Social Security are happier than employees generally, they are actually quite a bit less happy than SES employees at agencies generally. The agency's leadership scores generally compare poorly with other agencies

     By the way, all the other large agencies have cabinet rank but not Social Security.

We're Doing A Poor Job Of Helping Disabled Young People Make The Transition From School To Work

     From a recent report by the Government Accountability Office (GAO):

The Social Security Administration’s (SSA) primary approach for encouraging employment for transition-age youth (ages 14 to 17) with disabilities who receive Supplemental Security Income (SSI) is work incentives that allow them to keep at least some of their SSI benefits and Medicaid coverage while they work. But few transition-age youth benefit from these incentives. ... The work incentive targeted specifically to younger SSI recipients is the Student Earned Income Exclusion (SEIE), which allows income to be excluded from benefits calculations if a recipient is a student under age 22. However, less than 1.5 percent of all transition-age youth — and generally less than half of those with earnings —benefited from SEIE in 2012 through 2015. ... Data also show that almost no youth benefited from other incentives that allow them to exclude earnings used for specific purposes, such as the Impairment-Related Work Expenses incentive. The effectiveness of SSA-administered work incentives may be further limited because, according to SSA and other officials, youth and their families are often unaware of or do not understand them, and may fear that work will negatively affect their benefits or eligibility. ... 

SSA does not have a systematic way to connect transition-age youth on SSI to state Vocational Rehabilitation (VR) agencies that provide training and employment services under the VR State Grants program administered by the Department of Education (Education). Although youth receiving SSI are generally presumed to be eligible for VR services, GAO found that less than 1 percent had an open VR service record in 2015 in four of the five states from which GAO collected VR data. ...

We recommend that the Acting Commissioner of the Social Security Administration take the following actions: 

1. Analyze the SEIE data to determine why a large proportion of transition- age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it. 
2. Analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss – when applicable—how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations. 
3. Work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services. 
4. Explore various options for increasing connections to VR agencies and services , including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

     The report addresses an important topic. I have a few thoughts on this:

• Transition services are vitally important to disabled youths who are about to leave school. I have seen far too many cases where young people who urgently needed VR had no idea that VR exists. When I see clients in this situation, I tell them and their parents about VR but, of course, most disabled young people never see a Social Security attorney.
• Some years ago, at least in North Carolina, schools worked with VR to identify disabled young people in need of help and made sure they were offered that help. That seemed extremely effective. That's not happening now. (What about other states?) I'm pretty sure the problem is lack of VR funding. I'm not sure why the school systems don't at least give the disabled young people and their families the phone number for VR although as I discuss below state Vocational Rehabilitation may be of only limited value at this point.
• Sheltered workshops are a vital part of vocational rehabilitation for disabled young people trying to make the transition from school to work. Sheltered workshops have almost completely disappeared in North Carolina. I'm pretty sure it's due to lack of funding. (What about other states?)
• What I've seen over the last decade or two is declining effectiveness of North Carolina VR. They seem to be able to do little other than pay for community college courses. Disabled young people trying to make the transition from school to work typically need far more help. (What about other states?)
• Social Security's work incentives are far, far too complicated. That's not the agency's fault. Congress wrote the work incentives, not Social Security, but don't expect simplification to help much. There's plenty of evidence that work incentives have little value.
• Social Security lacks funding to do much to help disabled young people making the transition from school to work. I suppose the agency could send out mailings but they would need additional appropriations to do anything more. I think the money might be better spent elsewhere.
• I think additional funding for VR along with provisions requiring VR to coordinate with school systems would work better than anything the Social Security Administration can do.
• Finally, don't expect miracles. Most disabled children won't work on a regular basis no matter what anyone does. Many people who work at the Office of Disability Adjudication and Review (ODAR) or who represent claimants get the mistaken impression that almost all children receiving SSI benefits have psychiatric or cognitive impairments that are of less than overwhelming severity. That's because that group is vastly over-represented in the population requesting hearings on SSI child disability claims. Most disabled children on SSI have physical problems and most of those problems are so overwhelming that the disability claims are approved quickly. Work is unlikely to ever be in the picture for most of these children. Many of those suffering from psychiatric disability have schizophrenia. While Social Security is denying too many schizophrenics, it's still a fact that most schizophrenia claims are being approved fairly quickly. The vast majority of schizophrenics won't be able to work no matter what anyone does for them.

Where We Stand

     Social Security's budget for the current fiscal year declined by $60 million from the previous year. By contrast, NASA received an increase of $226 million for outer planet exploration. I've got nothing against outer planet exploration but still ....

Social Security Wants To Give Priority To Terminating Disability Benefits

     From a recent report by Social Security's Office of Inspector General (OIG):

Statutory benefit continuation allows an individual to continue receiving disability benefits during the appeal of a medical cessation determination at the reconsideration or ALJ hearing levels. If the cessation determination is upheld after appeal, the Social Security Administration (SSA) considers the payments received during the appeals process overpayments the individual must return to SSA. ...

We project SSA overpaid approximately $682.5 million to individuals in our population who continued receiving disability benefits during the appeals process but for whom ALJs upheld the cessation determinations from October 1, 2013 through July 8, 2016. This comprised $138.5 million overpaid to DI beneficiaries and $ 544 million overpaid to SSI recipients. 

We estimate, as of August 2016, SSA was in the process of collecting 28 percent of the amount overpaid to DI beneficiaries. It had collected only 4 percent, waived or terminated collection action on 17 percent, and posted another 37 per cent to the beneficiaries’ records but did not take action to collect, waive, or deem them uncollectible. SSA had not posted about 14 percent to the beneficiaries’ records for collection. Likewise, for the amount overpaid to the SSI recipients, SSA was in the process of collecting 61 percent. It had collected 2 percent, waived or terminated collection action on 13 percent, and had posted another 17 percent to the recipients’ records but did not take action to collect, waive, or deem them uncollectible. SSA had not posted 7 percent to the individuals’ records for collection. The average processing time for medical cessation appeals had increased from our prior reviews. Specifically, processing times were 766 days for sampled DI beneficiaries and 831 days for sampled SSI recipients — increases of 18 percent and 20 percent, respectively. If SSA prioritizes medical cessation appeals, it could increase DI and SSI programs’ financial performance. For example, we project SSA could have avoided $69.7 million in DI overpayments and $266 million in SSI overpayments had it completed the appeals process for medical cessation s within its processing time goals totaling 394 days. ...

     The agency's response to the suggestion that it should prioritize cutting people off benefits because that would save money was to say "We agree."