Following a comprehensive review of the Social Security Administration's implementation of legislative changes in the Supplemental Security Income (SSI) childhood disability program, Social Security Commissioner Kenneth S. Apfel today directed additional reviews of cases to ensure that children are given every chance to receive benefits for which they are eligible.

Specifically, Commissioner Apfel announced that some 45,000 children who had their Supplemental Security Income (SSI) disability benefits ceased under stricter eligibility provisions of the 1996 welfare reform law will have their cases reviewed. In addition, the families of children who lost benefits and who did not appeal that decision will be given a second opportunity to do so.

Commissioner Apfel noted that there are approximately one million children receiving SSI disability benefits. Of those, about 288,000 were subject to eligibility redetermination under provisions of the welfare reform law. To date, approximately 263,000 have received decisions. More than 127,000 have had their SSI benefit eligibility continued; about 135,000 have had their benefit eligibility ceased.

SSA issued the new SSI childhood disability regulations in February of this year to comply with provisions of the 1996 welfare reform legislation, which tightened the definition of childhood disability. As the implementation of the new regulations progressed, SSA identified three areas of concern: (1) the status of children classified as having mental retardation; (2) the actual case processing in some areas; and (3) confusion regarding appeal rights.

Mental retardation

Of the approximately one million children on the SSI disability rolls, about 407,000 were coded in SSA's data with the primary diagnosis of mental retardation. About eighty percent of these children -- over 325,000 -- had impairments that met our eligibility criteria and were not subject to redetermination. Of the 80,000 children who received redeterminations, over half were ceased.

Part of this cessation rate can be attributed to the fact that historically some children who do not have mental retardation were coded as having mental retardation. But the agency also found that some decisions in mental retardation cases were wrong. In particular, there was concern that children with mental retardation may have been inaccurately ceased.

The actions announced today mean that all redetermination cases showing the mental retardation code will be reviewed, as well as all denials of initial applications adjudicated on or after August 22, 1996. If deficiencies are found, the cases will be reopened. In addition, SSA will reopen all cases of children with the code for mental retardation with IQS of 75 or below whose eligibility was ceased or whose applications were denied.

Actual case processing

SSA's primary concerns are that case decisions are correct, and that all administrative procedures designed to protect claimants and beneficiaries are correctly followed. As part of its quality assurance efforts, SSA examined differences in case characteristics, the quality of case development, and the overall accuracy of determinations. According to Commissioner Apfel, while the general quality of case processing was high, there were some areas of concern.

SSA found variations in benefit cessation rates, much of it attributable to case characteristics.

Also, while the accuracy of decisions has been above the regulatory threshold for accuracy nationally, the agency's quality assurance data show that accuracy varies by state and by categories of impairments.

To ensure childhood disability cases were processed correctly, SSA will take the following action: In addition to the reviews of all cases with the code for mental retardation, we will review a portion of the cessation cases in those areas which had been found to have the greatest likelihood of error.

Before reviewing these cessation cases, SSA will provide additional training to all of its adjudicators addressing the issues regarding the evaluation of mental retardation and any other specific case processing concerns about which adjudicators should be aware.

Commissioner Apfel noted that SSA will continue to monitor for quality assurance throughout the review of the SSI childhood disability cessation cases.

Appeals

Finally, the SSA review addressed concerns about confusion regarding our appeals process and requests for benefit continuation. Although the appeal rate for these cases exceeds the overall appeal rate for SSI applications, some concerns were raised that some children didn't appeal decisions ending their benefit payments, or didn't exercise their right to have benefits continue to be paid during the appeals process, because the cessation notice advising them of their legal rights was hard to understand.

Some concerns were also raised that beneficiaries were discouraged from filing appeals or asking for benefit continuation, and that beneficiaries were unaware of the availability of free legal services.

Although SSA found only isolated evidence to support these allegations, Commissioner Apfel has directed that the agency work with legal assistance organizations to provide toll-free telephone numbers in our field offices, teleservice centers, our Internet site and on the notices we send to make sure that beneficiaries and claimants are aware of the availability of legal representation.

Also released today was a sample of 151 ceased cases to help the agency to answer the question, "Who are These Children?" The sample indicates that the children affected do have limitations in function, but by and large, their conditions are not as severe as the 900,000 children who will continue to receive benefits. The majority of cases where children came off the rolls involved learning problems such as attention deficit hyperactivity disorder and conduct disorders. A third of the children had demonstrated medical improvement.

Reemphasizing that this review is about protecting children with disabilities and not about budgetary numbers, Commissioner Apfel estimated that once all cases are reviewed and appropriate action taken, the number of children impacted by the new SSI childhood disability provisions will decline from 135,000 to approximately 100,000.

See also the complete report, Review of SSA's Implementation of New SSI Childhood Legislation.