The following 12 papers contain proposals for improving the Social Security Disability Insurance (SSDI) program.
Authors: David Stapleton, Yonatan Ben-Shalom, and David Mann.
Summary:The authors propose to pilot and gradually implement a revised disability determination system that combines timely employment supports for workers and a redesigned SSDI eligibility determination process. The goal of the program is to reduce exit from the labor force and entry into SSDI, improve the disability determination process, and improve economic outcomes for workers. Such a system would be based on existing models from private disability insurance providers, worker's compensation, and international examples.
Authors: Jennifer Christian, Kim Burton, and Thomas Wickizer
Summary: The authors will submit a plan to develop, test, evaluate, and implement a national program to avoid needless work disability by establishing a network of local, community-focused health and work services to provide just-in-time assistance to workers when newly acquired or altered disabilities have just begun seriously disrupting their jobs. The proposed program is intended to help them optimize their functional level and find a way to stay employed and remain in the workforce, thus delaying or avoiding application to SSDI. The program will incorporate features of two existing programs, one in Washington state, the other in the United Kingdom. The paper will outline a sequence of projects to assure success, beginning with design, development, feasibility and effectiveness testing, then validation of ROI before rolling it out gradually across the country. The paper will include some preliminary analysis of the pre-requisites for establishing such a program including legislative, regulatory, and organizational changes, development timeframe, expected costs and benefits.
Authors: Julie Kerksick, David Riemer, and Conor Williams
Summary: The authors propose a group of policy changes centered around offering Transitional Jobs to SSDI beneficiaries. Transitional Jobs (TJ) are subsidized wage-paying jobs, typically in either the private non-profit or private for-profit sector, in which an unemployed or underemployed individual does actual, productive work while pursuing permanent employment in the regular economy. The authors suggest that TJs can be offered to current (as well as potential) SSDI beneficiaries in order to encourage work. They also propose a complementary expansion of the Earned Income Tax Credit (EITC) and a gradual offset of benefits with earned income disregards.
Authors: Alex Constantin, Julia Porcino, John Collins, and Chunxiao Zhou
Summary: The authors propose to analyze the processes SSA use to designate medical improvement diaries and to prioritize medical Continuing Disability Reviews (CDRs). The authors will use the analyses to develop ways to improve those processes, aiming to alleviate case backlogs and better select cases for full medical reviews. The authors will develop methods for extracting medical information from beneficiaries’ electronic folders, to develop an automated method for designating the likelihood of future medical improvement, and to improve the current CDR predictive model. These actions would help SSA more accurately designate medical improvement, improve the diary set for review, better target CDRs toward those most likely to have recovered, and thus make the best use of limited CDR dollars.
Title: Social Security Disability Adjudicative Reform: Ending the Reconsideration Stage of SSDI Adjudication after Sixteen Years of Testing and Enhancing Initital Stage Record Development (Presentation)
Author: Jon Dubin
Summary: The author proposes several measures to improve the disability determination process. This includes eliminating the first level of appeal (reconsideration) and enhancing case development at the initial claim level.
Authors: David Engel, Dale Glendening, and Jeffrey Wolfe
Summary: Recognizing persistent ongoing backlogs and rising costs in the Social Security disability hearings and appeals process, the authors propose comprehensive procedural and jurisprudential reforms. As more than 80% of all disability claimants are now represented, fundamental reforms include adoption of an adversarial jurisprudence/process with inclusion of government counsel (able to resolve disability appeals by agreement early in the appeals process), accompanied by adoption of a body of comprehensive procedural rules. The authors further propose reduction of the scope of Appeals Council review, streamlining the adjudicatory process; and fundamentally restructuring payments to representatives, including elimination of representative travel reimbursement; and reorganization of representative fees, so that fees are no longer calculated on “past due benefits,” foreclosing fee-based incentives for delay.
The opinions and views expressed are those of the authors and do not represent any view, position, policy or policy statement, or finding of the U.S. Government or the Social Security Administration or any of its components.
Authors: David F. Babbel and Mark F. Meyer
Summary: The authors propose to reduce the number of people needing SSDI benefits through better interaction with existing private disability insurance programs and offer three recommendations. First, they propose to expand private disability insurance coverage to more employees by encouraging employer use of “automatic enrollment arrangements” for group disability insurance plans. By expanding private disability insurance coverage, the authors believe that more workers will benefit from the early disability management and return to work supports provided by private plans, and will be less likely to apply for SSDI, thus reducing program costs. Second, the authors recommend undertaking a Federal education and outreach program to encourage workers and employers to face key disability income security issues and workforce productivity issues. Third, they suggest exploring private sector techniques and strategies to improve SSDI work outcomes.
Author: Mark Perriello
Summary: The author proposes policy changes to create a comprehensive system in the United States to ensure workers with disabilities have affordable access to adequate health insurance coverage and long-term services and supports (LTSS). First, the author proposes establishment of a new program to wrap around coverage to commercial health insurance to provide LTSS to working people with disabilities. The program would supplement the worker's health insurance; fill gaps in current health insurance coverage (e.g., adequate durable medical equipment coverage) and provide LTSS (such as personal attendant care) not covered by health insurance; and prevent individuals from having to apply for Medicaid, which is the only program that now provides them with such services and supports. Secondly, the author proposes to expand the Medicaid Buy-In program (currently active in 45 states) by making the program national, standardizing the earnings and asset limits, and making other changes to improve the level and consistency of the covered services and supports. This would prevent working individuals from having to meet the current strict income/asset standards to qualify for Medicaid and thus obtain the covered services and supports. Finally, the author proposes to improve current tax provisions available to workers with disabilities to assist in covering the costs of needed supports and services not covered, or not fully covered, by the above two programs that are financed out of pocket.
Authors: John F. Burton Jr. and Xuguang (Steve) Guo
Summary: The authors propose to address a number of the interaction between SSDI and Workers' Compensation (WC) and investigate several policy options that could reduce SSDI expenditures in the process. Particularly, the authors will consider changes to Federal standards requiring States to compensate work-related injuries/disease; the enactment of new federal rules requiring WC settlements to set aside funds to cover future WC cash benefits; the implementation of experience-rating employers so those with more employees filing for SSDI pay higher FICA taxes, thus providing incentives for employers to reduce injuries and diseases and to rehabilitate disabled workers; and changes to the law that currently allow some states to reduce WC payments once an individual begins to receive SSDI payments (a “reverse-offset”), as opposed to the other way around.
Authors: Kim Hildred, Pam Mazerski, Harold Krent, Jennifer Christian
Summary: The authors propose to investigate creating a transitional disability benefit for a small subset of SSDI beneficiaries who have medical conditions that are expected to improve. The authors would explore the development of a pathway for individuals that would proactively provide medical supports and employment services to help them improve their health and well-being and reattach to the labor market when possible.
Author: Jason J. Fichtner and Jason S. Seligman
Summary: The authors propose to create a time-limited and partial disability benefit option in order to better reflect the nature of disability as a continuum rather than an all-or-nothing state. A disability insurance system that offers both partial and time-limited benefits would better motivate productive employment of remaining ability and, when possible, rehabilitation of lost ability following any partial or temporary disability determination. Their proposal will also explore an increased role for private employers in providing disability insurance. They expect this reform option to increase opportunities for rehabilitation and work, and they propose demonstration projects to test this assumption. They propose to provide grants to fund demonstration/pilot projects to provide empirical evidence needed for full implementation.
The views in this piece are the authors’ and do not necessarily represent the views of the Mercatus Center, the United States Department of Treasury, or the U.S. Government.
Authors: Neil Jacobson, Aya Aghabi, Barbara Butz, and Anita Aaron
Summary: The authors propose to redefine disability for purposes of the SSDI and SSI programs, potentially leading to a change in the fundamental principles of the program and, in turn, a new focus on early intervention. The authors argue that this would result in a significant increase in employment and self-sufficiency for people with disabilities. The new definition will contain no reference to “inability to work” and is expected to change SSDI from an income replacement program to a program that protects people from the high cost of disability and helps people work, stay at work, or return to work. The revised program will rely on inter-agency coordination and funding will flow from multiple sources.
Selection of these papers does not imply endorsement of them by the Initiative Co-Chairs, Advisory Council, staff, or other authors.