The Bipartisan Policy Center (BPC) recently convened a Disability Insurance Working Group and released their recommendations to address the upcoming exhaustion of the Social Security Disability Insurance (SSDI) trust fund. The group brought together diverse stakeholders that spanned from disability community advocates and former policymakers to academics and business leaders to find consensus recommendations that involved tradeoffs from all perspectives of the situation in order to make a comprehensive proposal.
The Working Group, guided by 11 principles for their decision-making process, agreed that the immediate funding need would need to be addressed by reallocating payroll tax revenue from the Old-Age and Survivors' Insurance trust fund to the SSDI trust fund, and they also suggested the following program recommendations:
Improve Work Incentives
Emphasize Continuation of Benefits is Contingent on Lack of Medical Improvement; Pilot New Approaches to Facilitate Return-to-Work
- For dually eligible (SSDI and SSI) beneficiaries, replace the “cash cliff” with a $1-for-$2 benefit offset for monthly earnings exceeding $700; eliminate Trial Work Period and establish continued program attachment (including Medicare) except in the case of medical improvement.
- For SSDI beneficiaries who qualify for the program before the age of 50 and are not dually eligible, establish a voluntary pilot to test a benefit offset beginning at thresholds below the substantial gainful activity level ($1,090 per month for non-blind beneficiaries in 2015).
- For all beneficiaries, establish electronic earnings reporting, quarterly benefit adjustments, and allow the Social Security Administration (SSA) up to six months to adjust benefits due to overpayments if earnings reports were timely and accurate.
Improve Interagency Coordination on Workforce Attachment and Pilot New Approaches to Help People with Disabilities Stay at Work and Return to Work
- Indicate clearly in award letters that continuation of SSDI benefits is contingent upon the lack of medical improvement.
- Guarantee timely Continuing Disability Reviews (CDRs) with adequate funding. From 2016-2020, CDRs should be accommodated through appropriations and cap adjustments, meaning that SSA would have all necessary funds at its disposal to complete CDRs on schedule and clear out the backlog of approximately 900,000 medical CDRs for SSDI and SSI.
- Experiment with additional communications to beneficiaries about available work supports.
- Test making return-to-work benefits available to beneficiaries for one year after their benefits are terminated due to medical improvement.
- Engage multiple agencies to provide transition support for beneficiaries whose benefits are terminated due to medical improvement.
- Establish a voluntary partial disability benefit pilot for new entrants and existing SSDI beneficiaries who attempt work.
- Implement a new organizational structure to manage pilots, including an office responsible for pilot implementation located at a high level within SSA, which would be monitored by an external oversight committee appointed by the Social Security Public Trustees.
Evaluate the Medical-Vocational Guidelines
- Establish a Workforce Attachment Venture Investment (WAVI) Board, convened by the Office of Management and Budget and composed of officials from Labor, Education, Health and Human Services, and SSA.
- Provide $400 million in seed funding for workforce-attachment pilots to be selected and monitored by the WAVI board; pilots could engage states, employers, not-for-profits, private disability insurance carriers, others.
- Scale up demonstrably effective interventions with coordinated, interagency efforts.
Implement reforms to improve SSA program integrity and program operations, including:
- Fund a third-party evaluation of the efficacy and performance of the medical-vocational guidelines.
- Examine whether and to what extent additional factors (other than age, education and work experience), such as functioning in the workplace, should be incorporated into this step of the determination process.
- Complete the evaluation by 2020 at the latest. Then, SSA should propose adjustments to this stage of the eligibility process and issue proposed regulations, as necessary, without delay.
- Enact several provisions to increase criminal and civil penalties, and require collection of proven fraudulent payments.
- Expand Cooperative Disability Investigation units to additional states.
- Test the establishment of a corps of medical and vocational consultants to provide assistance at all levels of the eligibility determination process.
- Establish pilots to improve the process of obtaining complete evidence for the record at the initial (DDS) level.
- Send administrative law judge (ALJ) hearing notices at least 75 days before the scheduled hearing date, and strongly encourage claimants to submit all relevant evidence at least five days before the hearing.
- Provide additional funding for and authorize the Appeals Council to proactively conduct post-effectuation reviews of decisions from ALJs with unusually high or low approval rates so that backlog is not increased.
- Provide funding for the Appeals Council to conduct additional quality reviews, which are already authorized by law, without increasing the backlog.
- Clarify existing policy and provide additional training to DDS examiners on the Medical Improvement Review Standards and its exceptions.
These recommendations deserve serious consideration as Congress works to enact reforms to the SSDI program to accompany efforts to avoid the projected 2016 trust fund depletion. CRFB’s McCrery-Pomeroy SSDI Solutions Initiative is also working on identifying a menu of options for improvements to the program. Among these include 12 sets of proposals discussed at this month’s SSDI Solutions Conference covering early intervention and work support, structural reforms, determination and adjudication reform, and interaction with other programs.
Congress will certainly have many options at their disposal to find solutions to this critical issue, and we hope they work together to enact the best of these options into law.