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FY 16-17: Agency Priority Goal
Improve Supplemental Security Income payment accuracy
Priority Goal
Goal Overview
The Social Security Administration manages the Supplemental Security Income (SSI) program. SSI is a needs-based program that provides a monthly benefit to people who have low income and few resources, and who are age 65 or older, blind, or disabled. Adults and children (i.e. an individual under the age of 18 or an individual under age 22 who regularly attends a qualifying school and is not married nor head of a home) can receive benefits based on disability or blindness.
The SSI program is complex, in part, because we determine an individual's eligibility on a monthly basis. An individual must meet all factors of eligibility each month to receive SSI benefits. Factors of eligibility include, but are not limited to, having low income and few resources.
A person is not eligible for benefits if his or her countable resources are worth more than $2,000. Married persons who live in the same household are not eligible if their countable resources are worth more than $3,000. In general, we count as resources items that individuals can change to cash and use for their support and maintenance, such as property, stocks, U.S. savings bonds, and money in bank accounts. Generally, we do not count as resources such items as the home in which a person lives, one vehicle for transportation, burial plots for an individual or the immediate family, household goods, and personal property.
If a person is eligible for SSI, we calculate the payment based on a legal definition of income and living situation (arrangement). Income can be in-kind or cash. In-kind income is not cash, but is food, shelter, or an item that a person can use to get one of these items (e.g. a third party pays for the person's food or shelter). Some types of cash income include wages, net earnings from self-employment, Social Security benefits, pensions, and unemployment compensation.
In addition, an individual's eligibility for SSI and payment amount may change if he or she moves into a different living arrangement - whether a person lives alone, lives with others, or lives in a medical facility or other institution. When a change occurs, we decide whether the individual is eligible for SSI. If eligible for SSI, we calculate the payment. For example, when a person moves into a nursing home and is eligible for SSI, we may reduce the person's payment to $30 per month. Also, when an individual moves from his or her own home into the home of another person and the person gives food or shelter to the individual, we decide whether the change affects the individual's eligibility for SSI. If eligible for SSI, we may lower the individual's payment because the individual is receiving in-kind income.
In general, we calculate an eligible person's payment based upon income received two months (e.g. January) before the month of payment (e.g. March). Since an individual's circumstances may change from month to month, paying the correct amount at the right time is problematic. Therefore, we are working to increase our ability to pay benefits correctly by making the program simpler and using more data and technology. While our main goal is to prevent paying individuals more SSI payments than they are due (overpayments), we are also committed to avoid paying people less money than they are due (underpayments).
We must decide eligibility monthly and calculate payment monthly based upon several factors, such as income and living arrangements. Mostly, we depend on an individual to report changes that may affect eligibility or payment. Without a person's timely reporting, we have difficulty getting information about changes and correcting benefits quickly if necessary, which causes us to release some improper payments. Additionally, if an individual reports changes timely (i.e. no later than 10 days after the end of the month in which the change occurred), the agency must give written notice of how the change affects his or her benefit before we make any changes. The written notice must give the person the right to appeal our decision. The notice and appeal process delay our ability to correct payments timely.
Generally, we pay SSI on the first day of the month. We decide eligibility about the third week of a month (e.g. February) for the next month (March). If a person is eligible for SSI, we calculate payment based upon income the person received two months (e.g. January) before the month of payment (e.g. March). Since we use information that we have before the first day of the month to decide eligibility and payment for the month, any changes that may occur during the month can affect the benefit due, which can result in an overpayment or underpayment. Therefore, the program's rules for deciding eligibility and payment may cause us to issue benefits incorrectly.
Strategies
Redeterminations - The strategy includes periodic reviews (redeterminations) of an individual's resources, income, and living arrangements to make sure the person is eligible for SSI. Generally, we review eligibility and payment amounts of most individuals once every one to six years.
Redeterminations are one of our most powerful and reliable program integrity tools. To ensure the most cost-effective investment of agency resources, we use an automated method that predicts and identifies cases where we are most likely to pay more benefits to individuals than they are due (overpayments). The agency estimates that every dollar spent on SSI redeterminations yields about $5 in program savings over 10 years, including Medicaid program effects. In most states, persons who qualify for SSI payments get Medicaid.
Access to Financial Institutions (AFI) - We are maximizing the use of data with projects like AFI that allow us to detect assets in undisclosed bank accounts that are countable resources for SSI. (KI)
Non-Home Real Property - Building upon the AFI model, we are exploring the use of commercial data to help find unknown real property held by persons who are applying for or receiving SSI. (KI)
SSI Wage Reporting - Over the last few years, we have used tools to help people with reporting their wages timely. Individuals can report wages by mail, telephone, or online using a mobile application. (KI)
Using Behavioral Science Insights to Improve Recipient Reporting - As part of SSA's initiative to reduce payment errors and enhance program integrity, SSA is planning a randomized trial that uses behavioral insights to improve SSI reporting compliance.
Data Exchange Opportunities - The agency is relentlessly working on receiving and sharing information - both commercial data and other Federal data. Among commercial data, we are looking to third party payroll providers for timely wage data to decide eligibility and payment. Additionally, we are seeking information from the Department of Homeland Security (DHS) about persons who leave the United States. Knowing when people leave the United States for a full calendar month or longer would help us identify people who are ineligible for SSI because of the absence. (KI)
Progress Update
For FY 2016, Target: 95% SSI overpayment (OP) accuracy, the mid-year FY 2016 accuracy results are expected the first quarter of FY 2017, and the end of FY 2016 accuracy results are expected April 2017.
Our most recent performance results (FY 2015) are the highest in over a decade:
- SSI OP accuracy 93.9% (highest since FY 2003)
- SSI UP accuracy 98.6% (highest since FY 2005)
We exceeded all FY 2016 secondary indicators including number of SSI redeterminations (2.5 million) and SSI wage reports (1.05 million) processed. In the fourth quarter we processed 174,094 wage reports using SSI Mobile Wage Reporting (SSIMWR) and 97,311 wage reports using SSI Telephone Wage Reporting (SSITWR). Compared to fourth quarter of FY 15, we processed 33.47 percent more SSIMWR reports and 9.81 percent fewer SSITWR reports. We expected the decrease in SSITWR reports as users continue to move to SSIMWR. We have also expanded the Improper Payments Community of Practice to 13 agencies.
FY 2016 Quarterly Milestones
Q4- Begin measuring program outcomes from Access to Financial Institutions based on denials and suspensions.
- We have been working collaboratively with the Analytics Center of Excellence (ACE) on fundamental business questions to better measure the number and amount of Improper Payments we detect or prevent because of AFI. Results expected in the first quarter of FY 2017.
Q4 - In the month of September 2016, increase the number of wage reports we process using our automated tools (telephone) and smart phone wage reporting) by 7% over the number in the month September 2015.
- We exceed this milestone. In September 2016, we processed 174, 094 wage reports using SSI Mobile Wage Reporting (SSIMWR) and 97,311 wage reports using SSI Telephone Wage Reporting (SSITWR). Compared to September 2015, we processed 33.47 percent more SSIMWR reports exceeding the milestone target. However, we processed 9.81 percent fewer SSITWR reports, in September FY 2016 compared to September 2015; we expected the decrease in SSITWR reports as users continue to move to SSIMWR.
Q4 - Complete software development for automated non-home real property searches in the SSI system.
- Through Q4, we continued software development with expected completion in the first quarter of FY 2017 and moving into NHRP validation the second quarter of FY 2017.
Q4- Begin measuring program outcomes from Access to Financial Institutions based on denials and suspensions.
- We have been working collaboratively with the Analytics Center of Excellence (ACE) on fundamental business questions to better measure the number and amount of Improper Payments we detect or prevent because of AFI.
Q3 - Begin software development for automated non-home real property searches in SSI system.
- The Office of Quality Improvement (OQI) obtained executive signoff on the Project Scope & Management Agreement in Q2 and the NHRP Release agreement (Q3). The project is on track to complete requirements in FY 16 with nationwide implementation scheduled for Q4 FY 2017.
Q2 - Absent new legislative authority, determine path forward for commercial wage data and submit request for agency resources to support integration in SSI systems.
- Due to recent legislation in this area, we do not have any Q2 milestones to report.
Q2 - Begin DHS TECS data exchange study to identify persons who are ineligible for SSI due to their absence from the U.S. TECS is a system DHS officers use at the border to help with screening persons who are entering the U.S.
- In December, DHS completed an update to its System of Record Notice required to perform the exchange. We are finalizing the Letter of Intent/Memorandum of Understanding to document all actions for the exchange, and we hope to receive the TECS ADIS data in the first quarter FY 2017.
Q2 - Report results of SSI RoboCalling pilot designed to improve SSI wage reporting.
- In the second quarter, the Office of Research, Evaluation and Statistics (ORES) completed an assessment of the SSI RoboCalling pilot. The goal of the evaluation was to determine whether automated messaging informing SSI recipients of our wage reporting tools may encourage them to use these options. Analysis of the SSI Robocalling pilot revealed a correlation between the messaging and an increase in wage reporting at approximately 3 percent. Based on these preliminary results, we will consider whether to pursue a larger pilot study.
Q1 - Report findings from evaluation and data analysis of AFI expansion policy implemented in October 2013 to measure program savings based on $400 threshold and 10 negative searches.
- In December 2015, the Office of Research, Demonstration, and Employment Support (ORDES) issued a closeout report on AFI usage during SSI initial claims based on full implementation. In general, ORDES recommended better access to data and better data storage. In Q2, ORDP will meet with stakeholders to discuss next steps in data analytics and metrics development as well as a coordinated approach forward. Our goal is to determine whether we fully maximize the return on investment for the AFI process.
- Report study findings measuring the impact of a lower AFI threshold ($0.00) and expanded periodic searches (e.g. in-between redeterminations).
- Office of Quality Review (OQR) field sites reviewed 3,550 cases, which had a Stewardship Review conducted between 2012 and 2014 and a redetermination within 26 months of the Stewardship Review. OQR completed its initial evaluation in December 2015 and will issue a final report in the second quarter.
- Start commercial wage data study to measure program effects of an automated, real-time, wage match in the SSI system.
- We are no longer pursuing the commercial wage data study because of unexpected but welcome legislation in this area. Section 824 of the Bipartisan Budget Act of 2015 will give us the authority to obtain payroll data information in a batch exchange process with third party data providers once we receive authorization from the recipient or beneficiary. We have long supported this legislative proposal from an SSI perspective because it could help us reduce improper payments related to wages.
Q1 - Use a code on SSI records to identify specifically veterans who may be potentially eligible for payments from the U.S. Department of Veterans Affairs.
- In the first quarter, the Office of Quality Improvement (OQI) completed the FY 16 screening and selection of SSI recipients who may be entitled to pension benefits from the Department of Veterans Affairs (VA). As part of the Potential Entitlement initiative, OQI collaborated with Operations and Systems to develop a new limited issue (LI) diary. OQI sent the diary file, which contained the Social Security numbers of 7,938 SSI recipients who appeared to meet the general VA requirements, to Systems to include in a monthly redetermination run with the diary. This effort will improve the living circumstances for those veterans entitled to VA pension benefits. That said, the selection was done electronically by OQI, but with much manual data manipulation that would be difficult for Systems to replicate. We will continue internal discussions to determine the best path forward. If Systems takes this process over completely, it may have to cast a much wider net than OQI did, which would have an impact on Operations.
Next Steps
Next Steps:
- Develop aggressive yet reasonable FY 2018-2019 Agency Priority Goal Target;
- Build the business process for direct data matches with payroll providers;
- Engage with Federal partners on projects and legislation to reduce Improper Payments, sharing costs of obtaining data where possible
- Expand Data Analytics efforts and collaboration. Collaborating with Analytic Center for Excellence (ACE) to evaluate efficient of AFI. Results expected first quarter FY 2017.
FY 2017 Milestones
Q1 - Report results of SSI Commercial Wage Data Study, evaluating actual program savings achieved using real-time commercial payroll data.
Q2 - Implement automated non-home real property searches nationwide in the SSI systems.
Q3 - Begin measuring program outcomes from non-home real property based on denials and suspensions.
Q4 - In the month of September 2017, increase the number of wage reports we process using our automated tools (telephone and smart phone wage reporting) by 7% over the number in the month of September 2016.
Q4- Agency decision point regarding any further expansion of Access to Financial Institutions such as a lower threshold and/or searches at different intervals.
Q4- Complete 100% of budgeted redeterminations for FY 2017.
Other Indicators
SSI overpayment accuracy rate
SSI underpayment accuracy rate
Increase SSI wage reporting via telephone and the mobile application
Complete the budgeted number of SSI non-disability redeterminations
Contributing Programs & Other Factors
The main risks that could prevent us from achieving our priority goal include -
Legal obstacles that prevent us from conducting matching operations with commercial entities.
Continued reliance on recipients to timely self-report changes that may affect eligibility or payment amount.
Inability to establish new data exchanges with Federal and State partners.
As we increase our fraud detection activities, our incidence of overpayments may likely increase
In addition, we note the risk that fraud presents to our efforts to prevent and reduce improper payments. To more efficiently and effectively detect, deter, and mitigate fraud, waste, and abuse of our programs, we established the Office of Anti-Fraud Program Management to provide centralized oversight of and accountability for our anti-fraud activities. This office will drive our anti-fraud efforts by researching new strategies and sponsoring new initiatives as resources allow, supporting component anti-fraud efforts, centralizing anti-fraud predictive analytics capabilities, ensuring vigilance in preventing and detecting fraud, and supporting the Inspector General's efforts to investigate fraud.
The Office of Anti-Fraud Program Management will be critical in helping us implement an anti-fraud framework that supports a comprehensive approach to fraud prevention and aligns anti-fraud efforts with industry standards. As we sharpen our focus in this area and use new tools to identify and address instances of fraud, any resulting overpayments could potentially increase the amount of improper payment in the social security programs.
Our assumptions for this priority goal include -
Sufficient funding for completion of program integrity activities, which supports our ability to conduct SSI redeterminations.
We will report out on our SSI payment accuracy on a semi-annual and annual basis, which we believe to be the most accurate and cost effective method for such reporting.
No Data Available
