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Review faulted on disability benefits for children

Report says revisions could yield savings

By Patricia Wen
Globe Staff / May 24, 2012
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Federal officials overseeing a fast-growing $10 billion children’s disability program have failed to follow up on the progress of 400,000 beneficiaries with behavioral, learning, and mental disorders, allowing families to receive monthly cash benefits for years even if their children’s condition has improved, according to a draft report from the Government Accountability Office obtained by the Globe.

The report by the investigative branch of Congress estimated that the Social Security Administration, which runs the Supplemental Security Income program, might save $9 for every $1 it spends on disability reviews by determining that some children no longer qualify. Reviews are typically required once every three years for the 1.3 million children now receiving benefits, a record high.

Investigators also cited many instances of incomplete data or highly subjective factors being used to evaluate children with mental impairments, who now account for more than half of all cases. Though the program rejects half of all claims for disability payments, it has over the past decade seen a surge of awards in three categories - attention-deficit hyperactivity disorder, speech delay, and autism spectrum disorders - particularly for young boys.

Treatment with psychotropic drugs, which alter mood and behavior, does not appear to play a pivotal role in awarding benefits, the report said, despite investigators’ findings that there is “a perception among some parents that medicating their child would result in an award of benefits.’’

In fact, children who were on such drugs were more likely to be denied than approved, sometimes because the psychiatric medications, particularly for ADHD, were viewed as improving their condition.

The report - scheduled for public release next month and subject to modifications based on input from Social Security officials, lawmakers, and others - was requested by a bipartisan group of lawmakers, including Senator Scott Brown and Representative Richard Neal of Massachusetts, following a Globe series in 2010 called “ The Other Welfare .’’

The newspaper documented how, over the past decade, behavioral, learning, and mental disorders had come to dominate the caseload, and described how low-income parents face perverse incentives to have their children labeled as disabled - and maintain that designation - to qualify for benefits of up to $700 a month.

Some parents said they heard through word of mouth that a child had to be on psychotropic drugs, particularly for cases involving ADHD, to stand a chance of approval. Also, teenagers reported disincentives to get part-time work, because their income would be counted against their family’s financial eligibility for the program.

To qualify for SSI benefits, which average about $600 a month, a child must be deemed to have severe disabilities and impairments and reside in a household with income below poverty thresholds.

A Social Security Administration spokesman declined to comment on the report Wednesday, saying the agency prefers to wait until the final report is issued next month.

However, in an interview last year, its commissioner, Michael Astrue, said he believed the program needed reform in many areas, and he would be seeking funds for an in-depth study by the Institute of Medicine, the nonprofit health research wing of the National Academy of Sciences. President Obama has requested $5 million in next year’s budget for such a study.

Astrue has said budget constraints have prevented the agency from conducting the required disability reviews. The GAO report found that reviews for children with behavioral, learning, and mental impairments fell 80 percent in the past decade, to about 16,000 last year.

The report comes as advocates and reformers of the program are engaged in an emotional battle over its future.

Many disability, mental health, and antipoverty advocates argue that the SSI program is a lifeline for the nation’s most vulnerable families and that the increase in beneficiaries is largely related to a surge in diagnosis of mental impairments and to an increase in families plunging into poverty. They argue that, for the most part, the program is well run.

Critics, however, worry that the program has morphed into an alternative welfare system for children with hard-to-measure behavioral, mental, and learning disabilities and is vulnerable to abuse when the nation can least afford it.

The report raised questions about the sharp increase in children receiving benefits for speech and language delay, as early as their toddler years. Investigators said some speech specialists they consulted were surprised by this growth and wondered whether it had become a “provisional diagnosis for very young children’’ when something is concerning about the child but nobody can pinpoint the reason.

Investigators also noted that about 5 percent of all beneficiaries, or 64,000 children, reside in a household where more than one child receives SSI benefits. Agency rules dictate that these sibling arrangements be given heightened scrutiny for potential fraud, yet these cases often went undetected.

Ron Haskins - a senior fellow at the Brookings Institution, a nonpartisan think tank based in Washington, D.C., who presided over a recent panel discussion on the program - said he believes the GAO report will add to momentum in the nation’s capital to take a close look at the program’s troubling trends and incentives. Haskins also chided various advocacy groups that are “so reluctant to look at this with any dispassion.’’

Dr. James Perrin, a Massachusetts General Hospital pediatrician who has served on federal panels evaluating the SSI program, has been among those seeking to protect the program from major overhaul or cutbacks until further study. He said he understands the report’s concerns about subjective criteria used in assessing claims, however he said many mental impairments, especially ADHD, are based on evaluations of impulsivity or social interactions that are inherently subjective.

He said the ADHD diagnosis in the SSI program is “going to continue to be an issue’’ in the heated debates over this program, until some respected research proves whether these children are, in fact, severely impaired.

Patricia Wen can be reached at wen@globe.com.

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