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Social Security Agency To Investigate If California Is Illegally Denying Social Security Disability and SSI Claims

Social Security Commissioner Says Furloughs of Federally Funded State Employees In Dept. of Social Services Who Help In Determining Eligibility May Be Cause of Possible Violations of Federal Social Security Laws - Investigation Comes After Charges Made by San Diego Congressman Who Charged That  Denials of Claims Are Coming At "Expense of Those In Greatest Need"

SACRAMENTO, CALIF (CDCAN) [Updated 11/23/09  07:20 AM  (Pacific Time)  -  The US Social Security Administration will investigate allegations by Rep. Robert Filner (Democrat - San Diego) made before the US House Way and Means Subcommittee on Social Security on November 19th that California is improperly denying social security and SSI (supplemental security income) program claims as a means to get around delays caused by mandatory furloughs of state workers in the Disability Determination Service division within the Department of Social Services, who play a critical role in determining eligibility for those two programs.  The investigation will also look at similar policies and problems in Hawaii which has instituted similar mandatory furloughs of its state employees.

There was no official statement by the Schwarzenegger Administration reacting to the Social Security Administration's investigation.

As a budget cutting measure, earlier this year Governor Arnold Schwarzenegger ordered mandatory furloughs of all state departments and agencies - including the Department of Social Services, which are closed on the first, second, and third Friday of each month until June 30, 2010.  The Department of Social Services' Community Care Licensing Division and the Disability Determination Service Division offices will remain open and operate on "self-directed furloughs".

Commissioner Michael J. Astrue who heads the federal agency, said on Friday (November 20) that in a memo to Patrick P. O'Carroll, Inspector General of the Social Security Administration, ordered the investigation writing that:

...Governor Schwarzenegger has insisted on furloughing California Disability Determination Service...employees, despite the fact that we fully fund both their salaries and overhead.  According to Congressman Robert Filner, the State is attempting to find ways to improperly circumvent the effects of the furlough at the expense of some of the State residents who are in the greatest need.

The action by the Social Security Administration, which has no immediate impact on the state, does add yet more uncertainty about various state budget reductions, with California facing yet another huge budget shortfall - now estimated to be $21 billion by the end of the 2009-2010 State budget year (June 30, 2010).  Advocates and policymakers alike expect more major spending cuts to be proposed in the coming months to close the growing shortfall.

Congressman Filner Makes Charges of Improper Denial of Claims

Congressman Filner testified last Thursday that the California's Disability Determination Service (known as "DDS" - same initials as the "Department of Developmental Services" which is a completely different state agency)  is denying the claims of disability applicants who fail to return a 25 page report within 20 days - a practice which has been adopted since the mandatory state furloughs were implemented earlier this year, reporting the following:

• One California Disability Determination Service field office, Filner claimed, had closed 30% of its cases due to an individual's failure to return the completed application form within 20 days.
• In addition, Filner said he believed that California Disability Determination Services (under the California Department of Social Services) may be manipulating its service numbers by assigning claims to fictional examiners or supervisors, which Filner says would allow the state to hide the fact that these cases are not actually being reviewed.

Commissioner Is Bush Appointee - Reports Directly to President Obama

Commissioner Astrue, appointed by President Bush on September 14, 2006 and confirmed by the US Senate on February 2, 2007, was sworn into office on February 12, 2007 for a 6 year term that expires January 19, 2013.

The commissioner, who oversees the independent federal agency with over 60,000 federal employees and 1,500 offices across the nation,  reports directly to President Obama.  The headquarters is in Baltimore, Maryland.

Impact on People With Disabilities, the Blind & Seniors

The issue has actual and potential impact on thousands of children and adults with disabilities, mental health needs and seniors, among others, who are applying for federal social security disability benefits or federally funded SSI grants.  In California the SSI recipients also include an additional state funded "SSP"  (Supplemental Security Payments) grants.

Any delays or outright denial of claims - especially those dealing with SSI/SSP - could have a ripple effect also on a person's immediate accessible and affordable housing, transportation and medical and other support needs.

The Department of Social Services estimated in May the SSI/SSP caseload by June 30, 2010, will total 1,290,473 persons:

• 376,163 who are seniors or 30% of the projected caseload
• 20,225 persons who are blind (or 2% of the projected caseload)
• 894,085 who are children and adults with disabilities (or 68% of the projected caseload)

Background of Disability Determination Service

• The federal Disability Insurance program, established under Title II of the federal Social Security Act, provides benefits to wage earners and their families in the event the wage earner becomes disabled.
• The Supplemental Security Income program, established under Title XVI of the federal Social Security Act, provides benefits to financially needy individuals who are aged, blind, or disabled.
• The federal Social Security Administration (SSA) is responsible for implementing policies of handling and determining eligibility of disability claims under the Disability Insurance and Supplemental Security Income programs.
• Persons apply for either social security disability or SSI at any Social Security office. If the person applying meets the non-medical criteria, their application would then be sent to the state's Disability Determination Service, who will then obtain the applicant's medical and other related records to determine severity of the disability or impairments and the impact on the ability to engage in work.
• In each of the 50 states (plus the District of Columbia and Puerto Rico), eligibility - or determinations under both Disability Insurance and Supplemental Security Income are performed by its own "Disability Determination Service" (known as "DDS" - same initials used for the Department of Developmental Services, which is a different state agency entirely, though the same person could have gone through Disability Determination Service for SSI eligibility - and then to the Department of Developmental Services for supports and services) in each state. In California, the Disability Determination Service is a division under the Department of Social Services. It has 11 branch field offices, including 3 in Los Angeles County.
• The federal Social Security Administration reimburses state Disability Determination Services for 100% of allowable expenditures up to its approved funding authorization.

Social Security Administration Previously Raised Concerns of State Furlough Impact on Social Security Disability and SSI Claims

In a related action by the Social Security Administration dealing with the impact of California's furloughs, on October 16th, the US Department of Justice, on behalf of the Social Security Administration,  filed a "Statement of Interest" in the state lawsuit "Union of American Physicians and Dentists v. Arnold Schwarzenegger, Governor of California" that seeks to stop the mandatory state furlough program.    The state lawsuit, filed in the Alameda County Superior Court, is still pending further action.  It is one of several lawsuits filed by different unions and agencies regarding the mandatory state furloughs.

The Union of American Physicians and Dentists includes state employees of the California Disability Determination Services Division under the Department of Social Services, who evaluate the medical or health part of a person's Social Security Disability or SSI (Supplemental Security Income) claims.  The federal government fully pays for the salaries and overhead costs for these state employees in all 50 states.

The "Statement of Interest" which indicates in this instance support of this specific lawsuit, notes that California's furloughs of these specific state employees are inconsistent with the state's obligations and responsibilities under the federal Social Security Act which requires a state, in carrying out disability determination functions, "to the best of its ability, facilitate the processing of disability claims by avoiding personnel freezes, restrictions against overtime work, or curtailment of facilities or activities."

Commissioner Astrue said in October:

...for many months we have been trying to convince California officials that furloughing [Disability Determination Service Division state] employees does not save the state a single penny, and actually costs the state money.  It also unnecessarily harms their citizens with disabilities and their civil servants. Unfortunately, our arguments have fallen on deaf ears.  We hope our Statement of Interest will awaken state officials to the irreparable damage their furlough policy is causing.

Asture said in October that California's furlough of Disability Determination Service employees under the Department of Social Services costs the state $849,000 per furlough day in administrative funding and that  "...each furlough day results in a delay costing California's disabled citizens over $420,000 in much-needed Social Security benefits".

The State, represented by the California Department of Justice, is denying those claims in the various lawsuits.

TEXT OF COMISSIONER ASTRUE'S MEMO ORDERING INVESTIGATION

The following is the memo to Social Security Administration Inspector General Patrick P. O'Carroll from Commissioner Astrue, dated November 20th:

At yesterday's [November 19th] hearing before the House Ways and Means Subcommittee on Social Security, I testified about some disturbing practices the State of California has instituted that aggravate, rather than help, in response to its budgetary situation.  As you know, Gov. Schwarzenegger has insisted on furloughing California Disability Determination Service (DDS) employees, despite the fact that we fully fund both their salaries and overhead.  According to Congressman Robert Filner, the State is attempting to find ways to improperly circumvent the effects of the furlough at the expense of some of the State residents who are in the greatest need.

Congressman Filner indicated that since the furloughs began, the California DDS [CDCAN Note: same initials as Department of Developmental Services which is a different state agency] has begun denying the claims of those disability applicants who fail to return a 25-page report within 20 days.  This practice, if true, places applicants in an untenable position because the substantial amount of information required must often be gathered from third parties.  If an applicant fails to return complete information within the time set by the State, the DDS deems the applicant to have failed to cooperate and closes the file, thereby depriving that applicant of fair and full consideration.

I am also greatly concerned by Congressman Filner's report that the California DDS may be manipulating its service numbers by "staging" claims, assigning them to fictional examiners or supervisors, rather than to actual examiners.  According to Congressman Filner, this practice would allow the DDS to claim that the cases have been assigned, rather than indicate that they are still in queue, thus minimizing the effects of the furlough.

If true, these practices are, of course, very disturbing.  Therefore, I am asking you to undertake a full review of the practices of the California DDS to determine the scope and breadth of any inappropriate practices.

I am also concerned about the State of Hawaii, which is furloughing its DDS employees for as many days as California, and which has made statements about new business efficiencies that closely track statements made by California officials.  Accordingly, I ask that you also review that agency to ensure they are fully adhering to all SSA rules and policies.

Thank you for your assistance.