30,000 died in fiscal 2023 waiting for disability decisions from Social Security

Thirty thousand people died while waiting for Social Security disability determinations during fiscal 2023, the Social Security Commissioner Martin O’Malley told Nextgov/FCW in a recent interview.

It’s a grim statistic for an agency undergoing what O’Malley describes as a “customer service crisis” induced by a lack of adequate funding and associated staffing woes.

“A disability claimant is waiting for basic income and health insurance,” said David Camp, CEO of the National Organization of Social Security Claimants’ Representatives, an association for those representing disability claimants. 

“To wait an extra month could be the month in which the untreated, already cured disease kills,” he said, noting that although SSA can’t prevent all deaths among those waiting for disability benefits, it has a responsibility to reduce that number.

The 30,000 individuals who died were waiting for a decision from the agency at the initial, reconsideration or hearing levels. That’s out of over 1.6 million who were waiting for a decision on average that year, according to an agency spokesperson who said that this was the first time the agency calculated this statistic.

SSA delivers two kinds of disability assistance. Supplemental Security Income, or SSI, is need-based assistance for older adults and people with disabilities with limited income. Social Security Disability Insurance, or SSDI, is also for individuals with disabilities, but it’s tied to work history.

Currently, the wait time for an initial disability decision is almost eight months, and the agency has a backlog of 1.1 million pending initial disability claims, as of fiscal 2023. Those that ask for SSA to reconsider their initial decision for a disability claim have to wait another seven months, and those that request a hearing wait a year.

O’Malley recently told Congress the buildup of disability claims is one of three targets he was focusing on after being confirmed as commissioner in December, in addition to wait times for the agency’s 1-800 number and problems with overpayments and underpayments in benefits.  

The former Maryland governor was confirmed to lead SSA in December of last year, following over two years of acting leadership at the agency after President Biden ousted Trump appointee Andrew Saul from the top post in 2021. O’Malley entered an agency that in recent years has made headlines for closed field offices during the pandemic, fraught union relations and low morale among its staff.

“The root cause” of his top three problem areas “is the reduction of our staffing to 27 year lows, combined with the rising tide of the numbers of customers,” O’Malley told Nextgov/FCW.

For disability determinations specifically, staffing problems are especially challenging. At play are both attrition and the federated model used for the agency’s disability programs, where state offices make initial disability decisions. Those offices are federally funded, but states set salaries, said O’Malley, noting that some of these state offices are largely operating on trainees.

Funding is also a big problem, said the commissioner, noting that “for most of our history,” Congress allowed SSA to operate on about 1.2% overhead of the benefits sent out annually. 

Over the last decade, that percentage has dipped. SSA received about 0.95% of expected benefit outlays in the recent fiscal 2024 appropriations package, or about $14 billion, and is asking for 1% in administrative funding in 2025, which comes out to about $15 billion, according to the agency. SSA is funded by its trust funds, although Congress sets limits for what it can use on administrative expenses.

Moving administrative funding to 1.2% of outlays would only have a small impact on SSA’s trust fund, said O’Malley, who said that that level of overhead funding is low compared to private sector insurance companies. 

“The longer arc of this agency is a phenomenally dedicated, committed, compassionate culture. [SSA staff has] been traumatized by the increased volume and nine years of steady staff reductions, given the lack of any Congressional attention to our budget or even the decency of our own appropriations hearings,” said O’Malley.

The already nuanced policy landscape and new complexities added by Congress — such as requirements that state disability determination services funded by SSA have their disability decisions reviewed by a doctor — also haven’t helped wait times, said O’Malley. 

The SSI program “purports to be a program of last resort,” but “forces the poorest of people to jump through hoops, stand on their head and gargle peanut butter in order to qualify for it,” he told lawmakers at a recent hearing.

The program is also “extremely difficult to administer,” O’Malley told Nextgov/FCW, requiring “a lot of hands-on administration every time there’s a change in circumstances.”

There are some legislative proposals that could reduce the burden of what the agency has to do to administer the SSI program, said Camp. SSA has also turned rulemaking meant to streamline the program by updating certain policies.

Moving forward, the agency is looking to prioritize hiring with the newly passed 2024 funding, after the hiring freezes caused by continuing resolutions, as well as make some IT investments, said Michelle King, deputy commissioner of operations at SSA. Among the ongoing tech focuses of the agency is an effort to make it easier to find information online so that fewer people have to call the agency for help in the first place. 

O’Malley is also holding bi-weekly “rotating operational scrums” on top issues, he said, including operations, fraud, the 1-800 number and more, as a way to move the cadence of improvements away from the budget process.

That gathering of different parts of the organization together is unique, as is the pace of accountability demanded by those meetings, said Camp, whose organization regularly interfaces with SSA directly in its work. 

The agency will have to show Congress results with the funding it does have to garner credibility as they ask for more funding, he said, pointing to recent changes to allow electronic signatures as an example.

Long-term, another focus is redesigning the SSI application — an effort O’Malley called SSA’s “white whale.”

Currently, application isn’t available online and typically takes nearly two hours to complete with help from an SSA technician, according to the agency.

SSA started an effort to simplify the questions on SSI applications and create a modern application in 2022, according to an agency spokesperson, although O’Malley “pumped the brakes on it.” The agency says that was because of concerns surfaced during a public comment period about offline users being the last to see the simplifications. 

The agency will “take another run” at it, but doesn’t have a planned release date, said O’Malley, who noted that the agency has still put forward regulations to simplify the program for beneficiaries.

“We can and must do better,” the commissioner told lawmakers at a recent hearing.