Social Security: Major Changes Needed for Disability Benefits for Addicts (Letter Report, 05/13/94, GAO/HEHS-94-128). The number of addicts receiving disability benefits has grown substantially during the last 5 years--from fewer than 100,000 to about 250,000 today. The annual cost of providing benefits to addicts is about $1.4 billion. The vast majority of addicts receiving disability benefits are either not in treatment or their treatment status is unknown. About 100,000 addicts have not been assigned a third-party or representative payee to manage their benefits. Consequently, the Social Security Administration (SSA) has no guarantee that these persons are not using their benefit checks to buy drugs or alcohol. Even in cases when payees have been assigned, their control over benefit payments is questionable; most of these payees are friends or relatives. Because addicts can abuse, threaten, and pressure their payees, GAO believes that organizations would make better payees for addicts than friends or relatives. SSA needs to ensure that all disability benefit recipients are in treatment and that all addicts have a third-party or representative payee. Also, Congress needs to consider expanding the treatment requirement to all addicts and restructuring the program to improve the payoff from treatment. --------------------------- Indexing Terms ----------------------------- REPORTNUM: HEHS-94-128 TITLE: Social Security: Major Changes Needed for Disability Benefits for Addicts DATE: 05/13/94 SUBJECT: Social security benefits Alcohol abuse Drug abuse Drug treatment Alcoholics treatment Rehabilitation programs Eligibility criteria Internal controls Disability benefits Questionable payments IDENTIFIER: Supplemental Security Income Program SSI Drug Addiction and Alcoholism Program AIDS Social Security Disability Insurance Program ************************************************************************** * This file contains an ASCII representation of the text of a GAO * * report. Delineations within the text indicating chapter titles, * * headings, and bullets are preserved. 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We are unable to accept electronic orders * * for printed documents at this time. * ************************************************************************** Cover ================================================================ COVER Report to Congressional Requesters May 1994 SOCIAL SECURITY - MAJOR CHANGES NEEDED FOR DISABILITY BENEFITS FOR ADDICTS GAO/HEHS-94-128 Disability Benefits for Addicts Abbreviations =============================================================== ABBREV AIDS - acquired immunodeficiency syndrome DA&A - drug addiction and alcoholism program DDS - disability determination service DI - Disability Insurance HHS - Department of Health and Human Services RMA - referral and monitoring agency SAMHSA - Substance Abuse and Mental Health Services Administration SSA - Social Security Administration SSI - Supplemental Security Income Letter =============================================================== LETTER B-253838 May 13, 1994 The Honorable Andy Jacobs, Jr., Chairman The Honorable Jim Bunning, Ranking Minority Member Subcommittee on Social Security Committee on Ways and Means House of Representatives The Honorable Harold Ford, Chairman The Honorable E. Rick Santorum, Ranking Minority Member Subcommittee on Human Resources Committee on Ways and Means House of Representatives Recent media reports as well as February 1994 hearings held by your committees\1 have raised several issues concerning disability benefit payments to addicts, including (1) the alarming increase in the number of addicts receiving benefits, (2) the need for tighter controls on benefit payments, and (3) the desirability of restructuring the program to improve the payoff from treatment. As you requested, we have assessed the effectiveness of Social Security Administration (SSA) controls over disability payments made to drug addicts and alcoholics (addicts). Addicts may receive disability payments under SSA's Disability Insurance (DI) and Supplemental Security Income (SSI) programs. Both programs have the same disability criteria. State agencies called disability determination services (DDSs) determine whether applicants meet the criteria. You expressed particular interest in payments to certain addicts under SSI. By law, these individuals must participate in treatment--when appropriate treatment is available--for their addiction and have a representative payee or third party manage their benefits as a condition of receiving disability benefits. These requirements provide the framework for SSA's drug addiction and alcoholism (DA&A) program. According to SSA, addicts required to participate in the program are those who qualify for disability because of their addiction. You also sought our recommendations for improving SSA's controls over payments to addicts in general. In doing our work, we analyzed SSA's computerized SSI and DI records and interviewed SSA headquarters and regional officials. We also visited drug and alcohol treatment facilities and organizations under contract with SSA to monitor the treatment of addicts receiving benefits. Appendix I includes additional details on our objectives, scope, and methodology. -------------------- \1 Joint hearings were held on February 10, 1994. GAO testimony was titled Disability Benefits for Drug Addicts and Alcoholics are Out of Control (GAO/T-HEHS-94-101). RESULTS IN BRIEF ------------------------------------------------------------ Letter :1 The number of addicts receiving disability benefits has grown substantially in the last 5 years--from fewer than 100,000 to about 250,000 currently.\2 The cost of providing disability benefits to the current addict population is about $1.4 billion per year. The vast majority of addicts receiving disability benefits are either not in treatment or their treatment status is unknown. Although the 78,000 addicts in the SSI DA&A program are required to attend treatment, because of poor monitoring by SSA, only about 1 in 5 are in treatment. The remaining addicts are not required to attend treatment, and SSA does not know their treatment status. About 100,000 addicts have not been assigned a third-party or representative payee to manage their benefits. Consequently, SSA has no assurance that these individuals are not using their benefit checks to buy drugs or alcohol. But, in many cases when payees have been assigned, how tightly they control benefit payments is questionable. Most of these payees are relatives or friends. Because addicts can abuse, threaten, and otherwise pressure their payees, we believe that organizations would make better payees for addicts than friends or relatives. Organizational payees, such as those under contract with SSA to monitor addicts' treatment, would be better positioned to provide the tight controls needed over benefit payments. We believe that SSA needs to act to ensure that all DA&A recipients are in treatment and that all addicts have a third-party or representative payee. Also the Congress needs to consider expanding the treatment requirement to all addicts and restructuring the program to improve the payoff from treatment. -------------------- \2 In commenting on a draft of this report, SSA said that our estimate "most likely does not reflect the true number" of addicts. We agree and, as discussed in this report, believe it is likely greater than 250,000. BACKGROUND ------------------------------------------------------------ Letter :2 Eligibility for disability benefits involving drug or alcohol addiction is determined like any other medical disorder. Benefits are awarded to those who cannot work and whose physical or mental impairment is expected to last for at least 12 months or result in death. The impairment must be established by medical evidence consisting of symptoms, signs, and laboratory findings. Those awarded benefits are to be periodically reviewed to determine whether they are still disabled. About 250,000 addicts receive disability benefits under the DI and SSI programs at an annual cost of about $1.4 billion. More than half of these addicts qualify for benefits on the basis of medical problems in addition to their addictions. For example, an addict may be eligible for benefits because of acquired immunodeficiency syndrome (AIDS) or disabling medical problems associated with heart disease or cancer. But all these people have addictions severe enough that the condition is included as a part of their diagnosis. Other addicts qualify solely on the basis of addiction, which by itself can be a disabling medically determinable impairment. Under the SSI program, addicts who qualify for benefits on the basis of their addiction are required by law to get treatment for their addiction and have a third-party or representative payee manage their benefits. These addicts are included in the SSI DA&A program and are those who would not qualify for disability if their addiction ended. The DI program has no similar requirements.\3 The objective of the SSI DA&A program is to rehabilitate addicts to be productive members of society and remove them from the SSI disability rolls. As of December 1993, the program had about 78,000 addicts.\4 The average age of the SSI DA&A recipients is 42, the majority are male, blacks outnumber whites, and more suffer from alcoholism than from drug abuse. Benefit payments to these individuals amount to about $285 million annually. SSA arranges for representative payees to manage the benefits of SSI recipients put into the DA&A program. SSA also is responsible for treatment referral and monitoring. In some states--18 by the end of 1993--SSA sends the case to a referral and monitoring agency or RMA. RMAs are state government or private organizations that arrange treatment for DA&A recipients, monitor treatment participation, and report to SSA on treatment status, including noncompliance. The types of treatment for SSI DA&A recipients can range from intensive inpatient care to outpatient care in informal support group settings. Data are not available on the types of treatment provided specifically for SSI DA&A recipients. In general, however, the vast majority of treatment for addiction in this country is provided on an outpatient or ambulatory basis, rather than through an inpatient or residential program. Exactly who pays for what types of treatment for SSI DA&A recipients is not known. SSA is not permitted to pay for treatment nor can the addict be required to pay for it. Some services are covered by state Medicaid programs, but states vary greatly in the type, amount, duration, and scope of services provided. How much money state Medicaid programs spend on treatment is generally not known because states do not keep specific records on payments made on behalf of addicts or other subpopulations. In general, most treatment for addiction in this country is paid for by funds from federal block grants and state and local governments. -------------------- \3 Under the DI program, DI beneficiaries are not required to attend treatment. However, when claimants have been determined to be incapable of managing benefits or legally incompetent, SSA assigns representative payees for them. \4 The analyses in this report are based on the SSI DA&A caseload of 69,419 at the end of August 1993. SUBSTANTIAL GROWTH IN PROGRAM ROLLS ------------------------------------------------------------ Letter :3 The number of addicts receiving SSI and DI disability benefits has increased significantly in recent years, totaling over 250,000 people today. See appendix II for information on the number of addicts receiving benefits in the 50 states and the District of Columbia. Five years ago, fewer than 100,000 addicts were on the rolls. The DA&A population has also grown substantially. From December 1989 through August 1993, the number increased from about 17,000 to about 70,000--more than a fourfold increase in the 4-year period. The annual growth in allowances with addiction diagnoses and DA&A cases is illustrated in figure 1. Figure 1: Disability Claims Allowed Annually With an Addiction Diagnosis Compared With Increases in DA&A Cases (1989-93) (See figure in printed edition.) Note: Number of claims allowed with addiction diagnoses is not available for 1993. Many possible explanations exist for these increases, including increased SSI outreach and cutbacks in state general assistance programs that have resulted in more SSI applications. However, the extent to which these and other factors contribute to the increase is not known. While the number of individuals with addiction diagnoses has increased significantly in recent years, the number of such individuals receiving benefits remains relatively small in comparison with all individuals receiving disability benefits. People diagnosed with addiction account for about 4.8 percent of the adult SSI population while DA&A recipients represent about 2.6 percent. Similarly, DI beneficiaries who are diagnosed with addiction represent about 2.8 percent of the adult DI population. THE TREATMENT STATUS OF THE VAST MAJORITY OF ADDICTS IS UNKNOWN ------------------------------------------------------------ Letter :4 Except for some of the addicts in the DA&A program, SSA does not know whether the vast majority of addicts are in treatment. About two-thirds of SSA's addict population is not required to attend treatment as a condition for receiving benefits. With respect to addicts in the DA&A program for whom treatment is a requirement, relatively few are in treatment. SSA has poorly monitored compliance with the treatment requirement for addicts in the DA&A program. While SSA can monitor treatment status through its computerized records and through RMA reporting, both methods are deficient. According to SSA records, only about 9 percent of the DA&A recipients are in treatment. The remainder are not in treatment (7 percent) or their treatment status is unknown (84 percent). This same situation was reported by the Department of Health and Human Services' (HHS) Inspector General in a 1991 report. Although about 85 percent of the DA&A population (60,000) is in those states with RMAs, as mentioned earlier, SSA had established RMAs in only 18 states through 1993. For those states without RMAs, SSA regional offices were to assume responsibility for treatment monitoring. According to SSA, however, no evidence exists that the regions monitored treatment. Of the addicts living in states with RMAs, however, RMAs report that only half of them (30,000) are being monitored, and only half of these (about 15,000) are in treatment. Data are not available to explain why the treatment status of the remaining 30,000 DA&A recipients in the RMA states is not being monitored. Two possible reasons are that (1) SSA lacks the necessary funding for the RMAs to monitor all DA&A recipients and (2) appropriate treatment may not be available.\5 -------------------- \5 Where appropriate treatment is not available, RMAs do not actively monitor these cases. In fiscal year 1993, the 18 RMAs reported about 400 cases where treatment was not available. ADEQUATE MONITORING BY RMAS IS NEEDED IN ALL STATES ------------------------------------------------------------ Letter :5 The absence of RMA monitoring in most states may have contributed to the underreporting of addiction diagnoses and DA&A recipients. Also, inadequate monitoring may have contributed to the relatively poor outcomes under the DA&A program. SSA is taking steps to correct these shortcomings. Underreporting of addiction diagnoses and DA&A recipients in the states without RMAs may occur because SSA and the state DDSs apparently have given a low priority to identifying these cases. California, for example, has an RMA and had about 26,000 DA&A recipients, while populous states without RMAs, such as Texas and Florida, had only 365 and 543 DA&A recipients, respectively. Only 38 DA&A recipients were reported for the District of Columbia, which has no RMA. In the states with RMA monitoring, little evidence exists of positive outcomes. For example, during 1993, the RMAs reported that, on average, only 75 addicts successfully completed treatment each month. During this same period, the rolls of the DA&A program were increasing by about 2,000 addicts a month. Moreover, the successes reported by the RMAs are not necessarily examples of rehabilitation and removal from the SSI rolls. Rather, they reflect completion of a specific treatment plan. SSA does not know how many addicts in the SSI DA&A program have been removed from the disability rolls due to rehabilitation. Also, the SSI DA&A program refers few addicts for vocational rehabilitation. SSA is establishing RMA monitoring in all 50 states and the District of Columbia. We believe this move, while belated, is nonetheless a good one. An SSA study showed that--in comparison with a control group that did not receive RMA monitoring--the RMAs accomplished their basic mission of keeping addicts in treatment. However, as evidenced by the inadequate monitoring in RMAs, simply establishing RMAs does not necessarily guarantee that all addicts will be monitored, much less get treatment. SSA, in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA), has initiated two demonstration projects in the states of Washington and Michigan to improve the DA&A program. Both projects are attempting to enhance case management and to develop improved referral and monitoring procedures that could be applied in other states. EFFECTIVENESS OF THE CURRENT REPRESENTATIVE PAYEE REQUIREMENT IS QUESTIONABLE ------------------------------------------------------------ Letter :6 While virtually all addicts in the DA&A program have representative payees, many other addicts do not have payees. We estimate, for example, that about 100,000 of the 250,000 addicts receiving SSI and DI disability benefits do not have payees. Finding qualified payees for addicts has been a long-standing problem for SSA. Payees are generally unpaid volunteers.\6 These circumstances, coupled with the potential for incurring abuse or threats from addicts, make finding representative payees difficult for SSA. When addicts have payees, the vast majority of them are relatives or friends. Studies in general have shown that, in those cases in which payees are present, how tightly they control benefit payments is questionable. In the absence of tight controls, addicts are free to purchase drugs and alcohol to maintain their addictions. This situation leaves the government open to charges of "enabling" because the benefit payments give addicts the means to support their addictions. Little data exist on how well representative payees control benefit payments for addicts. However, anecdotal data, including previous testimony before the Social Security and Human Resources Subcommittees, suggest that the representative payee requirement is not working well. A previous SSA study of the addict population found payee controls to be lax in many cases, particularly when addicts' friends were the payees. This study also showed that organizational payees such as RMAs and treatment facilities tended to provide the most control. We believe that organizational payees would be better positioned to implement the stringent controls needed over benefit payments to addicts. The reason for this is that organizations can more effectively deal with situations in which addicts are abusive or threatening. We believe SSA should use organizations as representative payees to the maximum extent possible. One way to expand the use of organizations is to use RMAs to provide payee services. Making RMAs the payees would consolidate case management functions, including treatment monitoring and money management. As with addicts in the DA&A program, we also believe the representative payee requirement should be applied to all SSI and DI addicts. The nature of such beneficiaries' medical problems suggests that SSA should require representative payees for all addicts receiving benefits. This is not the case now. In fact, no regulatory or programmatic requirement exists for addicts not in the DA&A program to have representative payees. The public must have confidence that these benefit payments are being used for the basic program purposes of food, clothing, and shelter. -------------------- \6 SSA is currently carrying out a demonstration program in which qualified organizations can be paid up to $25 per month for acting as a representative payee. The beneficiary pays the fee. REEXAMINATION OF THE DA&A PROGRAM NEEDED ------------------------------------------------------------ Letter :7 The DA&A program has not changed since the SSI program began more than 20 years ago. While the fundamental structure of the program is sound--that is, requiring addicts to have a representative payee and attend treatment--a rethinking of the program is long overdue. First of all, benefit payments to addicts should be examined in a broader context. The DA&A program as currently structured applies only to about one-third of the addicts currently receiving DI and SSI disability benefits. As noted earlier, we believe that all addicts should be required to have representative payees. We also believe that the Congress should consider expanding the DA&A treatment requirement to all addicts who receive DI and SSI disability benefits. Several other reform proposals were disclosed in a February 10, 1994, joint hearing before the Subcommittees on Social Security and Human Resources, Committee on Ways and Means. These proposals include the following: requiring addicts to complete 3 months of treatment before they are eligible to receive benefits; providing addicts vouchers instead of cash for buying essentials such as food, clothing, and shelter; and, establishing a "bridge" for addicts who are "cured" of their addiction, possibly a continuation of benefits in decreasing amounts. CONCLUSIONS ------------------------------------------------------------ Letter :8 SSA payments to addicts are out of control. The number of addicts is increasing at an alarming rate for reasons that are not well understood. The requirements for treatment are not being complied with or properly monitored. And there is little assurance that benefit payments are being used for the basic necessities rather than for the purchase of drugs and alcohol. SSA needs to take immediate action to deal with these problems, and the Congress needs to tighten controls for both the SSI and DI programs as they relate to drug addicts and alcoholics. In the short term, SSA needs to place RMAs in all states and strengthen RMA monitoring to assure that all DA&A recipients in pay status are accounted for and monitored as required. Also, SSA needs to expand and strengthen representative payee monitoring. It is clear that more effective treatment referral and monitoring must occur with the current DA&A population. SSA needs to work closely with the RMAs and SAMHSA to better identify the treatment needs of these addicts and to see that they receive appropriate services. Over the longer term, the Congress needs to consider expanding the treatment requirement of the DA&A program to include all addicts receiving DI and SSI disability benefits. Also, the Congress should rethink the program design to improve the payoff from treating addicts. RECOMMENDATIONS TO THE SECRETARY OF HHS ------------------------------------------------------------ Letter :9 The Secretary should direct the Commissioner of SSA to strengthen controls over disability benefits paid to addicts in the following ways: establish RMAs in all states, take appropriate measures to ensure that all DA&A recipients are in treatment and accounted for and monitored as required, require all addicts receiving SSI and DI benefits to have representative payees, and use organizational payees for addicts to the maximum extent possible and consider making the RMAs representative payees. MATTERS FOR CONSIDERATION BY THE CONGRESS ----------------------------------------------------------- Letter :10 The Congress should consider expanding the treatment requirement to all addicts and restructuring the program to improve the payoff from treatment. AGENCY COMMENTS ----------------------------------------------------------- Letter :11 By letter dated April 15, 1994, SSA agreed that it had not done well in administering the SSI DA&A program but stated that it is initiating changes to meet this responsibility. Concerning our recommendations to improve monitoring, SSA stated that all states and the District of Columbia would have RMAs by the end of this year. With respect to our recommendation that all DA&A recipients be in treatment, accounted for, and monitored, SSA said that monitoring does not guarantee that all individuals will get treatment because appropriate treatment--free to the recipient--must also be available. We continue to believe that the status of all DA&A recipients should be monitored and that this is fundamental to ensuring that these individuals attend treatment. Further, while SSA has no data on the status of the 30,000 individuals not being monitored in RMA states, lack of appropriate treatment is not likely a major reason for this. In fiscal year 1993, for example, the RMAs reported that appropriate treatment could not be found for only 400 DA&A recipients. SSA also said that the report implies that it has a greater role than ensuring that the SSI DA&A recipients are in treatment and is failing in this duty. We disagree. The report clearly states that currently SSA is only required to assure that DA&As are in treatment and asks the Congress to consider extending the treatment requirement to all addicts on the DI and SSI rolls. With respect to our recommendations to strengthen and expand the representative payee program for addicts, SSA said that immediately expanding the SSI DA&A criteria to DI beneficiaries would be costly and it is difficult to find payees. We know that these changes cannot be made overnight and will take time to fully implement. But we believe that this further supports that SSA act now to develop a plan to ensure that these addicts are eventually assigned payees. Concerning our recommendation requiring payees for all other addicts receiving DI and SSI benefits, SSA indicated that it did not want to require that all addicts have payees and that these decisions should be decided on a case-by-case basis. We disagree. Because an individual is an addict seems to us sufficient justification to warrant assigning a representative payee. Further, this is the same basic rationale for the legislative requirement for assigning payees under the SSI DA&A program. SSA agreed that organizational payees are generally preferable for DA&A recipients. Moreover, it agreed with our recommendation that RMAs be considered as organizational payees. SSA also made a number of technical comments, which we incorporated as appropriate. SSA's comments in their entirety appear in appendix III. --------------------------------------------------------- Letter :11.1 We are providing copies of this report to the Director of the Office of Management and Budget; the Secretary, HHS; the SSA Commissioner; and to other congressional committees with an interest in this matter. We will also make copies available to others upon request. Please contact me on (202) 512-7215 if you have any questions about this report. Other major contributors to this report are listed in appendix IV. Jane L. Ross Associate Director Income Security Issues OBJECTIVES, SCOPE, AND METHODOLOGY =========================================================== Appendix I Our primary objectives were to assess the (1) effectiveness of eligibility restrictions that the Social Security Act places on drug addicts and alcoholics who receive disability benefits under the SSI DA&A program and (2) adequacy of controls over payments to addicts in general. In conjunction with our primary objectives, we were asked to provide information on addicts in both the SSI and DI programs, including, but not limited to their numbers and medical diagnoses, the presence and types of representative payees, and their treatment status. In addition, we were asked to answer several questions on the types and financing of treatment provided to addicts in the SSI DA&A program. We analyzed selected data from SSA's computerized master files for SSI recipients and DI beneficiaries who were addicts in current payment status. We also extracted data from SSA's computerized 831 files, which provide data on claims on a calendar-year basis. Data on SSI addicts were extracted from the computer records on August 2, 1993, and data on the DI addicts were extracted on September 9, 1993. The 831 files were analyzed for the years 1988 through 1992. Calendar year 1993 data were not available at the time of our review. Because the master computer files show only primary medical diagnoses, we used the 831 data primarily to estimate the number of addicts with substance abuse as a secondary medical diagnosis. We interviewed disability program officials at SSA Headquarters and in SSA's Chicago, Dallas, San Francisco, and Seattle regional offices. We visited treatment centers in Oakland, California, and in the Seattle, Washington, area. We also visited referral and monitoring agencies in California, Washington, Pennsylvania, and Maryland. In addition, we obtained data from the RMA in Chicago, Illinois, and various SSA field offices in the Chicago, San Francisco, and Seattle regions. Our work was performed between July 1993 and February 1994 in accordance with generally accepted government auditing standards. NUMBER OF ADDICTS BY STATE ========================================================== Appendix II St at Grand e Totals SSI DA&As\a Primary\b Secondary\c Primary\b Secondary\c -- =========== ----------- ----------- ----------- ----------- ----------- Al 3,953 397 284 1,847 344 1,081 a b a m a Al 345 134 26 85 40 60 a s k a Ar 2,593 672 207 455 429 830 i z o n a \ d Ar 2,074 154 97 1,027 168 628 k a n s a s Ca 34,935 23,561 3,564 211 3,613 3,986 l i f o r n i a \ d Co 3,306 291 206 1,250 226 1,333 l o r a d o Co 3,715 190 193 918 283 2,131 n n e c t i c u t De 517 26 16 109 26 340 l a w a r e Di 920 37 50 583 17 233 s t r i c t o f C o l u m b i a Fl 13,728 465 430 7,088 544 5,201 o r i d a Ge 8,332 484 480 3,387 463 3,518 o r g i a Ha 957 209 30 158 95 465 w a i i \ d Id 536 98 47 195 54 142 a h o Il 27,723 11,643 3,302 2,102 3,705 6,972 l i n o i s \ d In 5,130 957 666 845 901 1,761 d i a n a Io 1,539 195 54 411 118 761 wa Ka 1,721 100 84 628 188 721 n s a s Ke 6,374 912 601 3,029 481 1,351 n t u c k y Lo 2,259 189 264 1,228 199 379 u i s i a n a Ma 1,615 284 125 225 235 746 i n e Ma 2,472 604 225 408 300 935 r y l a n d \ d Ma 9,287 1,679 1,270 2,066 1,124 3,148 s s a c h u s e t t s Mi 14,524 6,315 662 2,018 1,853 3,676 c h i g a n \ d Mi 5,171 1,992 308 552 761 1,558 n n e s o t a \ d Mi 1,547 177 192 363 188 627 s s i s s i p p i \ d Mi 3,586 524 115 927 331 1,689 s s o u r i Mo 985 222 46 389 82 246 n t a n a \ d Ne 1,091 107 22 379 73 510 b r a s k a \ d Ne 1,174 273 73 137 221 470 v a d a \ d Ne 719 26 37 182 64 410 w H a m p s h i r e Ne 4,759 366 442 1,770 418 1,763 w J e r s e y \ d Ne 1,270 177 121 609 136 227 w M e x i c o Ne 15,536 2,887 2,456 5,006 1,668 3,519 w Y o r k \ d No 6,215 388 275 2,493 413 2,646 r t h C a r o l i n a No 870 81 9 436 55 289 r t h D a k o t a Oh 9,086 1,91 968 2,749 1,064 2,386 i o \ d Ok 2,369 167 117 1,372 126 587 l a h o m a Or 2,799 618 159 573 324 1,125 e g o n Pe 7,657 1,849 713 2,141 742 2,212 n n s y l v a n i a \ d Rh 1,290 96 67 499 83 545 o d e I s l a n d So 2,271 167 137 1,176 201 590 u t h C a r o l i n a So 1,220 127 24 751 53 265 u t h D a k o t a Te 4,962 1,593 591 816 798 1,164 n n e s s e e \ d Te 6,833 319 274 3,425 402 2,413 x a s Ut 1,250 87 74 527 89 473 ah Ve 606 90 57 127 74 258 r m o n t Vi 3,054 516 177 769 382 1,210 r g i n i a Wa 5,003 1,941 312 523 662 1,565 s h i n g t o n \ d We 2,108 572 218 386 304 628 st V i r g i n i a Wi 6,755 2,524 390 1,137 928 1,776 s c o n s i n \ d Wy 458 19 11 252 17 159 o m i n g ================================================================================ To 249,199 69,419 21,268 60,739 26,065 71,708 t a l -------------------------------------------------------------------------------- \a SSI DA&A recipients in current payment status as of August 2, 1993. \b Number of addicts in current payment status as of August 2, 1993, (SSI) and September 23, 1993 (DI). \c Estimated number of addicts based on claims allowed during the years 1989 to 1992 and the relationship between those with primary diagnoses of substance abuse versus those with secondary diagnoses of substance abuse. \d States (18) with RMAs as of December 31, 1993. (See figure in printed edition.)Appendix III COMMENTS FROM THE SOCIAL SECURITY ADMINISTRATION ========================================================== Appendix II (See figure in printed edition.) (See figure in printed edition.) (See figure in printed edition.) (See figure in printed edition.) MAJOR CONTRIBUTORS TO THIS REPORT ========================================================== Appendix IV Barry Tice, Assistant Director, (410) 965-8021 Louis G. Tutt, Evaluator-in-Charge Luis Escalante, Jr. Ellen Habenicht Joanne Newman Tom Smith Vanessa Taylor