Housing Works Issues Public Comment on Social Security Administration Proposed Rule

WASHINGTON, Feb. 12 -- Charles King, CEO of Housing Works, Brooklyn, New York, has issued a public comment on the Social Security Administration's proposed rule entitled "Rules Regarding the Frequency and Notice of Continuing Disability Reviews". The comment was written on Jan. 27, 2020, and posted on Feb. 10, 2020:

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Housing Works writes in opposition to the proposed rule by the Social Security Administration (SSA) (Docket No. SSA-2018-0026) regarding the frequency and notice of continuing disability reviews.

Housing Works is a healing community of people living with and affected by HIV/AIDS. Our mission is to end the dual crisis of homelessness and AIDS through advocacy, provision of lifesaving services, and entrepreneurial businesses that sustain our efforts. Housing Works is the nation's largest community-based AIDS services organization, founded in 1990 on the simple premise that housing is the threshold step for improving the emotional and physical health of people with HIV experiencing homelessness. Since that time, Housing Works has housed and served over 20,000 New Yorkers with HIV/AIDS and has won nationwide recognition for developing innovative, client-centered models of housing, health care, and supportive services for hard-to-reach populations. Housing Works has also created the nation's most successful job training and placement program for people with HIV/AIDS, and it has pioneered the use of socially conscious entrepreneurial ventures to achieve organizational economic stability.

By greatly increasing the number and frequency of Continuing Disability Reviews (CDRs) completed on people who have been approved for Social Security disability benefits, the proposed rule under consideration will drastically increase denials of Social Security Disability Income (SSDI) and Supplemental Security Income (SSI) benefits, with a disproportionate impact on those most vulnerable - persons removed not because their impairments have improved, but rather because their impairments make it difficult for them to understand and comply with the CDR process. The rule will cause seriously ill individuals to lose desperately needed benefits, the vast majority of whom will not be able to replace the income from SSDI or SSI with earnings.

Because the CDR process is difficult and time-consuming, far more people will lose SSDI and SSI under the proposed rule because they cannot provide all required documentation than because their disability no longer meets the standard for benefits. Indeed, few disabled workers lose benefits because their medical condition has improved. In 2018, the SSA initiated 1.3 million CDRs for persons receiving disability benefits, with only 42,285 persons terminated because of medical improvements,/1 and recent experience indicates that the majority of these terminations will be reversed on appeal./2

Persons with the most severe limitations, including those experiencing housing instability, those with limited mobility, and those whose lack of education and/or mental health issues impair their ability to gather and present the required medical, educational and vocational evidence, will be at greatest risk of losing benefits due to the inability to complete the CDR process.

Indeed, history demonstrates that the proposed large increase in disability reviews will result in unwarranted denials, many of which will be reversed on appeal after months or years of uncertainty and severe hardship due to loss of benefits. Under the Reagan Administration, a similar approach to the proposed rule was adopted with such inhumane results that the policy was reversed after a public outcry when its harm became known. The Reagan Administration terminated benefits of 315,000 people. Nearly two-thirds of these denials were reversed. Among those who lost benefits, 21,176 people died./3

Nor is there any empirical evidence that persons whose SSDI or SSI benefits are terminated will return to the workforce. Studies, including research cited in the proposed rule itself, show that only a small minority will have even modest earnings; at least two-thirds or more will not be able to work because their health impairments are severe./4

It is far more likely that termination of financial and health-care benefits will lead to crises such as eviction, homelessness, hospitalization, bankruptcy, incarceration, declining health, and extreme poverty--all of which make locating and maintaining employment even more challenging.

Housing Works' extensive experience serving the most vulnerable persons living with HIV leads us to be particularly concerned about the proposed rule's impact on people with HIV and their communities. An inability to meet basic subsistence needs such as housing and food undermines HIV care, resulting in disease progression, premature mortality, and new HIV infections./5

Housing Works is deeply committed to New York State's Plan for Ending the HIV Epidemic, which includes recommendations to meet basic needs as critical enablers of effective HIV treatment. To advance our Ending the Epidemic goals, New York City, through its Human Resource Administration HIV/AIDS Services Administration (HASA), has made an unprecedented effort to assist low-income people with HIV infection to secure the stable housing, adequate nutrition and transportation assistance required to benefit from the antiretroviral therapy that prevents progression to AIDS and stops ongoing HIV transmission. As the result, in 2018 New York City became the first U.S. jurisdiction to meet the UNAIDS 90-90-90 goals, with over 90% of people with HIV diagnosed, over 90% of persons diagnosed with HIV on treatment, and over 90% of persons on treatment virally suppressed. Currently, nearly 40% of the 35,000 persons served by the City's HASA program rely on SSDI or SSI to meet basic needs, including a significant number of persons with serious mental health issues or other co-morbidities. The potential loss of these essential benefits due to recipients' inability to meet the additional burdens imposed by the proposed rule would not undermine the health and wellbeing of these individuals, but also threaten our ability as a community to end our HIV epidemic.

As noted in the Trump Administration's own initiative to end the United States HIV epidemic, End the Epidemic: A Plan for America, "responding to HIV is not just a biomedical issue, but a social challenge, too." One study found that nearly half of all U.S. adults living with HIV rely on federal disability benefits, and that "besides providing an income to those people living with HIV who cannot work, disability benefit status also confers access to Medicare and Medicaid coverage as sources of financing for HIV care and treatment, for those without other forms of insurance."/6

Efforts to increase denials of benefits will work in direct contradiction to the Administration's initiative to end the HIV epidemic, negatively affecting the health and well-being of people living with HIV and undermining efforts to reduce ongoing HIV transmission.

The proposed rule is not supported by evidence or any demonstrated rationale. The changes it proposes are arbitrary and capricious, in violation of the Administrative Procedure Act. Most importantly, experience demonstrates that changes of the type proposed will result in extreme hardship and poor health outcomes among the most vulnerable members of our communities. We strongly urge you to withdraw this proposed rule.

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Footnotes:

1/ Periodic CDR Cases Processed dataset, https://www.ssa.gov/open/data/Periodic-Continuing-DisabilityReviews.html

2/ https://www.ssa.gov/legislation/FY%202015%20CDR%20Report.pdf Table B2.

3/ Social Security Cuts From Reagan Years Being Restored, Chicago Tribune, December 4, 1989. Accessed January 24, 2020 at: https://www.chicagotribune.com/news/ct-xpm-1989-12-04-8903150162-story.html

4/ Hemmeter, J & Bailey, M.S. Earnings after DI: evidence from full medical continuing disability reviews. IZA J Labor Policy, 2016; 5, 11. https://doi.org/10.1186/s40173-016-0066-9

5/ Aidala, AA, et al. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. American Journal of Public Health, 2016; 106(1): e1-e23.

6/ Huang, YA, et al. Nearly Half Of US Adults Living With HIV Received Federal Disability Benefits In 2009. Health Affairs, 2015; 34(10): 1657-1665.

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The proposed rule can be viewed at: https://www.regulations.gov/document?D=SSA-2018-0026-0001

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