Total benefits paid.

6.7

2.2

unit 11

1 Figures for SSI include all Federal and State costs and recipients. State administrative costs for those States administering their supplemental payments were estimated by applying the overall proportion of administrative costs to benefit costs to the State benefit costs. This proportion is 8.9 percent. State-administered supplemental benefits are estimated by SSA to be $222,100 in fiscal year 1980.

2 Federal benefit costs include (in thousands):

Federal benefits...

Hold harmless payments to States.

Federal liability for errors.

Benefits to Indo-Chinese refugees.

Total

$5,652,911

39,312

9,286

5,952

5,707,461

3 State benefit costs include $1,786,741,000 in federally administered State supplements plus $222,100,000 in State-administered supplements (total $2,008,841,000).

4 UI benefits are paid by the States from the trust fund established with revenues from Ul taxes on employers.

5 The average AFDC family unit included 2.9 persons in December 1980. Thus, there were 10.5 million individuals in AFDC families.

6 Average number of recipients during the year includes 4,160,000 recipients of federally administered benefits plus 251,000 recipients of Stateadministered benefits, estimated from table M-25 in the December 1981 Social Security Bulletin.

7 ORS/SSA estimates the average SSI recipient unit to include 1.1 persons.

8 Number of recipients represent the average for a point in time for calendar year 1980. (Fiscal year figures are not available.)

9 Enrolled.

10 Received.

11 Filing Units: A filing unit is defined as either the individual or group of individuals on behalf of whom an eligibility determination and an assistance payment are made. For programs under which administrative actions are taken and/or checks are issued to individuals, the number of individual recipients is shown as the filing unit. For AFDC, one administrative action (eligibility and benefit determination) is taken and one check is issued per family. Therefore, for that program, the table shows the number of family filing units and the administrative costs per each of those units. Following is a description of the filing unit for each program shown in the table.

AFDC: The filing unit is a family, including dependent children and their caretaker relative. In 23 jurisdictions the unit may include families in which both parents are present if one is unemployed according to a specific definition of unemployment. In other States and territories, only single-parent families may qualify. The payments made are adjusted for family size. One application is made per family, and eligibility and benefits are determined on a family-unit basis. The average AFDC family included 2.9 persons in December 1980.

SSI: The filing unit is usually the aged, blind, or disabled individual. In cases in which a married couple receives SSI benefits, each member of the couple must pass the eligibility test individually. When each member of a couple is determined eligible, the total benefits to the couple equal 150 percent of the amount for a single individual. Thus, most SSI units are single individuals, although there are enough two-person units to make the average filing unit size 1.1 persons.

UI: Unemployment Insurance is paid on behalf of the unemployed worker, alone, with no consideration of the presence of other employed, unemployed, or dependent persons in the claimant's household. In some States there is a small dependent's allowance. Thus, the filing unit is only the individual claimant.

Low-Income Energy Assistance: These numbers should be considered approximate and preliminary. These benefits are paid to housing units. However, in 1980, assistance was to be provided to some categories of people on the basis of their participation in various transfer and social service programs, and the result was some duplication of benefits within housing units. Further, the 9,690,000 recipient units indicated in the table include some instances in which more than one grant award was issued to a housing unit during the winter. Therefore, this recipient unit figure for 1980 includes an unknown amount of double counting.

Medicare A and B: The recipients shown in the table are single individuals who were enrolled in or who actually received benefits from Medicare. No data are available on how these individuals may fall into household units, although there are clearly many couples receiving Medicare. Nevertheless, each person's medical needs are handled individually, and therefore the individual recipient is the appropriate unit for which to determine costs.

OASI: As in Medicare, the recipients shown in the table represent single individuals and do not reflect any household composition. The recipient individuals include survivors and dependents as well as the retired beneficiary. Under GASI, entitled individuals' checks may be issued separately or jointly for members of the same household at the choice of the recipients.

DI: Under Social Security Disability Insurance, beneficiaries include the disabled worker as well as the spouse of that worker and any dependents. The initial administrative action taken pertains to the workers' disability and financial eligibility. Once eligibility for a disabled worker is determined, a determination is made about benefits to the spouse and to dependents. When each family member's eligibility is established, individual checks may be sent to household members or benefits may be combined in one check. Nevertheless, administrative actions are required for each household member. The figures in the table indicate total beneficiaries, including the disabled worker and each recipient spouse or dependent. Data are not available on the number of families or households these recipients represent.

Source: AFDC, UI: Budget of the United States Government, fiscal year 1982.

SSI: Budget of the United States Government, fiscal year 1982; Social Security Administration, Office of Finance Resources.

LIEAP: The 1980 Low Income Energy Assistance Program: A Review and Assessment. U.S.R. & E. August 1981; HHS/OFA.
Medicare: 1980 Annual Report Federal Hospital Insurance Trust Fund, GPO-1980.

OASI, DI: 1981 Annual Report Federal Old-Age and Survivors Insurance and Disability Insurance Trust Fund, GPO-1981.

APPENDIX H

QUALITY CONTROL SYSTEMS

QUALITY CONTROL SYSTEMS

In the four major welfare programs, AFDC, SSI, medicaid, and the food stamp program, the Federal Government and the States have established on-going "quality control" systems. These systems have two goals: correcting faults in program administration that contribute to erroneous payments and reducing the extent of misspent benefit dollars. To these ends, they attempt to: (1) measure the extent and dollar value of "errors" in administration; (2) identify the types and causes of error; and (3) specify and monitor corrective actions taken to eliminate or reduce errors.

Fiscal incentives and sanctions have also been made a part of these systems. In the AFDC and food stamp systems, States may receive increased Federal funding of their program costs if their rate of erroneous payments meets Federal standards. Further, under the AFDC, medicaid and food stamp systems, they may be held financially liable to the Federal Government for erroneous payments in excess of Federal standards, based on information collected through the semi-annual quality control surveys. In the SSI system, the Federal Government may be held liable to States for erroneous payment of State-funded (but federally administered) supplements to the basic Federal SSI payment when they exceed a "tolerance" level of error.

MEASUREMENT OF ERROR

The core of the four existing quality control systems is the semiannual quality control survey. Every 6 months (October/March and April/September) each system compiles the results of a randomly selected, statistically valid sample survey of cases, ranging from 40,000 to 75,000 cases, nationwide. Each selected case is subjected to a thorough review by quality control personnel, including a full field investigation. This review identifies payments to ineligibles, overpayments, underpayments, the type of error made, the responsibility (recipient versus administering agency) for the error, and, in some cases, incorrect denials of aid. Error "rates" are then established for that 6-month review period for each State: "caseload" error rates indicate the proportion of ineligible cases, overpaid cases, underpaid cases, and, in some cases, improperly denied cases in the sample caseload; "payment" error rates indicate the extent of erroneous payments in each category of error as a proportion of total dollars paid out to the sampled caseload. Moreover, information on the sources and types of errors identified in each quality control review is compiled for use in implementing administrative "corrective actions" intended to reduce or eliminate similar errors in the future.

In the AFDC and food stamp systems, quality control error rates quantify the extent to which eligibility and payment errors exist in