SOCIAL SECURITY AND SSI

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SOCIAL SECURITY AND SSI

Social Security Administration Programs
Supplemental Security Income (SSI): Childhood Eligibility vs Adult Eligibility
Advocacy Tips for SSI Application
Work Incentives Available Under Supplemental Security Income
Social Security Disability Program Basics (SSDI and SSDAC)
How to Speed Up a Claim if Applying for Disability
Medical Insurance Under Social Security Disability
SSDI and SSDAC Work Incentives
Additional Resources

SOCIAL SECURITY ADMINISTRATION PROGRAMS

The Social Security Administration operates two programs to assist eligible individuals with disabilities to receive cash and/or medical benefits if they are severely disabled and unable to work:

A common concern for many adults with disabilities involves obtaining and maintaining Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) and medical benefits. The following articles address obtaining benefits for individuals who reach the age of 18 and work incentives available to maintain benefits when individuals go to work. Although some individuals receive a combination of SSI and SSDI benefits, these articles treat each provision separately. Portions of the following are excerpted from: (1) Social Security Administration's website, internet update November 14, 1997, and (2) "Social Security Work Incentives", an article by Frances Koehler of Koehler Consultation, 529 Ridgeley Lane, Suite 200, Richmond, VA 23229-7235.

SUPPLEMENTAL SECURITY INCOME (SSI): CHILDHOOD ELIGIBILITY VS ADULT ELIGIBILITY

Have you ever applied for SSI for your child and were turned down because your family income or resources were over the limit to receive monthly cash assistance?

If you have experienced any of these situations, you may wish to consider application for Supplemental Security Income cash assistance when your child reaches the age of 18. This is often a difficult and personal decision for families to make. For parents whose income has supported their child to this point, it is sometimes difficult to think about asking for assistance now. However, obtaining SSI is one of the supports that your child may receive as an adult which often makes it easier to receive and cover the costs for other adult services such as vocational rehabilitation, job coaching services, transportation assistance, or housing and living supports.

Before applying for SSI, it is important to understand that disability criteria for eligibility in the Social Security system differs greatly from disability criteria within the school system. Individuals applying for SSI benefits as adults must be considered to have a severe disability in order to qualify. If for example, an individual with a disability is planning to go to college and has functioned highly while in school, it is unlikely that the individual will qualify to receive SSI benefits.

The SSI program is based on economic need. Under the SSI program a child is considered for "independence" at age 18, without considering parental income. Once individuals with disabilities reach age 18, the Social Security Administration considers the individual's income, resources, and disability.

To be eligible for SSI benefits, an individual with a disability must have limited income and resources, and meet disability, citizenship and residency requirements. Eligibility considerations for disability, income, and resources for adults with disabilities are as follows:

Disability: For individuals who are blind, 20/200 vision or less in better eye with glasses, or field of vision of less than 20 degrees. Other individuals with disabilities must be considered unable to "engage in substantial gainful activity" of working due to a physical or mental impairment which is expected to last at least 12 months or result in death. Substantial gainful activity (SGA) is usually defined as the ability for individuals with disabilities other than blindness to earn $500 per month. SGA does not apply to individuals who are blind and applying for SSI.

Limited Income: The amount of a person's income is used to determine both eligibility for, and amount of, the SSI benefit. Income is defined as:

Earned income

Unearned income

Limited Resources:Resources are things a person owns, such as cash/bank accounts, stocks, bonds, mutual funds, land, personal property (anything that is not real estate), or life insurance which has a cash surrender value.
Not all resources count for SSI. For example, an individual's home ( if person lives in this home) is not counted as a resource, nor is one automobile of any value if used to provide necessary transportation to medical appointments or employment, or if no other transportation is available to carry out daily activities of living. If none of these circumstances applies, a vehicle having a current market value of less $4500 does not count as a resource). The SSI resource limit for an individual is $2000 and for a couple $3000.

Other Requirements: Individuals must apply for all other benefits for which they are eligible (for example: pensions, Social Security disability insurance, etc.) In some cases, individuals must accept vocational rehabilitation services if blind or disabled and under 65.

ADVOCACY TIPS FOR SSI APPLICATION

Denial of benefits to adults with disabilities on first application is approximately 75% of individuals applying. It is often necessary to consider appeals and provision of additional information in order to receive reconsideration.

Keep copies of all official documents which describe your child's disability and the effects of the disability on your child's functioning. Set aside a room or an area of your house where records can be kept, such as doctors' or psychologists' reports describing medical diagnosis, physical, psychological or psychiatric information. If your child has had unsuccessful work experiences while in school or requires intensive assistance on the job, consider supplying documentation of this information along with the application.

When making the first application, provide as much direct information as possible. If you have signed release forms for information from doctors or schools, follow up with them to check that they have forwarded the information. There is no system - wide check within the Social Security Administration to review if all requested information has actually been received.

You may wish to contact the Social Security Administration to request a review of the file in order to examine if all information has been received.

WORK INCENTIVES AVAILABLE UNDER SUPPLEMENTAL SECURITY INCOME

People who receive SSI may eventually enter the workforce. Work incentives are available which an individual may use to have monetary assistance for transportation to work, supported employment training on the job, additional education or training toward an occupational objective to become more self-sufficient, or for other items and services. There are Work Incentive opportunities as individualized as the needs of the employee or person working toward becoming an employee. Importantly, Work Incentives may also be available for some working individuals to have medical benefits continued after employment. It is up to the SSI beneficiary to choose to use a Work Incentive, however, most individuals would choose to use them if they had more information. The following are descriptions of Work Incentives available under the SSI program. Special work incentive provisions exist for individuals who are blind.

Continuation of SSI Benefits While Working: People who receive SSI can have some earnings and still receive SSI cash payments so long as their total income does not exceed income limits. Under a special provision of the Social Security Act, section 1619(a), people who receive SSI may continue to receive benefits even if earnings go over $500 per month , the "substantial gainful activity" level. Under the "Earned Income Exclusion" provision, the SSI benefit is gradually reduced based on what an individual earns, until enough is earned to reduce the benefit to zero. In figuring the SSI monthly payment amount, SSA first looks at the individual's total monthly income, "excluding" or subtracting $20 of income of any kind; then excluding $65 of earned income and an additional 50% of earnings over $65 per month. Basically, this translates to a reduction in the individual's SSI check of about $1 for every $2 earned over $65 ($85 if the individual's only income is through earnings on a job). This generally enables an individual with a disability who is working to receive a higher total monthly income than if only receiving an SSI check.
Even if the SSI benefit goes to zero because of earnings, an individual may still qualify for Medicaid through the work incentive provision 1619 (b) if earnings are under the State Medicaid Threshold.

Student Earned Income Exclusion: For individuals who are full-time students and under age 22, the first $400/month the student earns (up to $1620 in 12 months) before other exclusions or work incentives are applied does not reduce the student's benefit. The student status needs to be clearly stated to SSI.

Impairment Related Work Expenses (IRWE): Individuals who have expenses which must be paid in order to work and which are related to their disability may choose to use the IRWE provision. Impairment related work expenses must be approved through the Social Security Administration and paid for out of earned income. These expenses are subtracted from earnings to determine the effect of earnings on benefits. Examples of such expenses may be attendant care services, medical devices, home or van/car modifications, some transportation costs, etc. It is important to keep copies of receipts for items purchased and to supply these receipts to the claims representative.
Special provisions exist for individuals who are blind. Most work expenses (not just those related to the disability) may be deducted from income to determine eligibility for SSI. For example, special clothes on the job or special equipment needed to work can be deducted.

Plan to Achieve Self-Support:Under PASS, individuals are able to purchase or save for goods or services which will enable them to pursue a specific and feasible occupational objective and have higher earned income. A vocational evaluation can provide proof that an objective is feasible (in other words, that there is a reasonable chance for success to meet the objective). The individual must have income or resources other than SSI to put toward this goal and must be able to afford living expenses as well as the PASS items and services. An individual should have money management and record keeping ability, or have someone who can assist, as this is very important for PASS compliance. Persons who did not qualify for SSI because of income or resources may use that income and/or resource toward their goal and may become eligible for SSI. They must meet all other SSI eligibility criteria.
A PASS should be written and submitted to SSI for approval using the new 10 page PASS form provided. The PASS should contain the following information:

It is also beneficial to put the name and address of the person who assisted in developing the PASS as well as the name and address of any service provider who is assisting in reaching the goal.

A PASS is generally approved for an initial period of up to 18 months and is reviewed for compliance in 6 months, if savings are involved, and at the SSI annual redetermination. A PASS can be written to last up to 36 months and in the case of extended educational or training programs to 48 months; however, plans that are in compliance and require an extension, extensions of 6 months may be granted if it is likely that it will enable the person to achieve their occupational objective. A PASS should stop when the objective is met or the individual is not in compliance. In general, PASS may reimburse an individual, within limitations, by not reducing their SSI by up to 100% of their monthly PASS expenses.

Special Note:Several changes in the work incentive provisions for both SSI and SSDI are being explored by the Social Security Administration. In 1997 private and public rehabilitation agencies were able to apply to SSA to become Alternative Providers of rehabilitation services. Tax credits were proposed to benefit persons with disabilities who work. Proposals were made to extend Medicare and Medicaid to individuals who lose these benefits through an income-based buy-in.

SOCIAL SECURITY DISABILITY PROGRAM BASICS

This article addresses the Social Security Disability Insurance (SSDI) program, the Social Security Disabled Adult Child program (SSDAC) and Work Incentives to assist individuals receiving disability payments to return to work on a trial basis without losing benefits. Portions of this article are excerpted from: (1) the Social Security Administration website, March, 1998 and (2) "Social Security Work Incentives", an article by Frances Koehler of Koehler Consultation, 529 Ridgeley Lane, Suite 200, Richmond, VA 23229-7235.

Individuals of any age may be eligible to receive Social Security disability benefits.

Social Security Dependents Benefits are paid to children (disabled or non-disabled) under the age of 18:

If a disabled child under 18 is receiving benefits as a dependent of a retired, deceased, or disabled worker, you may contact Social Security to have checks continued at 18 on the basis of disability. Other family members qualify to receive dependents benefits under various circumstances.

Social Security Disabled Adult Child Program (SSDAC) Benefits are paid to eligible individuals who meet the following criteria. To be eligible for SSDAC a person must:

The "adult child" receives their benefit through their parent's work record and continues to receive this benefit as long as they remain disabled.

For adults, the Social Security Disability Insurance (SSDI) Program is likened to a disability insurance policy. What a person has paid in to the policy through Social Security (F.I.C.A.) taxes is the basis of what the policy will pay them when disabled. A young adult who works and earns six quarters of coverage prior to the age of 24 may become SSDI eligible. The SSDI payment amount is based on a worker's lifetime average earnings covered by Social Security.

HOW TO SPEED UP A CLAIM IF APPLYING FOR DISABILITY

The claims process for disability benefits is generally longer than for other types of Social Security benefits. It takes longer to obtain medical information and to assess the nature of the disability in terms of the ability to work. This process can be shortened by bringing the following documents:

Social Security number and proof of age for each person applying for payments, including spouse and children who are applying for benefits.

Names, addresses, phone numbers of doctors, hospitals, clinics, and institutions, and dates of treatment.

Names of all medications.

Medical records from doctors, therapists, hospitals, clinics, and caseworkers.

Laboratory and test results.

Summary of where you worked in the past 15 years and the kind of work you did.

A copy of your W-2 form (Wage and Tax Statement)

Dates of any prior marriages if spouse is applying.

MEDICAL INSURANCE UNDER SOCIAL SECURITY DISABILITY

Individuals who receive disability benefits are automatically enrolled in Medicare after receiving benefits for two years.

Medicare has two parts- hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. Taxes paid while working financed this coverage, so it is premium free for eligible individuals.. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. Individuals pay a monthly premium for this coverage if they choose to have this coverage.

For individuals who receive Medicare and have low income and resources, the state may pay Medicare premiums and, in some cases, other out of pocket Medicare expenses such as deductibles and coinsurance.

SSDI OR SSDAC WORK INCENTIVES

Work incentives provide support over a period of time to allow the individual with a disability to test their ability to work and gradually become self-supporting. There are a number of special rules that provide cash benefits and Medicare while attempting to work.

If you are receiving Social Security Disability benefits, the following work incentives apply:

Trial Work Period: For a period of 9 months (not necessarily consecutive), individuals may earn any dollar amount without affecting benefits. (The 9 months must fall during a five year period before the trial work period ends.) A trial work month is any month in which an individual earns over $200.

After the trial work period ends, work is evaluated to see if it is substantial. In other words, in 1998 if average earnings fall below $500 a month ($1050 for individuals who are blind), benefits generally continue. If earnings average more than $500 a month, benefits continue for a three month grace period.

Extended Period of Eligibility: The Extended Period of Eligibility is a minimum of 36 months which follows the Trial Work Period. During the Extended Period of Eligibility, individuals who remain disabled and whose earnings fall below $500 per month are eligible to receive a monthly benefit without a new application.

Impairment Related Work Expenses (IRWE)

Expenses related to disability may be subtracted from monthly earnings if these expenses are necessary in order to work. After these expenses are deducted, the Social Security Administration considers if earnings are substantial.

Examples of these types of expenses are certain payments for: special transportation, job coaching fees, attendant care services, medical devices, assistive technology, home modifications, the cost of a guide dog, certain non-medical devices and medications required for work. These expenses must be paid out-of-pocket by the individual and not reimbursed by another source.

As a result of the "IRWE", individuals who earn more than $500 per month continue to receive their SSDI check in addition to their paycheck if, after these expenses are deducted, their earnings fall below the Substantial Gainful Activity level.

Individuals who receive disability benefits are automatically enrolled in Medicare after receiving benefits for two years.

Medicare has two parts- hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. Taxes paid while working financed this coverage, so it is premium free for eligible individuals.. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. Individuals pay a monthly premium for this coverage if they choose to have this coverage.

For individuals who receive Medicare and have low income and resources, the state may pay Medicare premiums and, in some cases, other out of pocket Medicare expenses such as deductibles and coinsurance.

ADDITIONAL RESOURCES

Social Security on the Internet: Additional information on social security eligibility, employment and rehabilitation programs is available at the Social Security Administration Website Address

PACER Center's SSI Page contains current information on Social Security changes, legislation, and SSI links.

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