SSI The Relatively Painless Crash Course

1
SSI - The Relatively Painless Crash Course

• Presented on June 1st, 2006
• by Scott Leonard with KCDDD, and Joanne ONeill
  with the Arc of King County
• Department of Community and Human Services
• Developmental Disabilities Division

2
Before we start

• This is part 1 of a three-part series.
• There will be specific opportunities throughout
  the presentation to ask questions.
• Commonly used acronyms and terms are marked in
  red.
• Whats in your folder.

3
Social Security Administration

• Basic Programs
• Disability Eligibility
• Disability Reviews
• Questions

4
SSA

• The Social Security Administration, or SSA, is a
  federal agency.
• The headquarters, located in Baltimore, Maryland,
  provides support for over 60,000 employees.
• Most people access to SSA through local field
  offices, the web at www.ssa.gov , and the SSA
  phone service 1-800-772-1213.

5
SSA

• The Social Security Administration administers
  three basic benefit programs
• Retirement Benefits (commonly called Social
  Security Benefits)
• Social Security Disability Insurance, or SSDI
• Supplemental Security Income, or SSI.

6
SSDI

• SSDI benefits are paid to individuals (and their
  dependents) who have been employed and have paid
  Social Security taxes (FICA).
• These individuals and their family members may
  receive benefits when they retire, become
  disabled, or die.

7
SSI

• SSI is funded through the general revenues of the
  Federal Treasury.
• To receive SSI, you do not need to have a history
  of employment or payroll contributions.
• SSI is a need-based benefit intended for those
  who are aged, blind or disabled who have little
  or no income and resources.

8
Eligibility - Disability Determination

• As an adult, to be eligible for SSDI or SSI, you
  must first meet some basic disability
  requirements
• You must have a disability that can be documented
  by a qualified medical examiner
• The disability must be expected to last at least
  12 months
• At the time of application, you must either not
  be working, or earning under SGA (860 gross /
  month in 2006)
• If you are blind and applying for SSI, you do not
  have the SGA test.

9
Disability Determination

• Disability Determination Services, or DDS, are
  state agencies that make the disability decisions
  for Social Security.
• In making a disability determination, DDS workers
  will request medical records, work history
  information, and, when necessary, pay for
  specific medical exams.

10
Continuing Disability Reviews (CDR)

• SSA must periodically review the disability
  status of all beneficiaries and recipients.
• The length of time between CDRs depends upon the
  severity of the persons disability.
• Most people who are clients of WA DDD receive a
  CDR every 3 to 7 years, though certain
  circumstances can trigger a new CDR.

11
Continuing Disability Reviews (CDR)

• If you are profiled as a person with a low
  probability for medical recovery, you will first
  be sent a Disability Update Report via the mail.
• Depending upon the information you provide, SSA
  may or may not request a full medical review.
  (The full review is a lengthy process.)

12
SSI Redeterminations

• In addition to the disability reviews, if you
  receive SSI, SSA will conduct non-medical
  redeterminations to update your income, resource,
  and living arrangement information.
• These SSI redeterminations will occur every 12
  months.

13
Appeals

• You have the right to appeal an initial
  determination made by SSA, a denial of benefits,
  a reduction of benefits, termination of benefits,
  and overpayments.

14
Questions?
15
SSI The Application Process

• Application
• Documentation
• Questions

16
How do I apply for SSI?

• A complete application for SSI cannot be done
  over the internet.
• You can complete the Adult Disability and Work
  History part of the application on-line.
• You must either meet with an SSA representative
  in person, or arrange for an interview to be
  conducted over the phone.
• Call SSA at 1-800-772-1213 to set up this appt.

17
What information should I include with my
application?

• The more documentation you can bring, the better!
• What you MUST bring
• Birth Certificate (original or certified copy)
• SSN s of all people living in your home
• Other Benefit Info Unemployment, Child Support,
  Food Stamps, etc.
• Bank Statements
• Any wages or tax returns
• Rent / Mortgage payments
• Resource information (stocks, bonds, burial
  funds, etc.)
• Spouses wage information if working

18
What information should I include with my
application?

• What you should bring
• Any documentation regarding your disability
• Names, addresses, and records of schools
  attended. Include names of teachers and
  counselors.
• Names, addresses, telephone numbers, dates of
  treatment, and records from
• all physicians
• all therapists
• all clinics and hospitals.
• Statements by relatives, friends, and other
  people who know you, your disability, and the
  obstacles you face.

19
When should I apply?

• Individuals should apply for SSI benefits as soon
  as possible, even if all documentation is
  incomplete.
• If you call and indicate you want to apply for
  SSI, the date of your phone inquiry will count as
  the official application date IF the entire
  application is completed within 60 days of the
  phone call.
• SSI benefits begin the first month following the
  month of application.
• You will likely receive a retroactive SSI benefit
  check.

20
How long will it take?

• The waiting period for eligibility determination
  is approximately 120 days.

21
Appeals

• If denied eligibility, you have the right to
  appeal.
• A detailed description of the Appeals process is
  included.

22
Questions?
23
SSI The Basics

• Eligibility
• Amount
• Medicaid
• Questions

24
What is SSI?

• SSI is Supplemental Security Income. It is also
  known as Title XVI.
• SSI is a need-based benefit intended for those
  who are aged, blind or disabled who have little
  or no income and resources and no significant
  work history.
• People qualify for SSI if
• They have a disability AND
• They have little resources and income.

25
What are the Resource Restrictions?

• To be eligible for SSI, you must have less than
  2,000 in resources (3,000 if you are a couple
  and recipients of SSI).
• Exclusions to this restriction include
• Your own home
• A car
• Money sheltered in a Special Needs Trust
• Money sheltered in a PASS
• Money and equity in a self-owned business
• Burial funds, up to a certain amount
• Retroactive SSA payments for a certain period.

26
What are the Income Restrictions?

• Income is often referred to as being either
  Earned or Unearned.
• Earned Income is gross income that you get paid
  from a job.
• Unearned Income is money that you didnt earn
• SSDI
• Gifts
• Child Support
• Etc.

27
Income Restrictions, cont.

• Both Earned and Unearned Income can impact
• a persons eligibility for SSI and
• the size of the persons SSI check.
• Earned and Unearned Income affect SSI
  differently.

28
Income Restrictions, cont.

• When you first apply, you have to be earning less
  than SGA. In 2006, SGA is 860 / month.
• Once eligible, however, you can earn much more
  than SGA and still be eligible for SSI!

29
SSI So How Much Is It?

• SSI is based on whats called the Federal Benefit
  Rate (FBR).
• For 2006, the FBR is 603. If you are a couple
  and recipients of SSI, the FBR is 904.
• Other states have additional State Supplemental
  Payments WA does not.

30
SSI What It Covers

• The FBR, 603, is considered the minimum amount
  that a person needs in order to live on a monthly
  basis.
• A person is expected to use his/her SSI to pay
  for all food, shelter, and clothing costs.

31
SSI and Living Arrangement

• If a person is receiving support and not paying a
  fair share of living expenses, then SSA can
  reduce that persons SSI amount.

32
SSI and Living Arrangement, Example.

• Chip is 20 years old and living with his parents.
  Chip is not working, so his parents dont feel
  its fair to charge him rent. His parents also
  give him food and do not receive compensation.
• Because Chips basic expenses are being paid, SSA
  doesnt feel its necessary to pay the full SSI
  amount. As such, SSA reduces his SSI by 1/3rd.
  (He will receive 402 / mo as opposed to the full
  603.)
• This example is called the VTR, or Value of
  One-Third Reduction.

33
SSI and Medicaid

• If you are eligible for SSI, then you also
  receive Medicaid (the green and white coupon
  mailed monthly).
• Medicaid is health insurance.
• Unlike SSI, Medicaid is a state administered
  program. Each state sets its own guidelines
  subject to federal rules and guidelines. Certain
  services must be covered by the states in order
  to receive federal funds. Other services are
  optional and are elected by states.

34
Medicaid

• Medicaid does not pay money to you rather, it
  sends payments directly to your health care
  providers.
• When you receive Medicaid with SSI, it is
  referred to as CNP, or Categorically Needy
  Program Medicaid.
• Medicaid is not the same as Medicare.

35
Medicaid Generally What It Covers

• CNP Medicaid pays for mandatory health services
  such as
• Physician services,
• Inpatient and outpatient hospital care
• Nursing home care
• Some Dental Care
• Medicaid Personal Care
• Physical, occupational, and speech therapies and
• Prescriptions.
• If you receive both Medicare and Medicaid,
  prescription costs will be covered according to
  the new Medicare Drug Plan starting Jan 1, 2006.

36
Questions?
37
SSI and Earned Income

• How earned income impacts SSI
• Your responsibilities once you begin working.
• Questions

38
Earned Income and SSI

• If a person is working, SSA will adjust a
  persons SSI amount based on his / her gross
  monthly wages.
• How does SSA find out about your wages? You tell
  them!

39
Earnings and SSI - Reporting

• If you receive SSI and you are working, you must
  report wages on a monthly basis.
• When you first begin working, notify SSA.
• You will then be required to send in copies of
  your wage stubs to your local SSA office every
  month.

40
Earnings and SSI - Reporting

• Social Security will take this wage information
  and reduce your SSI accordingly.
• This process takes 2 months. The SSI amount in
  December is based on wages earned in October.

41
Earnings and SSI Calculations

• The general idea is that SSI is reduced by 1 for
  every 2 you earn.
• If SSI was reduced 1 for every 1 earned, there
  wouldnt be an incentive to work.
• By working and receiving SSI, you receive more
  income than by just receiving SSI alone.

42
Earnings and SSI - Calculations

• Heres how it works
• SSA looks at the gross amount received in the
  month
• They then dont look at 65
• If you have no Unearned Income, they exclude
  another 20
• They take the remainder and divide by 2
• They subtract this amount from your SSI to
  determine the new SSI amount.

43
Calculation Example

• Rocky receives 603 SSI. He begins working and
  gets paid 885 gross per month.
• What will be the new amount of his SSI?

44
Calculations Example

• 885 gross wages
• - 65 exclusion
• - 20 exclusion
• 800
• 800 / 2 400 Countable Income
• 603 FBR - 400 203 SSI.

45
Calculations Example

• If Rocky is paid 885 gross/ month, he will
  receive a 203 SSI check, for a total of 1,088.

46
Calculations Example

• Georgia was receiving SSI in the amount of 603.
  Georgia started a new job as a welder, and she is
  now being paid 1440 gross per month.
• What will happen to her SSI check?

47
Calculations Example 2

• 1440 gross wages
• - 85 (65 20 exclusion)
• 1355
• 1355 / 2 677.50 Countable Income
• 603 FBR - 677.50 0 SSI

48
Calculations Example 2

• By earning 1440 gross per month, Georgia will
  receive 0 SSI check.
• Does this mean Georgia now becomes ineligible for
  SSI?
• No!

49
1619b Status

• Even though she is not receiving an SSI benefit
  check, Georgia keeps her SSI eligibility and
  Medicaid eligibility because she has entered
  1619b status.
• 1619b is the status where an SSI-eligible
  individual receives no SSI check due to gross
  wages but remains eligible for SSI and Medicaid.
• In 2006, you can earn up to 23,959 in the year
  and maintain 1619b status.

50
Student Earned Income Exclusion

• If you are under 22 years of age and you are a
  full-time student, and you begin working, you may
  be eligible for the Student Earned Income
  Exclusion, or SEIE.
• You can earn up to 1,461 / month, up to a total
  of 5,910 in 2006, and your SSI will not be
  reduced.

51
Student Earned Income Exclusion

• The Transition Program typically qualifies for
  the SEIE.
• You need to remind SSA that you are in the
  transition program, and submit school documents,
  if necessary
• You must still report income to SSA on a monthly
  basis.

52
Questions?
53
SSI, Unearned Income, and Resources

• How unearned income impacts SSI
• Special Needs Trusts

54
Unearned Income

• Unearned Income is any income that is not earned
• SSDI / SSDAC
• Child Support
• Gifts
• Inheritances
• Etc.

55
Unearned Income

• Unlike wages, unearned income is weighed much
  more heavily by SSA.
• Whereas wages are looked at as roughly 1 for
  every 2 earned, unearned income is looked at,
  after a 20 exclusion, dollar for dollar.
• When calculating SSI, SSA will look at unearned
  income first, and earned income second.

56
Example

• Jordan, who is not working, receives both SSDI
  and SSI. Her SSDI is 440 / month. How large
  will her SSI check be?

57
Example

• 440 SSDI
• - 20 Exclusion
• 420 This is Jordans Countable Income.
• 603 FBR
• - 420 Countable Income
• 183 SSI
• If Jordan receives 440 SSDI, she will also
  receive 183 SSI, for a total of 623.

58
Example

• Jordan receives SSDI in the amount of 440 and
  SSI in the amount of 183.
• Jordan begins working and gets paid 300 gross /
  month.
• What happens to her SSI?

59
Example

• SSA will first look at SSDI
• 440 SSDI
• - 20 Exclusion
• 420 Countable Income
• 603 FBR
• - 420 Countable Income
• 183 SSI

60
Example

• Next, they will look at Earned Income
• 300 gross wages
• - 65 exclusion
• 235
• 235 / 2 117.50 Countable Income
• 183 SSI - 117.50 CI 65.50 SSI

61
Example

• Jordan receives 440 SSDI, 300 gross income, and
  65.50 SSI for a grand total of 805.50 monthly.

62
Suggestion for additional training

• To fully understand how SSDI and SSDAC income can
  impact SSI, it is important to understand how
  those benefits work.

63
Example 2

• Jessica receives 603 SSI. Her grandmother
  passes on, leaving her an inheritance of 10,000
  in the month of December.
• What will happen to her SSI?

64
Example 2

• This 10,000 will count as unearned income for
  the month of December.
• Jessica will not be eligible for SSI in December.
• For every month following she has access to that
  money, she will be over the resource limit and be
  ineligible for SSI.

65
Special Needs Trusts

• In Jessicas situation, she will need to either
  spend down her 10,000 or somehow shelter it if
  she wants to remain eligible for SSI and
  Medicaid.
• A common way to shelter money is through a
  Special Needs Trust.

66
Special Needs Trust

• A special needs trust preserves assets that would
  otherwise disqualify someone from Supplemental
  Security Income and Medicaid.
• The trust allows families and individuals to save
  for important services that may need to be paid
  for through personal funding.

67
Special Needs Trust

• One available trust is the Developmental
  Disabilities Life Opportunity Trust.

68
Questions?
69
Responsibilities

• SSA is a tremendously large, bureaucratic
  organization.
• It would be generally impossible for any
  organization this large to operate without making
  mistakes, or to always respond in a timely manner.

70
Responsibilities

• In cases of dispute, the burden of proof always
  falls on you! Therefore
• Keep all paperwork SSA sends you!
• If you talk to someone over the phone or in
  person, record the persons name, where the work,
  the date and time, and what was discussed.

71
Thank you!Please fill out the evaluation before
you leave.

• Department of Community and Human Services
• Developmental Disabilities Division