Terminology Social Security Benefits Title II Supplemental Security Benefits Title 16 SSI
Social Security Benefits Quarters of Coverage Quarter of coverage in 2003= $890 2004 = $900 Fully insured -- 40 quarters Or one quarter for each year after age 21 Currently insured: 6 quarters within a 13 quarter period ending with the quarter you: a) die or b) become entitled to disability or old age insurance benefits.
Retirement Must be Fully Insured Early Retirement Age 62 2004- apx. 20% reduction Born 1960 or later – 30% reduction Regular Retirement 2004 – Age 65 and 4 months Maximum benefits $1,825 Born 1960 or later – age 67
Dependent Benefits Children Insured entitled to old age or disability benefits or deceased Natural, adopted child, stepchild or grandchild/step grandchild (parents must be deceased or disabled at time insured became eligible for benefits or died) Under 18 or In secondary school under 19 or Disabled before age 22
Benefits for Spouses Spouses Insured entitled to old age or disability benefits Valid marriage and married at least one 1 year or child in common Age 62 or older or Caring for child of wage earner who is under age 16 or disabled Divorce Spouses may qualify
Widow(er)s Insured was fully insured Valid marriage and Marriage lasted 9 months (some exceptions) or Natural or adoptive parents of a child and age 60 or age 50 and disabled disability must have began within 7 years of the wage earner's death Unmarried or remarried after age 60 or age 50 if entitled as a disabled widow(er)
Benefits for Widowed Parents Insured was fully or currently insured at time of death Widow or widower and marriage lasted at least 9 months and Unmarried Caring for child of the insured who is under age 16 or disabled
Surviving Parents of Wage Earner Insured was fully insured and is deceased 62 years old Not married since insured person died Must have been dependent on insured for at least half of your support
Disabled Fully insured Disabled within last date of insurance -- 20 quarters in a 40 quarter period and disabled within that period unless: Under age 31 when become disabled or Previously disabled under age 31 or Statutorily blind and fully insured
SSI Age 65 and Meet the citizenship criteria Disabled
Appeals Process Initial Reconsideration Hearing Appeals Council Federal Court
Appeal Deadlines 60 days unless good cause shown SS presumes receipt 5 days from date of mailing 10 day rule for continuing benefits Applies for both reconsideration and hearing request Reopening 12 months of the initial decision for any reason Good Cause 2 years SSI 4 years SS
Adult Disability Definition The inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which: has lasted or can be expected to last for a continuous period of not less than 12 months or can be expected to result in death.
Resources Used by SSA in Disability Determinations Listings Grid Bureau of Disability Determinations Services – BDDS Medical Experts Vocational Experts
Rules Statute 42 U.S.C. §§ 401 et seq., 1381 et seq. Regulations 20 C.F.R. §§404 et seq., 416 et seq. Rulings POMS HALLEX
Definition of Disability for Children A physical or mental condition (or a combination of conditions) that results in marked and severe functional limitations and: The condition must last or be expected to last at least 12 months or be expected to result in the child's death.
Functional Equivalence - Six Domains Acquiring and using information Attending and completing tasks Interacting and relating with others Moving about and manipulating objects Caring for yourself Health and physical well-being
Functional Equivalence Need one extreme limitation or Two marked limitations Can also be functional equivalent if no listing exists for condition or combination of impairments “equals” a listing
Medical Improvement All cases are given a diary date Sequential evaluation different Appeal within 10 days to preserve benefits
Drug and Alcohol Cases Basis for the disability must be independent of drug or alcohol condition Payee will be appointed Can require treatment
Amount of Benefits - 2004 SSI- $564 individual $846 disabled couple Couple includes “holding yourself out as married” Paid on the first of the month Title 2 Maximum $1825 Usually at least $20 more than SSI if disabled or aged Medicare deduction – $66.60 Don’t forget IDHS programs to pay premium Payments dates vary
Reduction/Nonpayment of Benefits -SSI Income Unearned income disregard ($20) Child support disregard (1/3 of support) Earned income disregard ($65, and ½ of balance.) Inkind Income Deeming Asset limitation $2000 individual $3000 eligible couple Residents in public institutions Failure to comply with drug or alcohol treatment Fleeing felons
Reduction/Nonpayment of Benefits – Social Security No asset limitation Earned income Does not affect Retirement benefits if 65 or older Disability benefits Trial work period- any 9 months where you earn $580. Extended period of eligibility- 36 months, no payment if earn more than $810 Receipt of Other Title 2 benefits -reduced $ for $ Workers’ compensation Aliens who leave the country for more than 6 months Failure to comply with drug or alcohol treatment Nonpayment while serving time for a felony
Payment of Benefits Lump Sums Transitional Assistance and P3 offset- both SSI and SS disability SSI only Reduction for receipt of TANF Restricted account for children’s lump sum
Overpayments Reconsideration 60 day time limit Appeals within 30 days stays action until reconsideration issued. Appeals after 30 days stops action until reconsideration issued. Amount Recouped SSI – 10% SS- No limit, but can be negotiated
Waivers No time limit All recouped money returned if successful Must establish not at fault and Defeat the purposes of the SSI program to collect the overpayment or presumed for an individual receiving SSI Against equity and good conscience or Impede efficient or effective administration of program
Ticket to Work Voluntary program to assist Title II disability and SSI disability recipients Using a ticket will not result in a continuing disability review (“CDR”) No CDR for working after 24 months on benefits Expedited Reinstatement for Individuals whose benefits stop due to working Expanded medical coverage
Immigrant Restrictions - Qualified Immigrants Legal Permanent Residents Refugees, Asylees, Cuban/Haitian entrants, Amerasians, victims of trafficking, and those whose deportation is being withheld. Lawfully present active duty members of the U.S. Armed Forces and their spouses and dependent children. Lawfully present veterans with an honorable discharge and their spouses and dependent children.
Qualified Immigrants Who Arrived on or Before 8/22/96 Eligible for SSI Eligible for SS
Immigrants Who Arrive After 8/22/1996 SSI - Distinction between LPRs and other Qualified Immigrants SS - Qualified Immigrants Eligible
LPR’s Who Arrive After 8/22/96 Bar on SSI Only eligible if can be credited with 40 quarters (after a 5 year wait) Credits can be from worker, spouse, or parents while they were children No quarters counted after 12/31/96 if individual received “federal means tested public benefit” during the quarter Includes TANF, Medicaid, KidCare, Food Stamps
Resources Social Security Website http://www.socialsecurity.gov/ Includes Handbook, POMS, Rulings, HALLEX, CFR Dictionary of Occupational Titles (DOT) Diagnostic and Statistical Manual IV-TR Social Security Claims and Procedures - McCormick Medical Proof of Social Security - Hirshman Video tape library