Supplemental Security Income (SSI) for Adults with Disabilities John S. Whitelaw, Supervising Attorney, Community Legal Services Rebecca Vallas, Staff Attorney, Community Legal Services SSI Applications Project Pepper Hamilton, LLP January 2013

Purpose of this Project Elimination of General Assistance (GA) Getting SSI applications approved quickly is even more critical Unassisted applicants are much less likely to be approved at initial level Overall approval rate: about 1/3

What is SSI? Signed into law in 1972 by President Nixon Provides minimum income to elderly/ disabled low-income Americans Must meet financial eligibility criteria and medical disability standard Provides monthly benefit ($710 max for 2013) plus Medicaid (75% FPL)

Who gets SSI? 1.2 million aged 6.7 million disabled & blind ~7.9 million total Compare: 34.6 million retired workers getting Social Security

Eligibility criteria Medical eligibility Nonmedical eligibility Financial -- income & resources Citizenship Not discussed in this presentation

Definition of disability Unable to engage in substantial gainful activity (SGA) because of a medically determinable impairment(s) which is (are) expected to last 12 months or result in death. PHYSICAL MENTAL COMBINATION Same for SSI and SSDI

SSI vs. SSDI SSDI (aka Social Security Disability Insurance (“Title II”) Insurance program for workers who have paid enough in FICA taxes to be covered Not a needs-based program SSI (“Title XVI”) Provides a minimum income to people who have not worked enough to be covered Or who are covered but receive less than $730 in SSDI (“concurrent beneficiaries”) Means tested

Sources of Law Statute Regulations Title II of the Social Security Act (42 USC § 401 et seq) Title XVI of the Social Security Act (42 USC § 1381 et seq) Regulations 20 CFR § 401 et seq 20 CFR § 416 et seq Program Operations Manual System (POMS)

Application Process Individual submits application for benefits Local SSA office processes application, sends to state agency that makes decision Bureau of Disability Determination (BDD) (DOL) BDD requests medical evidence from providers BDD sends forms to providers to complete BDD makes initial decision about whether individual is disabled Average time: 3-5 months for initial decision

Application Process, cont’d If denied, individual has right to appeal 60-day* deadline, from date of notice Next step is hearing before SSA Administrative Law Judge Year or longer delay before getting a hearing Representatives often involved at this stage ALJ makes decision on disability Additional levels of appeal * 60 day deadline plus five days for mailing

BDD processes claim & makes disability determination April 17 Individual files application SSA determines non-medical eligibility SSA sends medical information and releases to BDD, disability examiner is assigned BDD processes claim & makes disability determination Applicant’s electronic record is returned to initiating SSA office SSA notifies applicant of decision by letter Non-medical information is evaluated first If the person does not qualify at this step, the application goes no further Be sure to address all non-medical criteria thoroughly and accurately Once accomplished, move on to the medical information – Module IV SSA-3368 Disability Report SSA-3369 Work History Report (Required, can be completed on-line) (optional, can be included in Medical Summary Report) SSA-827 Authorization to Disclose Information to SSA (one for each provider with medical information; use in conjunction with agency release form) IV - 2 11 11

“Sequential Evaluation” Five Steps Is applicant working at SGA level? Does the applicant have a medically determinable impairment or combination of impairments that is/are severe? Do(es) the applicant’s impairment(s): a. meet a listing; or b. medically equal a listing? Can the applicant return to “past relevant work”? Is there other work that exists in significant numbers in the national economy that the applicant can perform despite his/her impairments?

Step One: SGA? $1,040 per month for 2013 If applicant is working and earning this much or more per month claim is denied at step one without further review.

Step Two: Severe Impairment De minimis test Not an issue in most cases Typically comes into play with “older” adults 55+

Step Three: Listings Musculoskeletal Hematological Skin Digestive Respiratory Oncology Mental Immune

Step Four: Past Relevant Work (PRW) What qualifies as PRW? Work performed in the last 15 years Determine applicant’s current “residual functional capacity” (RFC) – what he can do physically and mentally on a sustained basis Can applicant do PRW with his/her current RFC?

Step Five: Other Work Taking into account the applicant’s age, education, and PRW, is there work that exists in significant numbers in the national economy that the applicant can perform on a sustained basis?

SSI Application Project: What You Will Be Doing “Clinic in a box” Limited representation for duration of application assistance Single meeting with each applicant No ongoing relationship, follow-up, obligations

SSI Application Project: What You Will Be Doing (Cont’d) Completion of online “disability report” Completion of supplemental forms Work History report Activities of Daily Living report SSA’s medical release forms Benefits Front-loads the application to increase chance of quick approval Ensures greater completeness and accuracy

https://secure.ssa.gov/apps6z/radr/radr-fe

Part I: Online Disability Report Basic info, medical history, work & education, functional information Note special education Don’t stress over specific details of treatment What’s important: provider name & contact info Think creatively about where applicant may have received treatment (eg: prison, hospital, therapy from LICSW) Print re-entry number (early on) and summary sheet (at end)

Part II: Supplemental Forms Activities of Daily Living report Handouts SSA’s medical release forms (827) Handout Get these signed and witnessed

Skills Development Interviewing skills Client contact Dealing with challenging clients Issue spotting and synthesizing facts into helpful evidence in support of approval

Interviewing Challenging Clients Homeless Mental illness Unreliable historians Difficulty abstracting

Questions? We will be at clinic sessions to help!

Contact us John S. Whitelaw, Esq. Rebecca D. Vallas, Esq. (215) 227-2403, jwhitelaw@clsphila.org Rebecca D. Vallas, Esq. (215) 981-3797, rvallas@clsphila.org www.clsphila.org