1. BENEFIT OVERVIEW

2. BENEFIT PROGRAMS Supplemental Security Income (SSI – Title XVI)
Needs-based Benefits
Entitlement-based Benefits
Supplemental Security Income
(SSI – Title XVI)
Social Security
(RIB, DIB, SIB, CDB) – Title II)
Medicaid
(Title XIX)
Medicare
(Title XVIII)
Cash Assistance (Income)
Medical Assistance

3. DISABILITY Physical or mental impairment 12 months or result in death
Prevents engaging in SGA

4. SSDI/MEDICARE ELIGIBILITY
Disability under SS
SSD 5 months after disability
Medicare 24 months after SSD
Prior earnings and payment of SS taxes
Benefits based on parent’s earning history if
Child disabled prior to age 22, and
Parent retired, disabled or deceased

5. SSDI Eligibility depends upon Sufficient work credits to be insured
Relationship to worker
Disability of
Worker
Dependent

6. SSDI ELIGIBILITY Necessary work credits range
From 20 for age 42 >
To 40 for age 62 <
Fewer work credits necessary if age 31 >
20/40 rule: 20 credits in last 10 years
10 years = 40 credits
Hence: “20/40” rule

7. RELATIONSHIP FOR SSDI Disabled insured person entitled
On own account if
Worked enough quarters
Earned enough
Children entitled
If minors or disabled adult children
On parent’s account if
Eligible parent disabled, retired, deceased
Adult child disabled before age 22 (CDB)

8. DISABILITY CRITERIA Determination delegated to State DDS
2 criteria of physical or mental impairment(s)
Expected to last (or lasted) 12 mos or result in death
Prevents worker from doing “substantial gainful work” existing in national economy considering
Age
Education
Work experience
Disability types
Listed impairment
Functional test (claimant to prove disability)
Seriousness (no substantial gainful work activity)
>$940/month

9. SSDI WORK ABILITY TESTS
First test: can worker do former job
Worker has burden to prove that can’t do former job
Second test: hold any job earning >$940
SSA has burden to prove gainful work alternative
Available in the national (not area) economy
Vocational expert often used in hearings
Test is relative to
Age (50 < presumed less able for other work)
Education
Work history

10. SSDI BENEFITS Primary Insurance Amount (PIA)
Cap on total worker/family benefit
“Family Maintenance Amount”
Worker’s family not to do as well as when working
Range from few dollars to about $2000 per month
Lose if earn >$940 (less work-related expenses)
5-month waiting period
For benefits after disability onset
Medicare eligibility
24 months after eligible for SSDI benefits

11. RECOVERY FROM DISABILITY
Periodic reviews
Frequency based on recovery likelihood
5-7 years
3 years if recovery theoretically possible
6 to 18 months if recovery expected
Regular income > $940
Benefits conditioned upon treatment compliance

12. RETURN TO WORK Trial work period (TWP) Test ability to work
For 9 months & continue benefits
Earnings >$670/mo
Once per lifetime
Work performance considered evidence that not disabled
Reinstatement if becomes disabled within 15 mos.

13. SSI/MEDICAID ELIGIBILITY
Disability under SS standards
Countable resources < $1,500 Medicaid, $2,000 for SSI
Income levels

14. SSI
Federal income program for persons with a disability who do not have Social Security coverage
SSI is intended to pay for the beneficiary's food, clothing, and shelter and nothing more

15. INCOME Disregard $20 unearned income
Disregard $65 plus one-half earned income
IRWEs
Deeming
In-kind support and maintenance (charge room & board)

16. EFFECTS OF INCOME ON SSI
Unearned Income
Earned Income
In-Kind Support & Maintenance
Gifts, payments from annuities, pensions, alimony, support , SNT distributions, dividends, interest, rents, awards, and other benefit programs (e.g., SSA but not welfare).
Wages, royalties, net earnings from self-employment, and any honoraria for services rendered.
Actual receipt of food or shelter, or something used to get one of these from any source or imputed. Acronym is “ISM.”
Reduces benefits dollar-for-dollar after first $20
Reduces benefits $1 for each $2 after first $85 ($65 + $20) earned monthly
Reduces benefits dollar-for-dollar up to max. of $20 + 1/3 ($ in 2005)

17. EXAMPLE Earnings = $585/month Less $85 disregards = $500 Less ½ = $250
SSI reduced to $387 ($637 – 250)

18. RESOURCES Owned by the individual
Available to the individual and can be converted to cash
Not “exempt”
Deeming

19. EXEMPT RESOURCES Household goods (collectibles are not exempt)
Residence
Vehicle
Irrevocable funeral contract
Burial plots
Whole life insurance w/ total face value < $1500
Back payments of SS (for 9 months)
Special needs or pooled trusts

20. INCOME v. RESOURCES Receipt of assets is income in the month received
10 day reporting requirement
If still owned next month, counted as resource

21. VALUE OF BENEFITS SSI - $637/month Medicaid medical/hospital care
prescriptions
rudimentary dental/vision
residential/institutional
Waiver - up to $14,000/month

22. SSI TRANSFER RULES Gifts within last 36 months disqualify
Gifts from current beneficiary disqualify
Disqualification determined by
Dividing the value of the gift by
SSI rates involved
Maximum disqualification is 36 months
Exceptions for transfers to special needs trust
42 U.S.C. § 1396p(d)(4)(A) – Payback Trust
42 U.S.C. § 1396p(d)(4)(C ) – Pooled Trust

23. SSI & DIB BENEFITS COLLIDE
Example: Helen disabled since age 20
Receives $579 in SSI monthly
Helen’s father, Earl, retires
Receives $1,000 RIB monthly
Helen then Receives $500 CDB monthly
Receipt of DIB unearned income
Reduces Helen’s SSI by $480
Helen then receives total of $599
$99 SSI + $500 CDB

24. SSI BENEFITS LOST Example Cont’d: Earl dies
Helen receives $750 DCB per month
Helen’s $579 SSI eliminated
Helen may lose eligibility for
Non-vendor Medicaid in some states
Unless does “spend down”

25. SS & SSI BENEFITS KNOWLEDGE IMPORTANT
Understanding of benefits
Essential
To estate planning
To special needs trust administration
To avoid jeopardizing eligibility when
Beneficiaries have mental illnesses
Families want benefits to continue
Source

26. REPRESENTATIVE PAYEE SSA procedures & standard
Refuse to honor DPOA
Refuse to honor guardian/conservator
Appointment & reporting requirements
Not burdensome
Funds Requirements
All to be used for beneficiary
No commingling with other funds (e.g., trust)
However, could use joint tenancy to avoid probate