1. Introduction to Public Benefits law

2. Public Benefits Programs
Benefits Administered by the Social Security Administration (SSA)
Supplement Security Income (SSI or Title XVI)
Social Security Disability Income (SSDI or Title II)
Regs are at 20 CFR 404 and 416
POMS online
Benefits Administered by the Illinois Department of Human Services (DHS)
SNAP (Food Stamps)
TANF (Cash assistance)
Medicaid (“Medical Card”)
Refer to Illinois Admin Code, Online DHS Policy Manual

3. Two Basic Types of Social Security
Supplemental Security Income (SSI)
Safety net, means-based program
Disabled individuals, kids
$733/mo standard benefit; $1,100 for a couple
Gets check on the 1st of month
Retirement, Survivors, and Disability Insurance
Social Security Disability Insurance (SSDI/DI)
Amount based on work history/taxes paid into system
Spouses, children, disabled adult children, parents can also be paid based on disabled or deceased worker’s record
Gets check on day other than 1st of month
Retirement
It’s Important to Know the Difference!
When in doubt: ask the monthly amount, check the notice

4. Applying for SSI/SSDI Benefits
Initial Application (at local Social Security office or On-line) – paper review, usually denied
Reconsideration
60 days (+ 5 for mailing)
Paper review, usually denied
Administrative Law Judge Hearing
Best chance for success if you have good medical documentation, comply with your treatment, and provide your records to SSA
Appeals Council – 60 days, Federal Court – 60 days

5. Common Issues with Social Security Cases
Cessation of Benefits for “no longer disabled”
Overpayment/recoupment of benefits
Reduction in benefit amount due to income
Termination of benefits for income or assets

6. “SSA Says I’m No Longer Disabled”
All cases are given review date (continuing disability review or “CDR”)
If denied, same appeal rights (recon, ALJ…)
60 days to appeal each time, extra “Hearing Officer review”
Appeal within 10 days to get continuing benefits
See 20 CFR §§ ,

7. Examples
Client with severe mental illness, lapses in treatment and compliance with meds
Child born premature, now has ADHD
Disability evolved over time, but not medically improved

8. Overpayment Causes SSI Social Security Disability
Failure to report household income/composition
Being over-resourced (more than $2,000 in assets)
Reporting changes, but SSA fails to act on them
Pursuing, then losing your appeal
Social Security Disability
Failure to report earnings or some lump-sum income

9. Can you work and get benefits?
SSDI – Yes, but the work rules change over time and benefits are either
turned “on” or “off”
The rules are detailed and complex, but basically, you have a bit more than 3 years (starting the first
day of work) to test your ability to work. In general, for every month you earn over $1,090,
your benefits will be turned off. After 36 months, if you earn over $1090, your benefits will stop
completely.
See 20 CFR § et.seq.
SSI – Yes, but benefits reduced
Work incentive – roughly half of earnings are counted against your benefit
No time limits as in SSDI, but if you work more than 12 months over SGA, your disability may be reassessed.
See 20 CFR § et.seq.
Bottom Line for Both Programs:
YOU MUST REPORT YOUR WORK TO AVOID AN OVERPAYEMENT, AND YOU SHOULD APPEAL ANY ADVERSE DECISION THAT YOU DISAGREE WITH AS SOON AS POSSIBLE
– PREFERABLY WITHIN 10 DAYS

10. What about other income and assets?
SSDI is insurance program – only earnings, workers’ compensation, and some pensions affect benefit. No asset limit
SSI - all income will have an effect on benefits in some way. Money that is “un-earned” or given to you will reduce your benefits dollar for dollar. $2,000 asset limit for a single person, some assets are excluded (the home you live in, 1 car, etc.)

11. Example SSI – Brain Tumor case
Asset went unreported, but client did not have knowledge of the asset until SSA brought it to his attention

12. Overpayments – What can you do?
Appeals
Challenge allegation of overpayment
Standard 60 day appeal timeframe
Waiver
Not challenging allegation of overpayment
Establish: 1) not my fault; and 2) cannot afford to pay it back
Can be requested at any time
Waiver request suspends recoupment until final decision reached at local office
See 20 CFR §§ , et.seq.

13. Recoupment SSI – recoupment limited to 10% of benefit
Can request different repayment plan (as low as $10/month)
SSDI – SSA initially recoups 100% of benefit

14. Termination of Benefits (Other than Disability Reviews)
SSI cases
Benefits may be reduced or stopped for earned or unearned income in the household (including income of a spouse that client is living with, or income of a parent if this is a children’s SSI case)
Benefits will be stopped if over-asset ($2,000 for one, $3,000 for disabled couple) or if “transferred” assets for less than market value
SSDI cases
Benefits may be reduced or stopped for not reporting earnings, workers compensation benefits, or some pensions

15. Examples SSI – A Home in Togo?
Benefits ceased because of bad asset determination
SSDI – Unreported Work that is Over the Limit
Benefits ceased because time period for earning over the limit was expired, but work was actually that of someone who stole ID

16. Termination of Benefits – What can you do?
If a client’s benefits have been reduced or stopped:
Client has 60 days (+ 5 for mailing) from the date of their notice informing them of the change to file an appeal
SSI CLIENTS SHOULD FILE WITHIN 10 DAYS for continuing benefits (until the local office makes a final decision after the informal conference). If they are beyond 10 days, they should still ask!
Clients on SSI will then be scheduled for an “informal conference” at which time they can present their evidence regarding income, assets, etc. (SSDI clients don’t have this option)
If appeal denied after a personal conference, client has 65 days to request an ALJ hearing (also done at local office)

17. IL Dep’t of Human Services Assistance aka “Public Aid”
Medicaid
Cash Assistance (“TANF”)
Food Stamps (“SNAP”)

18. Medicaid
Single adults between 19 and 64 without disabilities can now get Medicaid! (up to 138% FPL)
Children under 19 and custodial parents get Medicaid (up to 200% FPL)
Disabled Adults and those 65+ get “traditional” Medicaid
financial eligibility up100% FPL and $2000 asset limit
If over the income or asset limit, you “spend down” your income/asset each month to get covered

19. Common Issues with Medicaid Cases
“Redetermination” problems
Eligibility for the program is periodically redetermined. Clients must cooperate, turn in necessary documents, etc. If fail to do so on time, benefits will cease.
Termination of benefits
Likely for exceeding income limits
Access to care issues
Restrictions on some medications – 4 prescription limit
Pre-approval problems
Managed care issues

20. Cash Assistance (TANF)
Temporary Assistance for Needy Families
Kids under 18
Income test (no asset limit)
Parent with 2 kids gets $432/month
60 month limit, with exceptions
Disabled with pending SSI case
Domestic Violence
Caring for disabled family member
Work Requirement, with exceptions
Medical barrier
Domestic violence
Education Programs (GED, ESL, bachelors)
Mental health or drug treatment programs

21. Common Issues with TANF Cases
“Redetermination” problems
Eligibility for each program is periodically redetermined. Clients must cooperate, turn in necessary documents, etc. If fail to do so on time, benefits will cease.
Change in benefit amount
Usually based on change in income or household composition (ie – if one person moves out of household, or child turns 19)
DHS often doesn’t know who is in the household, which leads to errors (ex: “spouse in the house” cases)
Termination of benefits
Sanctioned for not complying with work activities without good cause (called a Responsibility and Service Plan, or “RSP”). Ist stage – reduction of benefits is 50% until cooperate, then 50% for at least 3 months, then 100% for at least three months
No longer “categorically” eligible (exceeding the 60 month clock, or no longer caring for minor relative children)
Overpayment/recoupment of benefits
Unlike Social Security cases, no “waiver” process. Only appeal available.
Recoupment – 10%, not to exceed $75/month

22. Food Stamps (SNAP)
Amount received is based on income and expenses (rent, utilities, and medical expenses) – no asset test
Household – buy and prepare food together
Issued on a “Link” card
Emergency Benefits – within 5 days if income and liquid assets less than your rent and utilities
U.S. Citizen children are always eligible, even if living in mixed-eligibility household

23. Common Issues with SNAP Cases
“Redetermination” problems
Eligibility for food stamps is periodically redetermined. Clients must cooperate, turn in necessary documents, etc. If fail to do so on time, benefits will cease.
Change in benefit amount
Usually based on change in income or household composition (ie – if one person moves out of household, food stamps will decrease)
Overpayment/recoupment of benefits
Unlike Social Security cases, no “waiver” process. Only appeal available.
Maximum recoupment for overpayments that were not due to fraud is 10%
Statute of limitations – 12 months for “agency error”, 60 months for anything else
Intentional program violations
IPVs usually result when a client used their SNAP benefits at a grocery store that was determined to be guilty of fraud
Automatic right to a hearing – do not need to appeal
Sanctions administered if you admit to fraud, are found guilty of fraud, or even waive your right to a hearing

24. Appeals for IDHS 60 days for cash or medical 90 days for Food Stamps
For IPV cases, no need to appeal – a hearing is given automatically. Client should be told NOT to send in “waiver of hearing” form they will receive in the mail.
File before “date of change” on notice – get benefits pending the appeal
Appeals can take months – many can be resolved administratively SO file new application too
File by phone – or 312/ , get confirmation number

25. Examples Medicaid TANF Food Stamps – Prior approval issues, pain meds
Requiring disabled individual to work, or insisting on impossible job locations
Food Stamps –
“Spouse in the House”

26. TIPS FOR WORKING WITH ANY AGENCY
Go in person (if you have time to wait, it’s the best way to get your questions answered)
Keep copies (of all records you turn in, and of everything you file).
Check for dates (copies of appeals won’t help you to proof you appealed on time unless they are dated)
Get receipts (insist of a file-stamps, a receipt, or other confirmation that you: showed up, turned in the required documents, or did whatever else you were instructed to do. If you can’t go in, think fax confirmation, certified mail, etc.)

27. TIPS FOR WORKING WITH ANY AGENCY
Appeal Deadlines are VERY STRICT
you must meet them to keep your case alive. If you miss a deadline, you have to prove you had “good cause” for missing it – a very high standard
REPORT REPORT REPORT!
You must report your changes in income or assets (and keep proof that you reported) in order to avoid an overpayment