20 CFR 416.1160(c) and 416.1163
The general issue before the Appeals Council is whether the claimant is eligible for SSI benefits. This depends upon whether her countable income exceeds the statutory limit. Specifically at issue is whether the amount of income deemed to the claimant from her husband, who lives with her and is ineligible for SSI benefits, may be reduced by an "allocation" for their three grandchildren, who are under age 18, are ineligible for SSI benefits, and live in their household. Whether an allocation may be made for the grandchildren depends on the definition of the term "ineligible child."
The claimant, born on December 17, 1926, filed an application for SSI benefits on November 22, 1978. The claimant was found to be disabled in a prior hearing decision issued no September 27, 1979. The case was then referred to SSA for a determination as to whether the claimant met the nondisability requirements for eligibility. It was determined initially and upon reconsideration that the income deemed to the claimant from her husband was in excess of the statutory limit and thus precluded her eligibility for SSI benefits. In determining the amount of income deemed to the claimant, her husband's income was not reduced by an allocation for the grandchildren living in their household because they were not her natural or adopted children or the natural or adopted children of her husband.
In his decision, the ALJ found, however, that an allocation could be made for the claimant's grandchildren. In reaching this conclusion, the ALJ reasoned that the term "ineligible child" was defined by age, rather than by age and relationship. The ALJ further found that even if the claimant's grandchildren were not considered "ineligible children" for deeming purposes by SSA, it would be inequitable not to allow an allocation for them as they were essentially dependent upon the claimant's husband for support. He cited section 1614(f)(1) of the Act which provides that all income and resources of an individual's ineligible spouse who lives in the same household must be deemed to the individual "except to the extent determined by the Secretary to be inequitable under the circumstances." The ALJ referred the case back to SSA for a recomputation of the claimant's deemed income. His decision would have the effect of substantially reducing the amount of income deemed to the claimant from her husband.
Section 1614(c) of the Act defines the term "child" as "an individual who is neither married nor (as determined by the Secretary) the head of a household, and who is (1) under the age of eighteen, or (2) under the age of twenty-two and (as determined by the Secretary) a student regularly attending a school, college, or university, or a course of vocational or technical training designed to prepare him for gainful employment."
Section 416.1160(c) of Regulations No. 16 provides, in pertinent part, that for deeming purposes -- ". . . 'Ineligible child' means your natural child, adopted child, or the child of your spouse . . . who is under age 21, lives in the same household with you, and is not eligible for SSI benefits. . . 'Ineligible spouse' means someone who lives with you as your husband or wife and is not eligible for SSI benefits."
Section 416.1163 of Regulations No. 16 explains how income is deemed to a claimant from his or her ineligible spouse. Paragraph (b) of that section provides that, before income is deemed to a claimant from his or her ineligible spouse, it is reduced by an allocation for ineligible children in the household to help meet their needs.
The general definition of the term "child," as found in section 1614(c) of the Act, does not contain any specific relationship criteria. Nor did the regulations that were in effect at the time of the ALJ's decision contain any relationship criteria in defining the term. After the ALJ's decision was issued, however, SSA published, in final form, new regulations on income and deeming under the title XVI of the Act. The preamble to those regulations, published in the Federal Register on October 3, 1980 at 45 FR 65541, indicated that the revisions were intended to reorganize, clarify, and made the regulations easier for the public to understand. As indicated above, § 416.1160(c) of the revised regulations includes a specific definition of the term "ineligible child" for deeming purposes, which was not included in the previous regulations.
The revised regulations clearly indicate that an allocation is made only for an individual's natural child, adopted child, or the child of the individual's spouse. There are no provisions for an allocation for grandchildren. Because these new regulations were meant to clarify what had been intended under the previous regulations, the Appeals Council believes they must be applied in this case. Thus, an allocation cannot be made for the claimant's grandchildren for the purpose of reducing the amount of income deemed to her from her husband.
The Appeals Council is of the opinion that Congress did not intend the specific amount of deemed income to be determined by the equities of each individual case. Such a broad standard would be impossible to administer in an effective manner. The Council believes that the formulas for deeming set forth in §§ 416.1160 through 416.1169, inclusive, of Regulations No. 16 constitute the Secretary's determination of the extent to which it is inequitable to deem income. Consequently, the claimant was ineligible for SSI benefits because the income deemed to her from her husband exceeded the statutory limit.
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