2008 Annual Report of the SSI Program

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This section presents a brief history and comprehensive description of the SSI program. This section also includes information on the administration of the program and coordination with other programs.
Federal entitlement programs for the aged, blind, or disabled have their roots in the original Social Secu­rity Act of 1935. That Act established an old-age social insurance program to be administered by the Fed­eral Government and an old-age means-tested assistance program to be administered by the States. Similar programs for the blind or disabled were added to the Act in later years. Means-tested assistance provided a safety net for individuals who were either ineligible for Social Security or whose benefits could not pro­vide a basic level of income.
This means-tested assistance comprised three separate programsOld-Age Assistance (OAA), Aid to the Blind (AB), and Aid to the Permanently and Totally Disabled (APTD). Despite substantial Federal financ­ing, these programs were essentially State programs. Federal law established only broad guidelines for assistance. The Federal Government provided matching funds to support whatever payment levels the States established, with no maximum or minimum standards. Consequently, each State was responsible for setting its own standards for determining who would get assistance and how much they would receive.
Beginning in the early 1960s, this State-operated, Federally-assisted welfare system drew criticism that was directed at the “crazy quilt” eligibility requirements and payment levels. Other criticism centered on specific requirements, such as lien laws and provisions that required certain relatives to bear responsibility for the maintenance of needy family members.
Responding to these concerns, Congress passed and the President approved the SSI program in 1972, reversing the Federal and State roles with regard to adult assistance. Under the new arrangement, SSI would provide a uniform Federal income floor while optional State programs supplemented that floor. The new program was historic in that it shifted from the States to the Federal Government the responsibility for determining who would receive assistance and how much assistance they would receive.
The main objective of the SSI program is to provide the basic financial support of needy aged, blind, or disabled individuals. Congress designed the SSI program based on the following principles:
Incentives and opportunities for those recipients able to work or to be rehabilitated that would enable them to reduce their dependency on public assistance;
Inducements to encourage States to provide supplementation of the basic Federal benefit and protec­tion for former recipients of State adult assistance programs who were converted to the SSI program; and
Prior to the SSI program, the eligibility of aged, blind, or disabled individuals for Federally-funded adult assistance depended on the State in which they lived. Benefit amounts varied from State to State. The SSI program replaced the State-run programs with a national program with uniform standards and objective eligibility criteria. These standards include:
A uniform limitation on the dollar amount or value of income and resources that an individual can have and still qualify for SSI assistance. The countable income limits for individuals and couples are equal to their respective Federal benefit rates2 and hence are increased annually according to changes in the cost of living. Effective January 1, 2008, the Federal benefit rate is $637 a month for individu­als and $956 a month for couples. The resource limit is $2,000 in countable resources for individuals and $3,000 for couples.
A uniform definition of disability and blindness. The definitions for individuals age 18 or older are the same as those used for the Social Security Disability Insurance (SSDI) program. In order to be considered disabled, an individual must have a medically determinable physical or mental impairment which is expected to last or has lasted at least 12 continuous months or is expected to result in death and (1) if age 18 or older, prevents him/her from doing any substantial gainful activity3 or (2) if under age 18, results in marked and severe functional limitations. However, individuals for whom addiction to drugs or alcoholism is a contributing factor material to the determination of their disabilities are not eligible for benefits. In order to be considered blind, an individual must have central visual acuity of 20/200 or less in the better eye with the use of a correcting lens or have tunnel vision of 20 degrees or less.
Uniform standards for citizenship and residency. In order to be eligible for SSI, an individual must  be  a citizen (or national) of the United States, an American Indian born in Canada who  is  under  section  289  of  the  Immigration  and  Nationality  Act (INA), an American Indian born outside the United States  who is a member of a Federally recognized Indian tribe under sec­tion 4(e) of the Indian Self-Determination and Education Assistance Act, a noncitizen who was receiving SSI benefits on August 22, 1996, or be a qualified alien in one of the following categories:
Refugees (eligibility generally limited to the 7-year period after their arrival in the United States);
Asylees (eligibility generally limited to the 7-year period after the date they are granted asylum);
Noncitizens who have had their deportations withheld under section 243(h) of the INA as in effect prior to April 1, 1997, or who have had their removals withheld under section 241(b)(3) of the INA (eligibility generally limited to the 7-year period after the date that deportation or removal is withheld);
Cuban and Haitian entrants as defined by Federal statute, including: 1) section 501(e) of the Ref­ugee Education Assistance Act of 1980; 2) former parolees and other aliens who became resi­dents under the Cuban Adjustment Act of 1966; 3) aliens who became permanent residents under the Nicaraguan and Central American Relief Act; and 4) aliens who became permanent residents under the Haitian Refugee Immigration Fairness Act (eligibility for these categories is generally limited to the 7-year period after the date that entrant status is granted);
Amerasian immigrants admitted pursuant to section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988, and subsequent amendments (eligi­bility generally limited to the 7-year period after their arrival in the United States);
Qualified alien status includes noncitizens (or their parents or children) who have been battered or subjected to extreme cruelty in the United States by a spouse or parent (or a member of the spouse’s or parent’s family) with whom they live, and who have an approved petition, or have a petition pend­ing, setting forth a prima facie case for adjustment of their immigration status. A complete list of non­citizens who are considered qualified aliens can be found in the Glossary under “Qualified Alien”. However, to be eligible to receive SSI benefits, these noncitizens also must be in one of the categories listed above.
In addition, certain noncitizens may be eligible for SSI regardless of their immigration status if they have been determined to be victims of trafficking in persons in the United States4. Such individuals are treated for SSI purposes as refugees. That is, they are eligible for SSI for 7 years after a determina­tion is made that they are trafficking victims.
Finally, certain Iraqi or Afghan noncitizens granted special immigrant status under emergency condi­tions are also treated as refugees for SSI purposes. Unlike trafficking victims, however, Iraqi and Afghan noncitizen eligibility is time-limited to 6 months (or 8 months for certain Iraqis providing assistance to the U.S. Government).
In addition to having to be a U.S. citizen (or national) or in one of the potentially eligible noncitizen categories, an individual must reside in the 50 States, the District of Columbia or the Northern Mari­ana Islands. An individual also must be physically present in the United States5 for 30 consecutive days, if he/she had been outside of the United States for 30 or more consecutive days. There are two exceptions to the residency and physical presence requirements:
Blind or disabled children who are citizens of the United States may continue to be eligible for payments if they are living outside the United States with a parent who is on duty as a member of the U.S. Armed Forces. This exception also applies to blind and disabled children of military personnel who are born overseas, become blind or disabled overseas or applied for SSI benefits while overseas.
Students studying abroad for not more than 1 year also may continue to be eligible for payments if the studies are sponsored by a U.S. educational institution but could not be conducted in the United States.
As a means-tested program, SSI takes into account all income and resources that an individual has or can access. The amount of an individual’s countable income and resources are the measure of his/her need for assistance.
1. Income
The amount of an individual’s income is used to determine both eligibility for, and the amount of, his/her SSI benefit. As countable income increases, an individual’s SSI benefit amount decreases. Generally, inel­igibility for SSI occurs when countable income equals the Federal benefit rate plus the amount of applica­ble Federally-administered State supplementary payment (State supplementation is discussed later).
The monthly Federal benefit rate6 is reduced dollar-for-dollar by the amount of the individual’s “count­able” income—i.e., income less all applicable exclusions. Countable income is determined on a calendar month basis. The result of this computation determines SSI eligibility and the amount of the benefit pay­able. These benefit rates are adjusted annually (in January) to reflect changes in the cost of living.
When an individual lives in the household of another and receives support and maintenance in kind (i.e., generally room and board) from the householder, the Federal SSI benefit rate is reduced by one-third in lieu of counting the actual value of the support and maintenance as unearned income. The value of food or shelter-related items the individual receives in kind from persons other than the householder (including in-kind assistance from outside the household in which he/she lives) is counted as unearned income.7 How­ever, the amount that is countable is limited to an amount equal to one-third of the applicable Federal ben­efit rate plus $20.
SSI law defines two kinds of income—earned and unearned. Earned income is wages, net earnings from self-employment, remuneration for work in a sheltered workshop, royalties on published work, and hono­raria for services. All other income is unearned including, for example, Social Security benefits, other pen­sions, and unemployment compensation. The distinction between earned and unearned income is significant because different exclusions apply to each type of income.
However, not everything an individual receives is considered to be income. Generally, if the item received is not food or shelter or cannot be used to obtain food or shelter, it will not be considered as income. For example, if someone pays an individual’s medical bills, or offers free medical care, or if the individual receives money from a social services agency that is a repayment of an amount he/she previously spent, that value is not considered income to the individual. In addition, some items that are considered to be income are excluded when determining the amount of an individual’s benefit.
Income Exclusions8
The principal earned income exclusions are:
Impairment-related work expenses of the disabled and work expenses of the blind;
Infrequent or irregularly received income (the first $30 received in a quarter).
The principal unearned income exclusions are:
2. Resources
The value of an individual’s resources is used to determine whether he/she is eligible for SSI in any given month. SSI law states that eligibility is restricted to individuals who have countable resources, determined monthly, that do not exceed $2,000 ($3,000 for a couple). The law does not define what resources are, but does stipulate what items are not considered resources.
Regulations stipulate that a resource is cash or other liquid asset or any real or personal property that indi­viduals (or their spouses) own and could convert to cash to be used for their support and maintenance. This definition is consistent with the general philosophy of the SSI program that only items that can be used for an individual’s food or shelter should be used in determining his/her eligibility and benefit amount. Not all resources an individual owns are counted. The value of an item may be totally excluded or counted only to the extent that its value exceeds specified limits.
If an individual disposes of resources at less than fair market value within the 36-month period prior to his/her application for SSI or at any time thereafter, he/she may be penalized. The penalty is a loss of ben­efits for a number of months (up to a 36-month maximum) obtained by dividing the uncompensated value of disposed-of-resources by the Federal benefit rate plus the maximum State supplementary payment, if any, applicable to the individual’s living arrangement. The penalty does not apply if, among other things, the individual can show that the resources were disposed of exclusively for a purpose other than establish­ing SSI eligibility.
Resource Exclusions10
The principal resource exclusions are:
Amounts deposited into either a Temporary Assistance for Needy Families (TANF) or “Assets for Independence Act” individual development account (IDA), including matching funds, and interest earned on such amounts.
3. Filing for Other Benefits
As the “program of last resort,” SSI benefits are provided to eligible individuals only to the extent that their needs are not met by other sources. That is, after evaluating all other income and resources, SSI pays what is necessary to bring an individual to the statutorily prescribed income “floor.” In keeping with this principle, SSI law requires that SSI applicants and recipients file for other payments for which they may be eligible, such as annuities, pensions, retirement or disability benefits, workers’ compensation, and unemployment insurance benefits.
SSA must provide an individual with written notice of potential eligibility for other benefits and of the requirement to take all appropriate steps to pursue these benefits. The individual has 30 days from receipt of the notice to file for the benefits involved.
4. Eligibility Issues for Residents of Public Institutions or Medical Facilities
State and local governments—rather than the Federal Government—traditionally have taken the financial responsibility for residents of their public institutions. The SSI program continues this long-standing pub­lic assistance policy. People who are residents of public institutions for a full calendar month are generally ineligible for SSI unless one of the following exceptions applies:
The public institution is a medical treatment facility and Medicaid pays more than 50 percent of the cost of care, or in the case of a child under age 18, Medicaid and/or private health insurance pays more than 50 percent of the cost of care—in these situations, the SSI payment is limited to $30;
The recipient was eligible under section 1619(a) or (b)13 for the month preceding the first full month in the public institution and is permitted by the institution to retain any benefits (payable for up to 2 months); or
A physician certifies that the recipient’s stay in a medical facility is likely not to exceed 3 months and continued SSI eligibility is needed to maintain and provide for the expenses of the home to which the individual will return. In these situations, the recipient may continue to receive the full benefit for any of the first 3 full months of medical confinement if all other conditions for payment are met.
5. Personal Needs Allowance
When individuals enter medical treatment facilities in which more than half of the bill is paid by the Med­icaid program, their monthly Federal payment standard is generally reduced to $30, beginning with the first full calendar month they are in the facility. In the case of an individual under age 18, the $30 payment standard is also applicable if more than half of the bill is paid by private insurance or a combination of Medicaid and private insurance. The theory behind this provision is that the individual’s basic needs are being met by the medical facility. In these cases, the SSI program provides up to $30 a month, which is intended to take care of small comfort items not provided by the institution.
6. Deeming
In certain situations the income and resources of others are counted in determining whether an individual’s income and resources fall below the levels established by law. This process is called “deeming” and is applied in cases where an eligible individual lives with an ineligible spouse, an eligible child lives with an ineligible parent, or an eligible noncitizen has a sponsor.14 In concept, the practice takes into account the responsibility of the spouse, parent, or sponsor to provide for the basic needs of the eligible individual.
a. Spouse-to-Spouse Deeming
When an eligible individual lives in the same household with a spouse who is not eligible for SSI, the inel­igible spouse’s income and resources are deemed to be available to the eligible individual. In determining the amount of income and resources available to the eligible individual, all applicable exclusions are used. In addition, a living allowance is provided for the ineligible spouse, as well as any ineligible children under age 1815 living in the household. The allowance reduces the amount of income to be deemed. Spouse-to-spouse deeming is intended to result in the same amount of income available to the couple as would be available if both members of the couple were aged, blind, or disabled and eligible for SSI.
Deeming does not apply when the eligible individual is not living in the same household as the ineligible spouse. However, if the ineligible spouse’s absence is temporary or is due solely to an active duty assign­ment as a member of the U.S. Armed Forces, deeming would continue to apply.
b. Parent-to-Child Deeming
A child under age 18 is subject to deeming from an ineligible natural or adoptive parent (and that parent’s spouse, if any) living in the same household. Deeming does not apply if a child lives in a household with only the spouse of a parent (i.e., a stepparent) and the natural or adoptive parent has permanently left the household. Certain amounts of the parent’s income are excluded, living allowances are provided for the parent(s) and an allocation is set aside for each ineligible child under age 18 who is living in the house­hold. Deeming to a child would continue if the parent is absent from the household but the absence is tem­porary or is due solely to active duty assignment as a member of the U.S. Armed Forces. If a child lives in a household in which all members are receiving public assistance benefits, that child is not considered to be receiving any support and deeming would not apply.
c. Sponsor-to-Alien Deeming
The income and resources of noncitizens are deemed to include those of their sponsors. The way the income and resources are deemed and the length of the deeming period depend on whether the sponsor signed a legally enforceable affidavit of support16 or the previous version of the affidavit. Generally, indi­viduals who entered the country before 1998 did so under the old version of the affidavit.17
Under the old version of the affidavit, deeming of the sponsor’s income and resources lasts until the non­citizen has been in the United States for 3 years.18 Living allowances equal to the Federal benefit rate are provided for the sponsor, and allowances equal to one-half of the Federal benefit rate are provided for each of the sponsor’s dependents. Allowances are also provided for the sponsor and his/her family members in determining deemed resources. These allowances reduce the amount of the sponsor’s income and resources deemed to the noncitizen.
For noncitizens admitted into the United States under a legally enforceable affidavit of support, deeming generally applies until the noncitizen becomes a U.S. citizen. Deeming ends before citizenship if the non­citizen has earned, or can be credited with, 40 qualifying quarters of earnings. Children and spouses of workers may be credited with quarters earned by the worker. A quarter otherwise earned after 1996 does not count as one of the required 40 if the noncitizen or worker received Federal means-tested public bene­fits during the relevant period.
Also for this group of noncitizens, deeming does not apply for specified periods if the noncitizens or their children or parents have been battered or subjected to extreme cruelty while in the United States or if sponsors leave the noncitizens indigent by not providing them with sufficient support.
SSI benefits provide a basic level of assistance for individuals who are blind or disabled with limited earn­ings ability due to their impairments. Nonetheless, for recipients who want to work, the SSI program is designed to encourage and support their work attempts in order to help them achieve greater degrees of independence. The SSI program includes a number of work incentive provisions that enable recipients who are blind or disabled to work and retain benefits or to increase their levels of work activity without the loss of SSI disability status or Medicaid. These incentives provide higher amounts of income or resource exclusions as recognition of the expenses associated with working or as inducements to seek rehabilitation services and support for work efforts.
The SSI program also includes provisions to help disabled beneficiaries obtain vocational rehabilitation and employment support services. These provisions were revised by legislation establishing the Ticket to Work program, which is described in section III.E.7.
1. Earned Income Exclusion
The first $65 ($85 if the individual has no income other than earnings) of any monthly earned income plus one-half of remaining earnings are excluded for SSI benefit computation purposes. This general earned income exclusion is intended to help offset expenses incurred when working. It assures that SSI recipients who are working will be rewarded for their efforts by having greater total income than those who do not work.
2. Impairment-Related Work Expense Exclusion
The costs of certain impairment-related services and items that a disabled (but not blind) individual needs in order to work are excluded from earned income in determining SSI eligibility and benefit amounts.
In calculating these expenses, amounts equal to the costs of certain attendant care services, medical devices, equipment, prostheses, vehicle modifications, residential modifications to accommodate wheel­chairs and similar items and services are deductible from earnings. The costs of routine drugs and routine medical services are not deductible unless these drugs and services are necessary to control the disabling condition. They are paid for by the individual, and they are not reimbursable from another source such as Medicaid.
3. Work Expenses of the Blind Exclusion
Any earned income by a blind individual that is used to meet expenses needed to earn that income is excluded from earned income in determining SSI eligibility and benefit amounts. A deductible expense need not be directly related to the worker’s blindness; it need only be an ordinary and necessary work expense of the worker.
Some frequently excluded work expenses include transportation to and from work, meals consumed dur­ing work hours, job equipment, licenses, income or FICA taxes, and costs of job training.
4. Student Earned Income Exclusion
The student earned income exclusion is an additional exclusion for an individual who is under age 22 and regularly attending school. It is intended to help defray the cost of educational training. Under current reg­ulations, up to $1,550 of earned income per month but no more than $6,240 per year may be excluded.19
5. Plan to Achieve Self-Support
A plan to achieve self-support (PASS) allows a disabled or blind individual to set aside income and resources to get a specific type of job or to start a business. This may involve setting aside funds for educa­tion or vocational training. Funds can even be set aside to purchase work-related equipment or pay for transportation related to the work goal. The income and resources that are set aside are excluded under the SSI income and resources tests.
The individual must have a feasible work goal, a specific savings or spending plan, and must provide for a clearly identifiable accounting for the funds which are set aside. The PASS must be approved by SSA. The individual must then follow the plan and negotiate revisions as needed. SSA monitors the plans once approved by reviewing them periodically to ensure the individual’s progress towards attaining the work goal.
6. Special Provisions for Disabled People Who Work
This work incentive generally is referred to by its section number in the Social Security Act, section 1619. Under section 1619(a), disabled individuals who would cease to be eligible because of earnings over the substantial gainful activity level can receive special cash benefits as long as they:
In many States, being a recipient of the special benefit permits the individual to be eligible for Medicaid benefits.
Under section 1619(b), “SSI recipient” status for Medicaid eligibility purposes also is provided to individ­uals:
Whose earnings preclude any SSI payment but are not sufficient to provide a reasonable equivalent of the SSI, social services, and Medicaid benefits that the individuals would have in the absence of earn­ings; and
To qualify for extended Medicaid coverage under section 1619(b) an individual must:
Have received a regular SSI cash payment in a previous month within the current period of eligibility. (In some States, the individual must have qualified for Medicaid the month preceding the first month of 1619 eligibility.)
In determining whether individuals’ earnings are not sufficient to provide them with the equivalent bene­fits they would be eligible for if they stopped working, their earnings are compared to a threshold amount for their State of residence. Section 1619(b) status continues if the earnings are at or below the threshold. If earnings exceed the State threshold, an individualized assessment of the need for Medicaid is made and 1619(b) status may continue.
7. Vocational Rehabilitation/Ticket to Work Program
Since the beginning of the SSI program, State Vocational Rehabilitation (VR) agencies have provided ser­vices to those blind or disabled SSI recipients whom they accepted as clients. SSA has traditionally reim­bursed the VR agency for services provided in situations where the services result in the individual’s working at the substantial gainful activity level for a continuous period of 9 months, and in certain other limited situations.
The Ticket to Work and Work Incentives Improvement Act of 1999 (“the Ticket legislation”) established a Ticket to Work and Self-Sufficiency program (“Ticket to Work program”) under which a blind or disabled beneficiary may obtain vocational rehabilitation, employment and other support services from a qualified private or public provider referred to as an “employment network” (EN), or from a State VR agency. In addition, the Ticket legislation provided for a new procedure for compensating ENs under an outcome or outcome-milestone payment system20. By expanding the pool of providers and giving the providers incen­tives for achieving success, this program seeks to expand a disabled beneficiary’s access to these services in order to assist the beneficiary in finding, entering, and retaining employment and reducing his/her dependence on cash benefits. Regulations issued by the Commissioner became effective January 2002.
After being phased in beginning in 2002, the Ticket to Work program has been in operation nationwide since November 2003. Under this program SSA provides eligible individuals who receive SSI benefits due to blindness or disability with a Ticket to Work document (“ticket”). These individuals may use the ticket to obtain the vocational rehabilitation services, employment services and other support services needed to return to work, or go to work for the first time. The Ticket to Work program provides that as long as the beneficiary is “using a ticket” as defined by the Commissioner, SSA will not initiate a continuing disabil­ity review to determine whether the beneficiary has medically improved. Therefore the beneficiary’s efforts under the Ticket to Work program to increase self-sufficiency will not be interrupted by a decision that his/her medical condition has improved. Individuals not eligible for a ticket may still request services from a State VR agency, which must decide whether they are eligible for services under the Rehabilitation Act of 1973.
ENs and State VR agencies are the only providers of VR services to disabled SSI recipients that can be compensated for those services by SSA. All ENs are compensated through the outcome-based system. State VR agencies are compensated under the traditional VR reimbursement system for those cases where they have not elected to participate as an EN. Any services provided by the State VR agencies to SSI recipients who are not yet eligible for a ticket will be compensated under the traditional VR reimburse­ment system.
Individuals receiving SSI benefits who improve medically and, therefore, are no longer considered dis­abled or blind can continue to receive SSI benefits if they are actively participating in the Ticket to Work program, or another approved program of VR services, employment services, or other support services, and SSA determines that continuation or completion of the program will increase the likelihood that they will be permanently removed from the SSI rolls. SSI benefits and Medicaid generally continue until the approved program is completed or until the individual ceases to participate in the program.
In 2008, SSA revised the Ticket to Work regulations to enhance beneficiary choice and improve the effec­tiveness of the program.  The revisions extended the program to all adult SSDI and SSI blind or disabled beneficiaries, removed disincentives for Employment Networks to participate in the program, provided incentives for them to support beneficiaries through a more gradual return to work and positioned them to better support ongoing retention of employment.
8. Expedited Reinstatement
A disabled or blind individual whose eligibility for SSI payments ended because of earnings can request expedited reinstatement of his/her SSI benefits without filing a new application. To qualify for expedited reinstatement, the individual must make the request within 60 months after his/her eligibility ended and must have a disabling medical condition that: (1) is the same as (or related to) the disabling medical condi­tion that led to the previous period of eligibility and (2) prevents him/her from performing substantial gainful activity. In determining whether the individual is disabled or blind, the medical improvement review standard is applied. Normal nonmedical requirements for SSI eligibility still apply.
An individual requesting expedited reinstatement may receive up to 6 months of provisional benefits while his/her request is pending. These benefits generally are not considered an overpayment if the request is denied. Provisional benefits may include Medicaid but do not include any State supplementary payments. Provisional benefits also may be received by the individual’s spouse at a couple’s rate if the spouse was previously eligible for SSI as a spouse.
The framers of the SSI program chose SSA to administer the SSI program because the basic system for paying monthly benefits to a large number of individuals was already in place in the form of the Social Security program, and SSA had a long-standing reputation for dealing with the public in a fair and humane manner.
1. Application Process
Individuals can apply for SSI benefits at any one of the approximately 1,300 SSA field offices around the country or through SSA teleservice centers. The claims process includes the application interview, the obtaining of necessary evidence and documentation, and the adjudication of the claim. Although many of the eligibility requirements for the Social Security program and the SSI program are different, the applica­tion process is very similar. Many times, individuals file for benefits under both programs at the same time.
SSA corroborates information provided by applicants for SSI through independent or collateral sources. Generally, the basic responsibility for obtaining evidence lies with the claimant, although SSA often gives advice and assistance on ways to obtain the needed information. Because of the special circumstances of the SSI population (for example, financial need, old age, or illness), SSA makes special efforts to assist claimants in obtaining the necessary proofs.
With regard to disability and blindness claims, SSA makes determinations of all of the nonmedical eligi­bility factors whereas each State’s Disability Determination Services (DDS) makes determinations of the medical eligibility factors.21
2. Determination of Eligibility for Benefits
SSI applications have no retroactivity and become effective in the month after the month of filing or the month after all eligibility requirements are met, whichever is later. Eligibility for benefits is determined on a current monthly basis. The amount of the monthly benefit generally is determined using income in the second month preceding the month for and in which the benefit is paid (a method called retrospective monthly accounting). However, at the start of a period of eligibility or re-eligibility, the benefits for the first and second months are both determined using the income received in the first month. (One-time, non­recurring income would only be counted in the month received.)
3. Payment of Benefits
SSI benefits generally are paid on the first day of each month. If the first of the month falls on a weekend or legal public holiday, benefit payments are delivered on the first working day preceding such Saturday, Sunday, or holiday. While SSA strongly encourages all SSI beneficiaries to receive their monthly benefits by direct deposit, benefit payments are also made by check if individuals do not wish to have their benefits sent directly to a financial institution. Monthly benefit payments include both the Federal SSI and State amounts if the recipient lives in a State in which SSA administers the State supplementary payment. (See section III.G.)
4. Ensuring Continued Eligibility for Benefits
SSI recipients are required to have their nonmedical eligibility factors redetermined periodically, generally every 1 to 6 years depending on their specific situation.
In addition to these nonmedical reviews, medical reviews are conducted on disabled or blind recipients in order to determine if they continue to be disabled or blind. For administrative efficiency the medical reviews are done most often on those disabled or blind recipients whose medical conditions are considered likely to improve. Medical reviews are required for disabled or blind recipients, for example, under the following circumstances:
Within 12 months after birth for recipients whose low birth weight is a contributing factor material to the determination of their disability, unless the Commissioner determines that the impairment is not expected to improve within 12 months of the child’s birth; and
Within 1 year after attainment of age 18 and using the adult eligibility criteria, for recipients whose eligibility for SSI benefits was established under the disabled child eligibility criteria.
Applicants and recipients are required to report events and changes of circumstances that may affect their SSI eligibility and benefit amounts. Such reports are required, for example, when an individual has a change in the amount of his/her income or resources, changes living arrangements, or leaves the United States. Failure or delay in submitting a required report can result in monetary penalties or ineligibility for SSI benefits.
The basic “failure to report” penalty is $25 for the first such failure or delay, $50 for the second such fail­ure or delay, and $100 for each subsequent failure or delay. However, in cases of fraud or false representa­tion of material facts, SSA’s Inspector General can assess civil monetary penalties in amounts as large as $5,000. SSA also has the authority to suspend eligibility to SSI benefits for periods of 6, 12, or 24 months.
Additionally, SSA may use an accelerated rate of overpayment recovery to encourage accurate reporting. Overpayments to SSI recipients are generally recovered by withholding from the monthly benefit an amount equal to 10 percent of the individual’s countable monthly income. For many recipients whose only income is SSI, this amounts to 10 percent of their monthly SSI payment. However, if SSA determines that misrepresentation or concealment of material information has occurred, 100 percent of the monthly SSI benefit may be subject to recovery.
5. Representative Payees
When SSI recipients are incapable of managing their benefits or are declared legally incompetent, SSA appoints representative payees for them, and their SSI benefits are sent to the representative payees. In many cases the representative payee is a spouse, a parent, or other close relative who will act in the recipi­ent’s best interest. In some cases, an SSA-approved organization may be appointed and some organiza­tions have been authorized by SSA to collect a fee from the benefit for acting as payee. The fee cannot exceed the lesser of 10 percent of the benefit amount or a specified amount ($35 a month in 2008 ($68 a month for disabled recipients who also have a drug addiction or alcoholism condition)).
Representative payees may use an SSI recipient’s benefit only for the use and benefit of the recipient and must account for all benefits received. Representative payees also are required to report any changes that may affect SSI recipients’ eligibility and payment amount and may be held liable for certain overpayments that occur. In cases in which a child is due a retroactive payment that exceeds six times the Federal benefit rate, the representative payee is required to establish a dedicated account at a financial institution to main­tain the retroactive payment. Expenditures from the account must be used primarily for certain expenses related to the child’s impairment.
6. Appeal Rights
Recipients must be informed in writing in advance of adverse actions SSA plans to take and must be given the opportunity to request that their benefits continue while a decision at the first level of appeal is pend­ing. Recipients can qualify for payment continuation when they appeal an adverse action within 10 days of receiving the advance notice. Slightly different rules apply to medical cessation cases. When appealing medical cessation cases, individuals may elect to have their benefits continued at both the reconsideration and hearing levels of appeal.
7. Fees for Attorneys and Non-attorney Representatives
At any time, an individual may appoint a representative in any dealings with the Social Security Adminis­tration. If such a representative is an attorney, he/she must be in good standing, have the right to practice law before a court, not be disqualified or suspended from acting as a representative in dealings with Social Security, and not be prohibited by any law from acting as a representative. If the individual is not an attor­ney, he/she must meet qualifications specified by the Commissioner (e.g., be of good character and able to provide valuable service to claimants).
A representative may charge and receive a fee for his/her services, but the Social Security Administration generally decides how much the fee will be. The representative may request authorization to charge and receive a fee under either the fee agreement or fee petition process. The fee that may be authorized under the fee agreement process is currently limited to the lesser of 25 percent of the retroactive payment or $5,300 23. There is no limit on the amount of the fee that may be authorized under the fee petition process; under this process a reasonable fee is authorized for specific services provided by the representative. A representative cannot charge or receive more than the fee amount authorized. The SSI program has tradi­tionally differed from the Social Security program in that amounts could not be withheld from an individ­ual’s SSI benefits to pay for attorney fees. SSI claimants were responsible for paying such fees directly to their attorneys. However, beginning February 28, 2005, direct payment of attorney fees has temporarily been extended to the SSI program under the same process and in the same manner as fees are directly paid in the Social Security program.24 As in the fee process for the Social Security program, attorneys are now charged an assessment of the smaller of 6.3 percent of each authorized fee withheld or $79. The flat-rate cap is adjusted based on annual cost-of-living adjustments, rounded down to the next lower dollar. In addi­tion, the Commissioner is conducting a nationwide demonstration project providing for extension of fee withholding for non-attorney representatives under Social Security and SSI. In order to be eligible to par­ticipate in the demonstration project, non-attorney representatives will have to meet specified prerequisites that include: having a bachelors’ degree or equivalent; having experience in representing claimants before SSA; having liability insurance; passing a criminal background check; and, passing an examination given by SSA that tests relevant knowledge of the Social Security Act and recent court decisions. The SSI fee withholding and direct payment of fees, and the demonstration project provisions, are temporary in that their authority ends after 5 years.
8. Advance Payments
The SSI program has provisions which help to respond to the immediate needs of new claimants. These procedures are in addition to State and local programs designed to help those in need, pending decisions on their SSI status.
a. Emergency Advance Payments
A new claimant who faces a financial emergency, and for whom there is a strong likelihood of being found eligible, may receive up to 1 month of SSI benefits, the Federal payment amount plus any applicable State supplement. The amount paid is recovered from later SSI payments (in full from the first payment or in increments over no more than a 6-month period, depending upon the circumstances). However, if the claim is subsequently not allowed because of not finding disability or blindness, repayment would be waived. If the claim is disallowed for other reasons, the amount paid would be an overpayment and pro­cessed as such.
b. Presumptive Disability or Blindness
Up to 6 months’ payments may be made to an individual applying for benefits based on disability or blind­ness when the available evidence reflects a high degree of probability that his/her impairment will meet the definition of disability or blindness and he/she is otherwise eligible. These payments are not consid­ered overpayments if the individual is later determined not to be disabled or blind. If the claim is disal­lowed for other reasons, the amount paid would be an overpayment and processed as such.
In designing the SSI program, Congress recognized that States25, in many instances, would want to provide a higher level of income maintenance than was available under the Federal program. At the same time States were given the option either to provide no supplementation to the Federal assistance payments or to supplement those payments based on their views of the needs of their citizens. Congress also mandated that States assure that their citizens would not receive lower benefits under the Federal program than they had under the former State program. The following paragraphs describe the various forms of State supple­mentation that currently exist. Table III.H1 summarizes State-specific participation in these programs as well as other programs requiring State and Federal coordination as discussed in section III.H.
1. Optional State Supplementary Payment Programs
For individuals who first became eligible for SSI in 1974 or later, each State could supplement Federal payments to whatever extent it found appropriate with respect to the needs of its citizens and resources of the State. Currently, 46 States have optional State supplementary payment programs.
Some States provide supplementary payments to all individuals eligible for SSI benefits, while others may limit them to certain SSI recipients such as the blind or residents of domiciliary-care facilities, or may extend them to persons ineligible for SSI because of excess income. States’ flexibility in setting supple­mentary payments, however, has been significantly restricted by the passalong provisions (see Passalong Provisions section below).
2. Mandatory State Supplementary Payment Programs
States are required26 to maintain the December 1973 income levels of individuals who were transferred from the former State adult assistance programs to the SSI program in 1974, except for Texas which has a constitutional bar against mandatory State supplementation. Over the years, many individuals who were converted to SSI from the State benefit rolls in December 1973 have died and others have had their incomes increased above the December 1973 level. As a result, there are few individuals who continue to receive mandatory State supplementary payments.
3. Administration of State Supplementary Payments
A State may administer its supplementary program or enter into an agreement under which SSA will make eligibility determinations and payments on behalf of the State. Under State administration, the State pays its own program benefits and absorbs the full administrative costs. Under Federal administration, States are required to pay SSA a $9.95 fee for each supplementary payment issued in fiscal year 2008. Fees are projected to rise in succeeding fiscal years, based on changes in the consumer price index.
States that administer their own supplementary payment programs to title XVI recipients establish their own eligibility criteria for the supplementary payments. States with Federally-administered programs may supplement the Federal benefit among a limited number of geographical and living arrangement variations for title XVI recipients.27
4. Passalong Provisions
When the SSI program began in 1974, Congress did not require States to maintain their efforts with regard to levels of State supplementary payments. However, in 1976 in reaction to States reducing their supple­mentary payment amounts when SSI payments were increased, Congress mandated that States pass along SSI benefit increases resulting from cost-of-living adjustments.
To meet the passalong (or maintenance-of-effort) requirement, a State may either maintain each State pay­ment level from year-to-year—the “payment levels” method—or it may spend the same amount of money, in the aggregate, that it spent for supplementary benefits in the 12-month period preceding the increase in the SSI benefit rate—the “total expenditures” method. Currently, 40 States use the levels method and 10 use the expenditure method. West Virginia has no optional supplementary plan and was not required to establish a mandatory plan because Federal SSI income standards exceeded all payments made under the State’s adult assistance programs in 1973.
SSI benefits are not the only form of assistance available to needy aged, blind, or disabled individuals. Medicaid, food stamps, and temporary State assistance also are important in keeping individuals from slid­ing further into poverty. SSA plays a limited but important role in helping States with regard to administra­tion of Medicaid and Food Stamp programs, and provisions in the SSI statute ensure that payments made by States or under the Social Security program are not duplicated by SSI benefits.
1. Windfall Offset
If a person receives SSI payments, and is later determined to be entitled to retroactive Social Security ben­efits, such retroactive benefits are reduced by the amount of SSI payments the person would not have been eligible for had the Social Security benefits been paid in the month they were due. This process is called the “windfall offset” and was enacted to prevent windfall payments to individuals when Social Security and SSI payments were paid for the same period.
2. Medicaid Determinations
Generally, SSI recipients are categorically eligible for Medicaid. A State may either use SSI eligibility cri­teria for determining Medicaid eligibility, or use its own criteria as long as the criteria are no more restric­tive than the State’s January 1972 medical assistance standards. Forty States use SSI criteria and 11 States use eligibility criteria more restrictive than those of the SSI program.
States also may enter into agreements with SSA for SSA to make Medicaid eligibility determinations on their behalf, as long as the eligibility requirements of the State’s Medicaid plans are the same as those for the SSI program. Under these agreements, SSA determines only when an individual is eligible for Medic­aid; SSA does not determine Medicaid ineligibility. SSA has Medicaid determination agreements with 33 States.
Continued Medicaid eligibility is provided for certain Social Security beneficiaries who lose SSI eligibil­ity due to entitlement to Social Security benefits, or due to a change in Social Security benefits resulting from:
3. Food Stamp Applications
SSI recipients in all States, except California,28 may be eligible for food stamps. Under agreements entered into by the Secretary of Agriculture and the Commissioner of SSA, Social Security offices notify Social Security and SSI applicants and recipients of their potential benefits under the Food Stamp program and make food stamp applications available to them.
The law also provides for Social Security offices to take food stamp applications from potentially eligible or eligible SSI households which are not already receiving food stamps and which do not have a food stamp application pending. Food stamp applications from SSI households may be taken in connection with initial SSI claims or at the time of a redetermination. Food stamp applicants have the option of applying at Social Security offices or applying at State food stamp offices if expedited service is required. Social Security offices forward the food stamp applications and any supporting documents to the local food stamp offices within 1 day of taking the application. Eligibility is determined by the food stamp office.
4. Interim Assistance Reimbursement
SSA may enter into agreements under which States or local governments are reimbursed for basic needs assistance provided during the period that either an eligible individual’s SSI application for benefits was pending, or the individual’s SSI benefits were suspended and subsequently reinstated (the interim period).
Under these interim assistance reimbursement agreements, if the individual has given SSA written authori­zation, SSA first reimburses the State, then pays the remainder in installments to the recipient or his/her representative payee.29 In certain disabled children cases, SSA pays the remainder in installments into spe­cial dedicated financial institution accounts for the children. Thirty-nine States have interim assistance agreements with SSA.
Table III.H1.— SSI State Supplementation 1 and Coordination with Other Programs
United States and
District of Columbia
Optional State program
Administered by:
Method of mandatory passalong of benefit increases from
cost-of-living adjustments
Medicaid eligibility determination
Interim assistance reimbursement agreement with SSA
Agreement with SSA to determine eligibility
Federal & State
See body of text for description of the various forms of State supplementation.
State has no recipients receiving mandatory minimum State supplementation.
Mandatory minimum State supplementation program is Federally-administered. No optional program.
Mandatory minimum State supplementation program is Federally-administered.
State provides assistance only in initial application cases. No assistance provided during periods that SSI benefits are suspended or terminated.
State does not have a mandatory minimum State supplementation program.

For example, as explained in section III.H, SSI recipients in most States are also automatically eligible for Medicaid, which generally provides for their medical needs.

See table IV.A2 for historical and estimated future Federal benefit rates.

“Substantial gainful activity” (SGA) is used to describe a level of work activity that is both substantial—i.e., involves the performance of significant physical and/or mental duties which are productive—and gainful—i.e., performed for remuneration or profit. SGA rules do not apply to the SSI blind. Gen­erally earnings from work activity of over $940 a month is evidence of ability to engage in SGA. If an SSI applicant is earning over $940 a month, he/she generally would not be considered disabled. However, if an SSI recipient is earning over $940 a month, he/she could continue to be eligible for SSI. (See “Incentives for Work and Opportunities for Rehabilitation” section III.E.) The SGA level of $940 was increased from $900 effective January 1, 2008 (72 FR 60708). Yearly increases in the SGA level are based on increases in the national average wage index.

Generally defined as the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

Fifty States, the District of Columbia or the Northern Mariana Islands.

See table IV.A2 for historical and estimated future Federal benefit rates.

SSA simplified the SSI program (70 FR 6340) by generally eliminating clothing from the definition of income and from the definition of in-kind support and maintenance effective February 7, 2005.

A complete list of the SSI income exclusions can be found in section V.B.

Any portion of this $20 amount not used to exclude unearned income may be used to exclude earned income.

A complete and more detailed list of the SSI resource exclusions can be found in section V.B.

The $2,000 value limit on household goods and personal effects was removed effective February 7, 2005 (70 FR 6340).

SSA also changed the evaluation of automobiles as an excludable resource, effective February 7, 2005 (70 FR 6340). Under the old rules, one automobile could be excluded (regardless of value) if necessary for employment, medical treatment or essential daily activities. If not excludable under this criteria, one automobile could be excluded to the extent its current market value did not exceed $4,500. The revised exclusion, applicable to any one automobile used for transportation, simplifies the evaluation of this resource.

See section III.E.6 of this report for a description of the special section 1619 provisions for disabled individuals who work.

Deeming also applies to an individual who lives with an essential person (a concept carried over from the former State assistance plans). However, there are fewer than 100 of these cases remaining.

Under age 22, if a student, effective June 16, 2008 (73 FR 28033). Previously, under age 21, if a student.

Legally enforceable affidavits of support are required by Public Law 104-208.

The Immigration and Naturalization Service now known as the United States Citizenship and Immigration Services (USCIS) began using the new, legally enforceable affidavits on December 19, 1997. However, if a potential immigrant had a visa issued before that date, the sponsor would sign an old version of the affidavit even if the affidavit was signed after December 19, 1997.

For a temporary period—January 1994 through September 1996—the deeming period was 5 years.

Increased from $1,510 and $6,100, respectively, effective January 1, 2008 (72 FR 60705). Under current regulations this exclusion is increased yearly based on changes in the cost of living.

State VR agencies generally have the option on a case-by-case basis of electing to be paid under an EN payment system or under the traditional cost reim­bursement payment system.

The applicant can appeal unfavorable determinations of either the nonmedical or medical eligibility factors. The administrative review process consists of several steps, which must be requested within certain time periods.

A medical review cannot be initiated while the SSI recipient is “using a ticket” under the Ticket to Work program.

Fee agreements prior to February 1, 2002, were limited to the lesser of 25 percent of the retroactive payment or $4,000.

P.L. 108-203, enacted March 2, 2004, granted temporary extension of the attorney fee payment system to title XVI claims for a period of 5 years.

References to State include, in addition to the 50 States, the District of Columbia. The applicable State supplementation provisions would also apply to the Northern Mariana Islands if it began making State supplementary payments.

Requirement does not affect West Virginia, since, in 1973, SSI Federal benefit rates exceeded the applicable income standards under the State’s adult assistance programs.

Includes, for this purpose, those eligible for title XVI benefits but for income.

California “cashes out” food stamps and SSI recipients there receive a cash payment in their State supplementary payment in lieu of food stamps.

In those cases where the retroactive benefits are less than a certain amount, SSA sends an individual’s first SSI benefit check relating to the interim period to the State or local jurisdiction that had provided the interim assistance. The State then deducts the amount it is owed and is required to forward the remain­der to the claimant within 10 days. Beginning February 2005, when an authorized representative fee may be paid directly, SSA reimburses the State and then pays the approved fee. Any remainder will be paid in installments, or the full remainder will be paid to the recipient. This change is a 5-year demonstration project.

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