2012 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. The Act established an old-age social insurance program administered by the Federal Government and an old-age means-tested assistance program administered by the States. Congress added similar programs for the blind or disabled 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 programs — Old-Age Assistance, Aid to the Blind, and Aid to the Permanently and Totally Disabled. 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 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, which substantially reversed the Federal and State roles with regard to adult assistance. Under the new arrangement, SSI provides a uniform Federal income floor while optional State programs supplement that floor. The new program was historic in that it shifted responsibility from the States to the Federal Government 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 levels 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 increase annually according to changes in the cost of living. For 2012, the Federal benefit rate is $698 a month for individuals and $1,048 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 that 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 or 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 admitted to the United States 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 categories4:
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; 4) aliens who adjusted status as Cuban/Haitian entrants under the provisions of the Immigration Reform and Control Act of 1986; and 5) aliens who became permanent residents under the Haitian Refugee Immigration Fairness Act (the law generally limits eligibility for these categories 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 are treated as refugees for SSI purposes:
Noncitizens certified by the Department of Health and Human Services to be victims of trafficking in persons in the United States,5 with eligibility for SSI generally limited to the 7 years after a determination is made that they are trafficking victims; and
Iraqi or Afghan noncitizens granted special immigrant status under emergency conditions (i.e., Iraqis or Afghans who have provided service to the U.S. government and, as a result, may be in danger within their country of origin), with eligibility for SSI generally limited to the 7 years after the special immigrant status is granted.
In addition to being a U.S. citizen (or national) or in one of the potentially eligible noncitizen categories, an individual must reside in one of the 50 States, the District of Columbia, or the Northern Mariana Islands. An individual also must be physically present in the United States6 for 30 consecutive days, if he or 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 or disabled children of military personnel who: (1) are born overseas; (2) become blind or disabled overseas; or (3) 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 or her need for assistance.
1. Income
The Social Security Act requires us to consider an individual’s income in determining both eligibility for, and the amount of, his or her SSI benefit. We first compute an individual’s “countable” income—i.e., income less all applicable exclusions—on a calendar month basis. We then compute his or her monthly benefit by subtracting countable income from the applicable Federal benefit rate.7 Generally, ineligibility for SSI occurs when countable income equals the Federal benefit rate plus the amount of an applicable Federally-administered State supplementation payment.8
When an individual lives in the household of another and receives support and maintenance in-kind (i.e., room and board) from the householder, the Federal benefit rate decreases by one-third. This is in lieu of counting the actual value of the support and maintenance as unearned income. In contrast, we count 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 or she lives) as unearned income. However, the amount that is countable is limited to an amount equal to one-third of the applicable Federal benefit rate plus $20.
The Social Security Act 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, under the law, not everything an individual receives is 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 or 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 Exclusions9
The principal earned income exclusions are:
Impairment-related work expenses of the disabled and work expenses of the blind;
The principal unearned income exclusions are:
The first $20 per month;10
2. Resources
The Social Security Act also requires us to consider the value of an individual’s resources in determining whether he or she is eligible for SSI in any given month. The statute states that eligibility is restricted to individuals who have countable resources, determined monthly, that do not exceed $2,000 ($3,000 for a couple). Although the statute does not define “resources,” it lists those items that are not considered resources. Our regulations define a resource to be a liquid asset, such as cash, or any real or personal property that, as a general matter, individuals (or their spouses) own and could convert to cash for their support and maintenance, but there are numerous and complex exceptions to this general rule.
If an applicant disposes of resources at less than fair market value within the 36-month period prior to his or her application for SSI or at any time thereafter, he or she may be penalized. The penalty is a loss of SSI benefits for a number of months (up to a 36-month maximum).11 The penalty does not apply if, among other things, the applicant can show that the resources were disposed of exclusively for a purpose other than establishing SSI eligibility.
Resource Exclusions12
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,” eligible individuals receive SSI benefits only to the extent other income and resources do not satisfy their needs. 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, the Social Security Act 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.
We 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 Treatment 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. 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 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 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 treatment facility is likely not to exceed 3 months, and SSA determines that continued SSI eligibility is necessary 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 he or she meets all other conditions for payment.
5. Personal Needs Allowance
When individuals enter medical treatment facilities in which Medicaid pays more than half of the bill, the law generally requires us to reduce their monthly Federal benefit rate 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 amount is also applicable if private insurance or a combination of Medicaid and private insurance pays more than half the bill. In these cases, the SSI program provides up to $30 a month for small comfort items not provided by the facility.
6. Deeming
The Social Security Act requires us to count, in certain situations, the income and resources of others in determining whether an individual’s income and resources fall below the levels established by law. We call this process “deeming"; it applies 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, we deem the ineligible spouse’s income and resources to be available to the eligible individual. In determining the amount of income and resources available to the eligible individual, we use all applicable exclusions. In addition, the law provides a living allowance for the ineligible spouse, as well as any ineligible children under age 18 (or under age 22 and a student) living in the household. The allowance reduces the amount of income to be deemed. Spouse-to-spouse deeming generally results in approximately the same amount of income available to the couple that 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 continues 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: (1) a child lives in a household with only the spouse of a parent (i.e., a stepparent); and (2) the natural or adoptive parent has permanently left the household. Deeming to a child continues if the parent is absent from the household only if the absence is temporary or 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, we do not consider that child to be receiving any support, and deeming does not apply.
In the deeming computation, we first calculate the parent’s income, using any exclusions that apply. Then we subtract a living allowance for the parent(s) and each ineligible child under age 18 (or under age 22 if a student) who is living in the household. We deem the remainder to be available to the eligible child(ren).
c. Sponsor-to-Alien Deeming
We deem the income and resources of noncitizens to include those of their sponsors. The way we deem the income and resources and the length of the deeming period depends on whether the sponsor signed a legally enforceable affidavit of support15 or the previous version of the affidavit. Generally, noncitizens who entered the country before 1998 did so under the old version of the affidavit.16
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.17 The law provides living allowances equal to the Federal benefit rate for the sponsor as well as allowances equal to one-half of the Federal benefit rate for each of the sponsor’s dependents. The law also provides allowances for the sponsor and his or 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.
For this group of noncitizens, deeming also 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 capacity 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 incentives 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, which the Administration has asked Congress to coordinate and simplify, 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 recipients obtain vocational rehabilitation and employment support services. These provisions were revised by legislation establishing the Ticket to Work program, which we describe in section III.E.7.
1. Earned Income Exclusion
We exclude the first $65 ($85 if the individual has no income other than earnings) of any monthly earned income plus one-half of remaining earnings for SSI benefit computation purposes. This general earned income exclusion offsets expenses incurred when working.
2. Impairment-Related Work Expense Exclusion
We exclude the costs of certain impairment-related services and items that a disabled (but not blind) individual needs in order to work from earned income in determining SSI eligibility and payment 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.
3. Work Expenses of the Blind Exclusion
We exclude any earned income by a blind individual used to meet expenses needed to earn that income from earned income in determining SSI eligibility and payment 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. Under current regulations, we exclude up to $1,700 of earned income per month but no more than $6,840 per year.18
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. A PASS may involve setting aside funds for education or vocational training. A recipient can also set aside funds to purchase work-related equipment or pay for transportation related to the work goal. We exclude the income and resources that a recipient sets aside under the SSI income and resources tests.
The individual must have a feasible work goal, must have a specific savings or spending plan, and must provide for a clearly identifiable accounting for the funds that he or she sets aside. We must approve the PASS; the individual must then follow the plan and negotiate revisions as needed. SSA monitors the plans by reviewing them periodically to evaluate the individual’s progress towards attaining the work goal.
6. Special Provisions for Disabled Recipients Who Work
This work incentive generally is known 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 may 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.
Section 1619(b) also provides “SSI recipient” status for Medicaid eligibility purposes to individuals:
Whose earnings preclude any SSI payment but are not sufficient to provide a reasonable equivalent of SSI benefits, social services, and Medicaid benefits that an individual 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, we compare their earnings 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, we make an individualized assessment of the need for Medicaid 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 have 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 established a Ticket to Work and Self-Sufficiency 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 that ENs would be compensated under an outcome or outcome-milestone payment system.19 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 or her dependence on cash benefits.
The Ticket to Work program has been in operation nationwide since September 2004. Under this program SSA provides eligible individuals who receive SSI benefits due to blindness or disability with services under the Ticket to Work Program. These individuals may 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” SSA will not initiate a continuing disability review to determine whether the beneficiary has medically improved.
ENs and State VR agencies are the only providers of VR services to disabled SSI recipients that SSA can compensate for those services. All ENs receive their compensation through the Ticket to Work program’s milestone or outcome-based payment system. Unless State VR agencies have elected to participate as an EN for specific cases, they receive compensation under the traditional VR reimbursement system. Any services provided by the State VR agencies to SSI recipients who are not yet eligible for a ticket receive compensation under the traditional VR reimbursement system.
Individuals who improve medically and, therefore, are no longer considered disabled or blind may 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. For benefits to continue, SSA must determine that continuing or completing the program will increase the likelihood that the individual will be permanently removed from the SSI rolls. SSI benefits and Medicaid generally continue until the recipient completes the approved program or 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 OASDI disabled and SSI blind or disabled beneficiaries, removed disincentives for ENs to participate in the program, provided incentives for ENs to support beneficiaries through a more gradual return to work and positioned ENs to better support ongoing retention of employment. The regulations also encourage partnership between State VR agencies and ENs to provide long-term services to a beneficiary by allowing the beneficiary to assign a ticket to an EN after receiving VR services.
8. Expedited Reinstatement
A disabled or blind individual whose eligibility for SSI payments ended because of earnings can request expedited reinstatement of SSI benefits without filing a new application. To qualify for expedited reinstatement, the individual must make the request within 60 months after his or 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 the performance of 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 or her request is pending. These benefits generally are not considered an overpayment if we deny the request. Provisional benefits may include Medicaid but do not include any State supplementation payments.
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 thoughtfully and respectfully serving the public.
1. Application Process
Individuals can apply for SSI benefits at any one of the approximately 1,250 SSA field offices around the country or through SSA teleservice centers. Although many of the eligibility requirements for the Social Security program and the SSI program are different, the application process is very similar. Individuals typically 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. Due to the special circumstances of the SSI population (for example, financial need, old age, or illness), SSA makes special efforts to assist claimants in obtaining this information.
With regard to disability and blindness claims, SSA determines the nonmedical eligibility factors and each State’s disability determination services (DDS) determines the medical eligibility factors.20
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 in a month is based on income received in that month. We generally calculate the amount of the monthly benefit using income in the second month preceding the month for which the benefit is paid.21 However, at the start of a period of eligibility or re-eligibility, we determine the amount of benefits for both the first and second months using the income received in the first month.
3. Payment of Benefits
In general we pay SSI benefits on the first day of each month. If the first of the month falls on a weekend or legal public holiday, we deliver benefit payments on the first working day preceding such Saturday, Sunday, or holiday. Monthly benefit payments include both the Federal SSI and State amounts if the recipient lives in a State in which SSA administers the State supplementation payment. (See section III.G.)
Effective May 1, 2011, applicants filing for SSI benefit payments must choose either direct deposit or the Direct Express® debit card, a prepaid debit card available to any individual receiving SSI payments. Individuals currently receiving payment by check will have until March 1, 2013 to switch to direct deposit or the Direct Express® debit card. In fiscal year 2011, just over 70 percent of SSI recipients received their benefits electronically.
4. Ensuring Continued Eligibility for Benefits
SSI recipients have their nonmedical eligibility factors redetermined periodically; the frequency of these reviews depends on a variety of factors.
In addition to these nonmedical reviews, we conduct medical reviews on disabled or blind recipients in order to determine if they continue to be disabled or blind. For administrative efficiency we conduct the medical reviews most often on those disabled or blind recipients whose medical conditions are most likely to improve. The Act provides for medical reviews for disabled or blind recipients under the following circumstances:
When earnings of recipients exceed the substantial gainful activity level;22
Not later than 12 months after birth for recipients whose low birth weight is a contributing factor material to the determination of their disability, unless SSA determines that the impairment is not likely to improve within 12 months of the child’s birth; and
Within 1 year after attaining age 18 for those recipients whose eligibility we established under the disabled child eligibility criteria. We conduct the required review using the adult eligibility criteria.
The Social Security Act requires applicants and recipients to report events and changes of circumstances that may affect their SSI eligibility and benefit amounts. The Act requires such reports, for example, when an individual has a change in the amount of his or her income or resources, changes living arrangements, or leaves the United States. Failure or delay in reporting such a change 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 withheld amount is 10 percent of their monthly SSI payment. However, if SSA determines that the recipient misrepresented or concealed material information, 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, we appoint representative payees for them, and we send their SSI benefits 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, SSA approves an organization to serve as a payee. SSA authorizes certain types of organizations to collect a fee from the benefit for acting as payee. The fee cannot exceed the lesser of 10 percent of the payment amount or a specified amount ($38 a month in 201223).
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. The Act requires representative payees to report any changes that may affect SSI recipients’ eligibility and payment amount. SSA may hold representative payees 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 Act requires the representative payee to establish a dedicated account at a financial institution to maintain the retroactive payment. Representatives must make expenditures from the account primarily for certain expenses related to the child’s impairment.
6. Appeal Rights
SSI applicants may file appeals if SSA determines they are not eligible for SSI. There are four levels of appeal: reconsideration, hearing, Appeals Council review, and Federal court review. If applicants do not receive the benefits they seek at one level, they may appeal to the next. A reconsideration is a complete review by SSA (or by the DDS if applicants are appealing a disability determination).24 A hearing gives applicants the opportunity to appear in person before an administrative law judge (ALJ) who had no part in the initial determination or the reconsideration. The Social Security Appeals Council may dismiss a request for review, deny a request for review if it believes the hearing decision was correct, or it may decide the case itself or remand the case to the ALJ for further action. A Federal district court may look at cases when applicants disagree with the Appeal Council’s decision or denial of the request for review.
SSI recipients must receive advance notice of any adverse action SSA plans to take against them and may continue to receive monthly benefits if they appeal the adverse action. For nondisability appeals, recipients qualify for benefit continuation at the reconsideration level if they file the appeal within 10 days of receipt of the notice of adverse action. For appeals of medical cessations or determinations reopened and revised due to medical reasons, recipients qualify for benefit continuation at the reconsideration and hearing levels if they file the appeal and elect benefit continuation within 10 days of receipt of the initial or reconsideration determination.
7. Fees for Attorneys and Non-attorney Representatives
At any time, an individual may appoint a representative in any dealings with SSA. If such a representative is an attorney, he or she must be in good standing and: (1) admitted to practice law before the U.S. Supreme Court, a U.S. Federal, state, territorial, insular possession, or District of Columbia court; or (2) a member of a state bar if that membership carries with it the authority to practice law in that state. Non-attorneys must be known to possess good character and reputation, and must be able to competently advise and assist claimants in presenting their cases. A person cannot be a representative if he or she is disqualified or suspended from acting as a representative with SSA or is prohibited by any law from acting as a representative.
With a limited exception, representatives must use one of SSA’s fee authorization processes to request a fee for their services.25 They can request a fee by either submitting a fee agreement or filing a fee petition. SSA reviews the documents and authorizes the fee the representative may charge or receive. Under the statute, the fee under an approved fee agreement is the lesser of 25 percent of the past-due benefits or a maximum amount (currently $6,000) adjustable by the Commissioner in his or her discretion. There is no limit on the amount of the fee based on a fee petition; a reasonable fee is determined after reviewing the specific services provided by the representative. After SSA authorizes the fee, the representative may not charge or receive more than the amount authorized.
The SSI program previously differed from the Social Security program in that we did not withhold amounts from an individual’s SSI benefits to directly pay the representative his or her authorized fee. SSI claimants were responsible for paying such fees directly to their representatives. However, beginning February 28, 2005, Congress extended direct payment of both attorney and non-attorney representative fees to the SSI program.26 As in the fee process for the Social Security program, we can withhold up to 25 percent of the individual’s SSI past-due benefits to pay an eligible representative’s fee directly. The law also requires that we charge representatives an assessment of the smaller of 6.3 percent of each authorized fee withheld or the flat-rate cap of $86. We adjust the flat-rate cap based on annual cost-of-living adjustments that we round down to the next lower dollar. This flat-rate cap has prevented SSA from recouping much of the costs incurred in the fee-withholding program.
Non-attorney representatives must meet specified prerequisites in order to be paid directly by SSA out of SSI applicants’ past-due benefits. These prerequisites include: having a bachelor’s degree or equivalent qualifications from training and work experience; securing and maintaining adequate professional liability insurance; passing a criminal background check; passing an examination given by SSA that tests knowledge of the relevant provisions of the Social Security Act and recent court decisions; and demonstrating ongoing completion of qualified courses of continuing education.
8. Advance Payments
The SSI program has procedures that 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 as they await 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; i.e., the Federal payment amount plus any applicable State supplement. We recover the amount paid 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 we subsequently deny the claim because the claimant is not disabled or blind, we waive repayment. If we deny the claim for other reasons, we treat the amount paid as an overpayment.
b. Presumptive Disability or Blindness
A claimant applying for benefits based on disability or blindness may be paid up to 6 months of benefits when the available evidence reflects a high degree of probability that his or her impairment will meet the definition of disability or blindness and he or she is otherwise eligible for disability benefits. We do not treat these payments as overpayments if we later determine that the individual is not disabled or blind. If we disallow the claim for other reasons, the amount paid is an overpayment.
In designing the SSI program, Congress recognized that States,27 in many instances, may want to provide a higher level of income maintenance than that provided by the Federal program. At the same time the law gave the States 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. Lawmakers also mandated that States not provide lower benefits under the Federal program than they had provided 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 Supplementation 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, 44 States and the District of Columbia have optional State supplementation programs.
Some States provide supplementary payments to all individuals eligible for SSI benefits, while others limit them to certain SSI recipients, such as the blind or residents of domiciliary-care facilities, or extend them to persons ineligible for SSI because of excess income. Congress significantly restricted States’ flexibility in setting supplementary payments, however, by the passalong provisions (see Passalong Provisions section below).
2. Mandatory State Supplementation Programs
Congress requires28 States to maintain the December 1973 income levels of individuals who were transferred in 1974 from the former State adult assistance programs to the SSI program, except for Texas, which has a constitutional bar against mandatory State supplementation. Over the years, many individuals who converted to SSI from the State benefit rolls have died and others have had their incomes increase above the December 1973 level. As a result, few individuals continue to receive mandatory State supplementation payments.
3. Administration of State Supplementation 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 fee for each supplementary payment issued. In fiscal year 2012, the fee is $10.94 per payment issued. Fees increase in succeeding fiscal years based on increases in the Consumer Price Index for All Urban Consumers.
States that administer their own supplementary payment programs to SSI 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 SSI recipients.29
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 supplementation payments. However, in 1976, in reaction to States reducing their supplementary payment amounts when SSI payments increased, Congress mandated that States pass along SSI benefit increases resulting from cost-of-living adjustments.
To meet the passalong 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, 39 States use the levels method and 8 States plus the District of Columbia use the expenditure method. West Virginia has no optional supplementary plan and the legislation did not require it to establish a mandatory plan because Federal SSI income standards exceeded all payments made under the State’s adult assistance programs in 1973. Arizona and North Dakota have no optional supplementary plan and no mandatory minimum State supplementation recipients remaining.
SSI benefits are not the only form of assistance available to aged, blind, or disabled individuals with limited means. Medicaid, nutrition benefits, and temporary State assistance are also important supports that help prevent further impoverishment and improve health outcomes.
The SSI statute includes provisions that are intended to prevent duplication between SSI benefits and other benefits that the Social Security program or States may provide. For example, the "windfall offset" prevents windfall payments to individuals entitled to receive Social Security and SSI payments for the same period.
SSA also plays a limited but important role in helping States administer the Medicaid Program and the Supplemental Nutrition Assistance Program (SNAP).30
1. Windfall Offset
If a person receives SSI payments and we later determine that person is entitled to retroactive Social Security benefits, we reduce such retroactive Social Security benefits 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. Congress enacted this “windfall offset” to prevent windfall payments to individuals entitled to receive Social Security and SSI payments for the same period.
2. 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 we suspended and subsequently reinstated the individual’s SSI benefits.
Under these interim assistance reimbursement agreements, if the individual has given SSA written authorization, SSA first reimburses the State, then pays the authorized representative’s fee, and pays the remainder in installments to the recipient or his or her representative payee. In certain disabled children cases, SSA pays the remainder in installments into special dedicated financial institution accounts for the children. Thirty-seven States and the District of Columbia have interim assistance agreements with SSA.
3. Medicaid Determinations
Most 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. Thirty nine States and the District of Columbia 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 for as long as the eligibility requirements of the State’s Medicaid plans match 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 32 States and the District of Columbia.
The Act provides continued Medicaid eligibility for certain Social Security beneficiaries who lose SSI eligibility due to (1) entitlement to Social Security benefits or (2) a change in Social Security benefits resulting from:
4. SNAP Applications
SSI recipients in all States, except California,31 may be eligible for SNAP benefits. Under agreements entered into by the Department of Agriculture and SSA, Social Security offices notify Social Security and SSI applicants and recipients of their potential benefits under the SNAP and make SNAP applications available to them.
The law also provides for Social Security offices to take SNAP applications from eligible or potentially eligible SSI households that are not already receiving nutrition benefits and do not have an application pending. Social Security offices forward the SNAP applications and any supporting documents to the local SNAP offices within one day of taking the application. The SNAP office determines eligibility for nutrition benefits.
Table III.H1.—SSI State Supplementationa and Coordination with Other Programs
United States and
District of Columbia
Method of mandatory passalong of benefit increases from
cost-of-living adjustments
Medicaid eligibility determination—
Interim assistance reimburse-ment agreement with SSA
Agreement with SSA to determine eligibility
Federal & State
Alabama b
Arkansas c
California d

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) describes a level of work activity that is both substantial — i.e., involves the performance of significant physical or mental duties that 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 $1,010 a month are evidence of ability to engage in SGA. If an SSI applicant is earning over $1,010 a month, he or she generally would not be considered disabled. However, if an SSI recipient is earning over $1,010 a month, he or she could continue to be eligible for SSI. (See “Incentives for Work and Opportunities for Rehabilitation” section III.E.) The SGA level of $1,010 was increased from $1,000 effective January 1, 2012 (76 FR 66112). According to regulation, SSA bases yearly increases in the SGA level on increases in the national average wage index.

Generally, the law limits SSI eligibility for humanitarian immigrants to 7 years. However, under the “SSI Extension for Elderly and Disabled Refugees Act,” which became law on September 30, 2008, lawmakers extended the 7-year period to 9 years during the window of October 1, 2008 through September 30, 2011. Afterwards, the SSI eligibility period reverted back to 7 years. Noncitizens who had naturalization applications pending during this same 3-year window were exempt from the 7-year limitation.

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. We adjust Federal benefit rates in January to reflect changes in the cost of living.

We discuss State supplementation payments in section III.G.

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.

We calculate the number of months of penalty by dividing the uncompensated value of disposed-of-resources by the Federal benefit rate plus the maximum Federally-administered State supplementation payment, if any, applicable to the individual’s living arrangement.

We include a more detailed list of the SSI resource exclusions in section V.B.

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 40 of these cases remaining.

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 $1,640 and $6,600, respectively, effective January 1, 2012 (76 FR 66111). Under current regulations this amount increases 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. Effective July 21, 2008, a State VR agency under the traditional cost reimbursement option and an EN under the EN payment system may be compensated for providing successive services to a beneficiary.

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

This method of calculating the benefit is called retrospective monthly accounting.

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

For disabled recipients who also have a drug addiction or alcoholism condition, the maximum permitted fee in 2012 is $75 a month (76 FR 66111).

SSA introduced a modification of this process in 10 States for disability applications filed October 1, 1999 and later. Under this revised process, applicants appeal initial disability denial determinations directly to the Office of Disability Adjudication and Review, thereby eliminating the reconsideration step. The options for appeal beyond the hearing level are unchanged.

We do not need to authorize a fee when the representative informs us in a prescribed manner that the claimant and affected parties are not liable to pay the representative’s fee. We also do not need to authorize a fee that the court authorized based on actions as a legal guardian or court-appointed representative.

Public Law 108-203, enacted March 2, 2004, granted temporary extension of the attorney fee payment system to SSI claims for a period of 5 years. Public Law 111-142, enacted February 27, 2010, made this extension permanent.

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 supplementation 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 SSI benefits but for income.

In 2008, the Food Stamp program changed its name to SNAP.

California “cashes out” nutrition benefits and SSI recipients there receive a cash payment in their State supplementation payment in lieu of benefits.

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