Brief Overview of the Social Security System

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Brief Overview of the Social Security System
July 2009
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The Social Security Administration

• Administers two cash programs for persons with
  disabilities.
• Also handles enormous Retirement Income System.
• Central Office (includes Office of Employment
  Supports, Regional Office (Denver Region) and
  Local Offices.

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Cash Benefits Programs for People With
Disabilities

• Social Security Disability Insurance
• Supplemental Security Income
• Same definition of disability used to qualify for
  both programs.
• SSA determines what, if any, program a person
  qualifies for and how much the cash benefit will
  be.

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Applying for Benefits

• Same for both programs.
• Call and schedule appointment at local office.
• File is sent to a disability determination agency
  within the state to collect evidence on
  disability.
• Many individuals are denied and must appeal in
  order to secure benefits.

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Definition of Disability

• Inability to do any substantial gainful activity
  by reason of any medically determinable physical
  or mental impairment which can be expected to
  result in death or which has lasted or can be
  expected to last for a continuous period of not
  less than 12 months.

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SSAs Adult Sequential Evaluation

• Are you working at or over SGA?
• Are your impairments severe?
• Do you meet or equal a listing?
• Can you do your past relevant work?
• Can you do any other work?

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Social Security Disability Insurance

• Insurance system.
• Individual must have relevant work history or be
  related to somebody (child, spouse, former
  spouse, parent) who is disabled, retired or
  deceased with work history.
• Benefit amount will vary depending on when
  relevant work income earned and the amount
  earned.

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More on the SSDI Benefit..

• Assets and amount of unearned income are
  irrelevant.
• Can vary in amount enormously.
• For SSDI on own account, first check begins on
  6th month of disability and SSA can award
  benefits retroactively for up to 12 months prior
  to application.
• Work counts in month earned.

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Types of Social Security Benefits for People with
Disabilities

• SSDI on own account
• Disabled Adult Child/Childhood Disability
  Beneficiary (collecting on parents account)
• Disabled Widower Benefit

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SSDI on Own Account

• Individual worked and paid into the system.
• Individual earned sufficient amount in a
  sufficient amount of quarters at the relevant
  time.
• Criteria differ depending on age.
• Minor children or spouse can receive a dependant
  benefit.

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Disabled Adult Child/Childhood Disability
Beneficiary

• 18 or older
• Disabled by SSAs definition before the age of 22
• Child of insured workers who are either disabled,
  retired or deceased
• If adult child marries, benefits will cease
  unless marriage is to another SSA beneficiary.

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Disabled Widower

• Must be widow or surviving divorced spouse
• Must be found disabled before a prescribed period
  of time
• Payments are not payable prior to age 50

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SSDI Beneficiary Medicare

• SSDI beneficiaries are eligible for Medicare
  after 24 month waiting period.
• Waiting period begins with first month in which
  person is eligible for check.
• Many have already passed waiting period when they
  receive first check because case was pending for
  so long.
• Some SSDI beneficiaries are eligible for
  Medicaid, if their income and assets are low
  enough or they are working.

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Social Security Disability Insurance and Medicaid

• Medicaid rules and eligibility vary by state.
• In Illinois, SSDI beneficiaries with countable
  incomes under 100 FPL and low resouces will
  qualify for Medicaid.
• Higher incomes may qualify for Medicaid with
  spenddown.
• Working SSDI beneficiaries often qualify for
  Medicaid through Health Benefits for Workers with
  Disabilities.

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Supplemental Security Income

• Needs based program. Not an insurance program.
• Strict asset and income guidelines.
• Countable income includes both earned and
  unearned income. Any money coming in could
  count, even gifts!
• Also considers the income of other relatives in
  certain cases (deeming).

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Why Two Cash Systems?

• SSDI is only for people who paid into the system
  or related to somebody who paid.
• What about those with same exact disability who
  were not able to pay into the system or have the
  right relative who is retired/disabled/deceased?
  
• SSI system was created later and fills in this
  gap.

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SSI fills in this gap, but.

• SSI is very different from SSDI in key aspects.
• SSI is best thought of as a payer of last
  resort.
• It will pay when nobody else will.
• So, everything you receive or have could
  potential count against the SSI check.

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Supplemental Security Income

• Federal Benefit Rate - standard amount of SSI in
  2009 is 674 for individual and 1011 for couple.
• May vary if there has been an overpayment or
  other income is being counted.
• Usually received on the 1st of the month.
• Can supplement a low SSDI check
• There is both childrens SSI and adult SSI.

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Supplemental Security IncomeResource Rules

• Asset limit is 2000 for single, 3000 for couple
• Home in which person resides does not count.
• One Car does not count.
• Long list of other exceptions in the Program
  Operating Manual System (POMS).

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Supplemental Security Income--Counting Other
Income

• Almost all unearned income counts against the
  check.
• Less than ½ of earned income counts.
• In Kind Support and Maintenance can be
  considered.
• Income of certain relatives can be considered.

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In-Kind Support and Maintenance Reducing the
SSI Check

• Because SSI is a needs-based program, assistance
  from others in the form of housing or food will
  be factored into the amount received.
• Purpose of SSI is to give you just enough to get
  the basics. So, if somebody else helps you with
  these things, SSA will help you less!

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Deeming Income

• Process by which SSA considers anothers income
  or resources available the SSI beneficiary.
• Extremely complex formula (not a matter of just
  counting all income or resources of other
  person). Refer to local SSA office for
  calculation.
• Parent to Child
• Spouse to Spouse
• Sponsor to Alien

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Supplemental Security Income--Medicaid

• In Illinois, SSI recipients are not
  automatically eligible for Medicaid.
• SSI recipients must complete application with the
  state. Since SSI income does not count and
  resources are low, they do qualify.
• Working SSI beneficiaries can also qualify for
  Medicaid without spenddown either because
  countable income is still low enough or under a
  special provision called 1619(b).

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Now that benefits are coming in.any other
hurdles?

• Once an individual qualifies for benefits, it is
  not a lifetime thing.
• SSA does Medical Continuing Disability Reviews
  (CDR).
• The standard in this review is medical
  improvement.
• There are regularly scheduled review periods
  (diary) or events that can trigger a review.