If your loved one has been diagnosed with HIV, he or she may be eligible for Social Security disability insurance and other government benefit programs.
Currently, thousands of individuals with HIV receive Social Security SSDI or SSI benefits. The Social Security criteria for HIV benefits differs from that held by the Center for Disease Control (CDC). So, how does the Social Security Administration evaluate an HIV related disability? The Social Security Administration and each state’s Disability Determination Service (DDS) work together to evaluate disability claims. The process includes:
- Deciding whether the individual with HIV is “severely” impaired. The severity of an individual’s impairment is assessed in terms of the amount to which the disability interferes with the individual’s ability to work.
- Deciding whether the disability is included in the list of impairments. A complete list of HIV-related impairments can be obtained from the Social Security Administration. Some of this list includes:
- Carcinoma of the cervix
- Herpes Simplex
- HIV Wasting Syndrome
- Hodgkin’s disease and all lymphomas
- Kaposi’s sarcoma
- Pneumocystis carinii pneumonia (PCP)
- Pulmonary tuberculosis resistant to treatment
- Syphilis and Neurosyphilis
- Deciding how frequently and to what level of severity any impairments that are not listed occur
- Assessing the individual’s ability to function in the three areas of daily activities, social functioning, and timely task completion.
- Assessing the ability of the individual to work, which is based on age, education, past work experiences, and transferable skills. If the person can’t work, he or she may receive benefits.
Individuals having “marked limitations” in the three areas, as well as repeated manifestations of HIV, may be found disabled. The Administration defines a marked limitation as one that interferes with an individual’s level to function appropriately, effectively, and independently.
Applying For Benefits
If your loved one is interested in applying for benefits, he or she will need to provide documentation of his or her medical condition during the eligibility assessment process. The HIV infection, as well as all HIV-related illnesses, should be documented and medical records and laboratory test results should be accessible to evaluators. Additionally, evaluators will look at other HIV symptoms experienced by your loved one, which may include: anorexia; depression or anxiety; dyspnea or exertion; enlarged lymph nodes, liver or spleen; fevers or night sweats; headache; lower energy or generalized weakness; nausea and vomiting; persistent cough; repeated infections; and the side effects of medication or treatment.
Additionally, the Social Security Administration recognizes certain gender-specific conditions. For women these include: condyloma (genital warts caused by the human papillomavirus); genital herpes; genital ulcerative disease; invasive cervical cancer; pelvic inflammatory disease (PID); and vulvovaginal candidiasis (yeast infection). A specific list of disorders pertaining to children with HIV also exists. Call a local Social Security office for a complete copy of any of these lists.
The application process for Social Security benefits is the same for individuals with HIV and those with other types of disabilities, but HIV application claims are given priority, which allows the Social Security Administration to lawfully presume that an individual with HIV who is applying is disabled. This allows the Administration to pay up to six months of benefits immediately upon approval of the claim. To qualify for this immediate benefit program, your loved one must:
- Have a medical source confirm that the HIV infection is severe according to SSA standards
- Meet other SSI non-medical requirements
- Not be doing “substantial work”
Multiple arrangements have been made between the Social Security Agency and various advocacy groups, AIDS organizations, and medical facilities to expedite this process. Additionally, if the local Social Security office can’t make this type of immediate program available, your loved one should contact the DDS evaluation specialist and ask whether he or she is considered eligible for a “presumptive” decision. These decisions are made when application materials suggest that approval for benefits will be highly likely and can occur any time in the application process. If the department later rejects the benefits offer, your loved one will not have to pay for any benefits received.
There are also things that your loved one can do to facilitate the application process. These include:
- Documenting the symptoms related to HIV early and often. This should include mental, physical, and psychological problems.
- Keeping records of the effects of HIV on his or her work.
- Compiling a list of the names, addresses, and phone numbers of all clinics, doctors, and hospitals. Your loved one should include his or her identification number if known.
- Requesting that his or her doctor keep a detailed chart of HIV-related symptoms.
If your loved one is eligible for Social Security benefits, he or she should learn more about the medical coverage that he or she may also receive. Many people who are eligible for SSDI, for instance, are also eligible for Medicare and/or Medicaid.
Additionally, your loved one should look into various work incentive programs that are offered in conjunction with Social Security benefits to individuals with HIV. These programs differ for Social Security disability benefits and SSI, so be sure to contact your loved one’s local Social Security Administration office to receive more information. Generally, individuals with Social Security disability benefits are allowed a nine month “trial period” in which the amount earned at work does not affect their benefits, as well as a three year guarantee that benefits stopped due to employment will be re-introduced in any month that earnings fall below $500. Additionally, your loved one may be eligible to receive Medicare benefits for the three years regardless of his or her earnings. SSI benefits allow Medicaid coverage to continue regardless of earnings by helping individuals to set up a “plan to achieve self-support” (PASS).
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