Basic information about the Supplemental Security Income Program.
The Supplemental Security Income Program, or SSI, is a federally funded aid program benefiting individuals who are at least 65 years old, blind, or deaf. Unlike Social Security benefits, the funds used to fund the SSI program come from general revenues instead of Social Security taxes.
To be eligible for SSI because of a medical condition, your loved one must:
- Have little or no income or resources
- Be a U.S. citizen or meet the requirements for non-citizens
- Be considered medically disabled
- Be a resident of the 50 states, District of Columbia, or Northern Mariana Islands
- File an application
- File for any and all other benefits that he or she is eligible for
- Accept vocational rehabilitation services if applicable
- Not be working or working at less than SGA level (unless blind)
If your loved one is eligible, he or she will be evaluated using earning guidelines and substantial gainful activity (SGA) work activity, as well as disability guidelines. It should be noted that SGA is not used as a guideline for individuals who are blind, and that the guidelines used for other individuals are the same as those used by Social Security Disability Insurance (SSDI). Specific SGA conditions apply regarding blind individuals who are or are not self-employed. (Call the local Social Security office to inquire about these regulations if your loved one is blind.)
Disability is defined as being unable to engage in SGA due to medically determinable physical or mental impairments that are expected to result in death or that have lasted or are expected to last 12 months or longer. Generally, disability can be determined by your loved one’s answer to five questions:
- Is he or she working? If so, and your loved one’s average monthly earnings are at SGA level, he or she is not considered disabled. If your loved one’s monthly earnings are below SGA level, his or her condition is assessed.
- Is your loved one’s condition “severe?” This means that the impairment significantly limits his or her ability to do basic work (e.g., remembering, seeing, walking). If it does not, your loved one is not considered disabled.
- Is his or her condition in the list of disabled impairments? If your loved one’s impairment is not on this list, the office will decide whether his or her impairment is equivalent to those impairments listed.
- Can your loved one do the work that he or she did previously? If your loved one has an impairment that is not equivalent to those listed, his or her ability to complete the kind of work he or she previously completed is assessed.
- Can your loved one do any other type of work? If your loved one can’t do the type of work that he or she previously did, his or her age, education, past work experience, and transferable skills are assessed. If he or she can perform any other type of work, your loved one’s claim will be denied.
The Application Process
If the Social Security office believes that your loved one meets these specifications, he or she will be sent to the Disability Determination Services (DDS) office to be assessed for a disability. A team, which includes a doctor or psychologist and a disability examiner, will consider every aspect of your loved one’s case to decide whether he or she may be classified as disabled. Before this meeting, it is a good idea to contact previous doctors and treatment facilities to let them know that the DDS will be requesting medical evidence. If the DDS requires additional medical information, your loved one may be asked to undergo a consultative examination, which is usually done by his or her normal doctor or at the normal treatment center. DDS pays for this examination and all related travel expenses.
Application for SSI should be made as soon as your loved one is qualified. Specific documentation is required for application, but you should call a local Social Security office even if your loved one doesn’t currently have all needed documentation. Required documentation includes:
- A copy of your loved one’s W-2 Form (if not self-employed) or his or her federal tax return for the previous year (if self-employed)
- Dates of any prior marriages
- Financial information pertaining to your loved one’s home, including mortgage or lease and the landlord’s name
- Income and ownership information, including bank books, burial fund records, car registration, insurance policies, payroll slips
- Appropriate test results and X-rays
- Names, addresses, and telephone numbers of doctors, hospitals, clinics, and institutions that treated your loved one and the dates that he or she was treated
- Names of all medications currently being taken and the dosage of each
- Proof of citizenship or non-citizen status
- Social security number and birth certificate (or other proof of age) for each applicant
- Your loved one’s bank account number if he or she wishes to have benefits direct deposited
- Work history for the past 15 years, including company names, addresses, supervisors’ telephone numbers, and the kind of work that your loved one performed
After DDS assesses his or her disability level, your loved one’s claim will be approved or rejected. This judgment will be mailed to your loved one. If he or she is approved, the letter will state a benefit amount and the date on which payment will start. If your loved one was rejected, the letter will provide an explanation for the rejection and information about the appeal process.
Generally, the SSI payment amount is determined by the amount of alternate income that your loved one receives, his or her living arrangements, and the state of residence. The basic monthly payment is termed the “Federal Benefit Rate” (FBR), and this rate is adjusted each year to account for cost-of-living increases. Some individuals also receive an additional “state supplement,” which varies from state to state. To determine your loved one’s SSI payment, an original sum is calculated from the FBR and the state supplement (if applicable) and your loved one’s countable income is subtracted from this sum. (Countable income is the remainder after all allowable deductions are taken from an individual’s income.)
If your loved one is eligible for SSI, then he or she is also immediately eligible for Medicare. In 32 states and the District of Columbia, any individual who is eligible for SSI also is eligible for Medicaid. In fact, these states use the same application for both. In contrast, Alaska, Idaho, Kansas, Nebraska, Nevada, Northern Mariana Islands, Oregon, and Utah use the same eligibility guidelines, but require a separate application for SSI and Medicaid. Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia have separate state eligibility requirements for Medicaid, which are different from SSI requirements.
Once these benefits have been granted, your loved one’s medical condition will be reassessed periodically. If his or her medical condition is expected to improve, a new assessment will occur every three years. If not, your loved one will be assessed every five to seven years. If SSI receives notice of your loved one’s return to work, he or she will be assessed at that time.
The last month that a person is eligible for SSI benefit is the month:
- When SSI considers the individual no longer disabled because of work at the SGA level or medical improvement (It should be noted that in this case SSI will be paid for a “grace period” of that month and the following two months.)
- An exception will be made for individuals involved in vocational rehabilitation programs so that benefits will continue until program completion.
© Copyright FamilyCare America, Inc. All Rights Reserved.