PABSS prerequisite

February 2016

Supplemental Security Income

Supplemental Security Income –Title XVI

In 1972, Congress passed Title XVI of the Social

Security Act. This federalized state programs for

people who are aged, blind or disabled, and have

limited income and resources.

Needs-based program for people with limited income

and resources.

It provides cash to meet basic needs for food and

shelter.

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Distinctive Features SSI

SSI - Funded by General Tax Revenues and

is affected by changes in income, resources

and living arrangements

Amount of payment is based upon income

and living arrangements

Paid on 1st of the current month

Medicaid eligibility (sometimes a separate

application is required)

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Social Security’s Definition of Disability

A medical condition or combination of

impairments preventing substantial gainful

activity for at least 12 months, or expected to

result in death.

The determination also considers age,

education & work experience.

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Who can get SSI?

Those age 65 or older, blind, or disabled who have limited income and resources

Are residents of the 50 States of the U.S., District of Columbia or Northern Mariana Islands

And citizen of the U.S. or those meeting immigration eligibility criteria

Those who have filed an application and meet medical and non-medical requirements

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SSI recipients

Aged - 65 or older, Blind - any age, Disabled

0 - age 65

Payments begin with the month after the

month of filing an application

Must meet medical and non-medical

requirements

Aged individuals are not PABSS eligible

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Supplemental Security Income -SSI

Payment amount is based on income, living

arrangements, marital status, the maximum amount

payable in the state, and whether the income of

another counts toward the person’s eligibility.

Unlike SSDI, SSI has “No Waiting” periods to initially

receive benefits. Medicaid eligibility begins

immediately

Earliest possible payment date is the month after the

month of application 20 CFR 416.335.

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SSI Overview: Payments

Monthly federal benefit rate (FBR) payment set each January. 2016 & 2015 SSI FBR is up to $733 for individual and up to $550 for a member of a married couple, $1100 if both are SSI eligible.

Many states have opted to supplement the FBR.

(state supplementation)

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SSI State Supplementation

This is the amount of money that some

states pay in addition to the SSI amount.

In some states the SSI application is an

application for the state supplement.

In some states you have to apply for the

supplement at the state agency.

POMS SI 01400.000 et seq.

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SSI State Supplementation

States that supplement the FBR vary widely in the criteria for supplementation and in the amount of the supplement.

For info on which states supplement, see POMS SI 01415.010.

Complete 2016 state supplement info for federally administered states supplements can be found at POMS SI 01415.047.

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Living Arrangements - SSI

Benefit amounts may vary depending on where a person lives:– In a his/her own home; or

– In someone else’s household; or

– In a group care or board and care facility;

– In a medical treatment facility;

– In a public institution.

20 CFR 416.211, .414, .401-.435, POMS SI 00835.100 - .170, SI 01400.000 et., SI 00520.001, .011

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Living in Another’s Household Limits SSI Payment Amount

A 1/3 reduction in the SSI Federal Benefit

Rate applies to SSI recipients who:

o Live in another’s household; and

o Receive both food and shelter-related

items from within the household without

paying their pro-rata share of those

expenses.

20 CFR 416.1131 - .1133

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Living in Another’s Household Limits SSI Payment Amount

Shelter-related items for this purpose are

only these: rent or mortgage, property taxes,

heating fuel, gas, electricity, water, sewer,

and garbage removal.

20 CFR 416.1133. POMS SI 00835.465D.1.

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Institutional Living arrangements Limit SSI Payment Amount

Payment is limited to a maximum of $30 per month

(minus any countable income) when:

– You are a resident in a public or private medical treatment

institution; and

– Medicaid pays over 50 percent of the cost of care for that

month.

The regs at 20 CFR 416.414 show the $30 FBR.

See also SI 00520.011

Residents of public institutions are eligible for 0 SSI.

20 CFR 416.211

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SSI Income Eligibility 20 CFR 416.1100 - .1147

Income is defined as “anything you receive in cash

or in kind that you can use to meet your needs for

food and shelter.”

– Income can be earned or unearned.

– Income can be in-kind in the form of shelter or

food received free or at reduced cost.

– Income can be deemed from a spouse, parent, or

sponsor (of an alien).

Income is counted in the month it’s received for SSI

income eligibility purposes.

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SSI - Earned Income20 CFR 416.1110 - .1111

Income from work, including:

– wages

– self-employment net income

– in-kind payment (e.g., free rent for work)

– royalties and honoraria

– Bonuses

– Payments for sheltered work or work activities

Treated much more favorably than unearned

income.

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SSI Unearned Income Examples

Annuities, pensions and other periodic payments

(such as SSDI and Unemployment)

Alimony, child support

Dividends, interest

Gifts, prizes

Rental income

Inheritances

In kind support & maintenance

20 CFR 416.1120 - 416.1131

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Unearned Income ExclusionsExamples 20 CFR 416.1124

$20 general income exclusion.

Exclusions specific to income types, e.g.:

– Gross rental income is reduced by expenses

associated with that income.

– Deemed income is reduced by deductions

contained within the deeming formulas.

– 1/3 child support for minors is excluded.

See POMS SI 00830.999 for more

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Noncountable Unearned Income Examples, 20 CFR 416.1123

Housing assistance such as public housing

or a Section 8 voucher

Food Stamps (Supplemental Nutrition

Assistance Program – SNAP)

Retroactive SSI or SSDI for 9 months after

receipt.

Assistance based on need wholly funded by

a state.

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SSI – Countable In-kind Income20 CFR 416.1140 – .1141

Food or Shelter-related items provided for

free or at reduced cost to an SSI recipient

count as in-kind income.

When the person is not living in the

household of another and not receiving both

food and shelter from within the household,

the presumed maximum value rule (PMV)

applies. 20 CFR 416.1133. POMS SI

00835.465.20

SSI – Countable In-kind Income continued

For this purpose shelter-related items are

only these: rent or mortgage, property taxes,

heating fuel, gas, electricity, water, sewer,

and garbage removal. 20 CFR 416.1133(c).

The maximum countable under the PMV is

the lesser of the actual or 1/3 of the SSI

federal benefit rate plus $20.

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What is not Income 20 CFR 416.1103

Examples of unearned income exclusions:

– Medical care and services

– Assistance provided in cash, or in kind, under a

state, federal, local providing medical care or

services (including VR.)

– Cash used to replace a resource (e.g. insurance

proceeds)

– Income tax refunds

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What is not Income (cont’d) 20 CFR 416.1103

Proceeds of a loan

Bills paid for the recipient – if paid directly to

the vendor (for non-shelter/food items)

Replacement of income that was lost, stolen

or destroyed

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Deemed Income20 CFR 416.1160 - .1166a

Limited to legal support obligations:

Parent to minor child (when living together).

Spouse to spouse (must live together).

Sponsor to sponsored immigrant (regardless

of whether living together).

[needs based]

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SSI – Resources20 CFR 416.1201 - .1266

SSI limits the amount of countable resources

that an SSI recipient can own.

Must both own and have legal access to the

resource or it’s not usually countable.

An individual recipient can hold only $2000 in

countable resources.

A married couple can hold only $3000 in

countable resources.

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SSI – Resources, cont’d20 CFR 416.1201

A resource is cash or any other liquid asset,

real estate, or personal property of the

individual (or spouse) that could be

converted to cash and used to meet basic

needs.

Income remaining as of the 1st moment of

the month after the month the income is

received becomes a resource.

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SSI Excluded Resources20 CFR 416.1210

Some examples of resources that are not

counted as a matter of policy:

– The home that the individual lives in.

– Household goods and personal effects.

– One automobile of any value.

– Cash surrender value of life insurance with face

value under $1500.

– Burial funds (up to $1500); burial spaces.

See POMS SI 01130.050 for more.

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Transfer of Asset PenaltyPOMS SI 01159,999 et seq

Funds transferred for less than fair market

value may result in a “transfer of assets

penalty” causing SSI ineligibility for a

maximum of 36 months.

The SSI recipient can spend down excess

funds to buy goods or services for herself, at

fair market value, without causing a transfer

penalty.

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Transfer of Asset Penalty continued

Individuals must keep good records and

receipts when spending down to show Social

Security when excess funds were spent and

on what.

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Suspense vs Termination20 CFR 416.1320 - .1336

SSI ineligibility for a non-disability reason

(e.g., income or resources) does not

immediately result in eligibility termination;

instead it results in a non-payment status

called suspense.

Excess funds may be spent down on oneself

for fair market value to regain SSI payment

status without having to reapply.

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Suspense vs Termination

Good records and receipts must be kept

when spending down to show Social Security

when excess funds were spent and on what.

Remaining in suspense for 12 consecutive

months results in termination of entitlement

to SSI. 20 CFR 416.1335.

Termination of entitlement to SSI requires a

reapplication to regain eligibility.

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Role of the Field Office (FO) and Disability Determination Service (DDS)

Local Social Security office takes the

application but does not make the disability

decision

Disability decision is made by state Disability

Determination Services (DDS)

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Disability Determination – Adults (18 and older)

If the individual is not working at the SGA level, SSA considers:

medical evidence to establish diagnoses;

medical, other professional, and lay evidence to establish the nature and severity of the condition(s) (functional limitations);

whether those disability related functional limitations prevent past work; and

whether they prevent other work for which the person may be suited in light of age, education, and whether past work was skilled or unskilled.

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Disability Determinations – Children (under age 18)

The child must have a physical or mental condition, or a combination of conditions, that results in “marked and severe functional limitations.” This means that the condition(s) must seriously limit a child’s activities, compared to same age children without disabilities.

The child’s condition(s) must have lasted, or be expected to last, at least 12 months; or must be expected to result in death.

The child must not be working at the SGA level.

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Sources of Law and Policy

United States Code (U.S.C.). Contains the federal statutes that created the Title XVI (SSI) (42 U.S.C. §1381 et. seq.) and Title II (42 U.S.C. §402 et. seq.) programs.

Code of Federal Regulations (C.F.R.). Contains the federal regulations implementing for the Title XVI (20 C.F.R. §416 et seq.) and Title II (20 C.F.R. § 404 et.seq.) Programs.

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Sources of Law and Policy

Case law. Decisions of the Federal District Courts, U.S. Circuit Courts of Appeals, and the U.S. Supreme Court.

Social Security Rulings (SSR). Statements of policy and interpretations adopted by SSA based on federal court and administrative decisions, policy statements, and opinions of SSA’s Office of General Counsel. Published in the Federal Register, they are binding on all components of SSA, but do not have the force and effect of law.

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Sources of Law and Policy

Acquiescence Rulings explain how SSA will apply decisions of the U.S. Circuit Courts of Appeals that are at odds with SSA’s national policies.

Program Operations Manual System (POMS).The POMS provides guidelines for day-to-day operations in SSA’s district offices and at Disability Determination Services (DDS). The POMS does not have the force and effect of law and cannot be used where it conflicts with the statute or regulations.

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Sources of Law and Policy

Hearings, Appeals and Litigation Law Manual (HALLEX). Published by the SSA Office of Hearings and Appeals (OHA), the HALLEX conveys guiding principles to OHA staff, defines procedures for carrying out policy, and provides guidance for processing and adjudicating claims at the ALJ hearing, Appeals Council, and federal court levels.

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Sources of Law and Policy

www.socialsecurity.gov

On the home page

– Go to - Our Agency

– Then, in the drop down box, choose - Program

Rules

– You can then choose to view statute provisions,

regulations, Social Security Rulings, POMS,

HALLEX, Emergency Messages, or Chief ALJ

Bulletins.

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Upon completion

Send the spoken verification words to

pabss@ndrn.org

Subject line - pre-requisite training

(If these are not received you will be denied entry to the

onsite training)

Feel free to send questions/comments to

Cheryl.Bates-Harris@ndrn.org

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