Supplemental Security Income (SSI)

Introduction
Eligibility Conditions
Benefits
Application Process
Financing
Administration
Procedures for Appeal

 

  

The SSI program is a nationwide federal assistance program administered by the Social Security Administration that guarantees a minimum level of income for “needy” aged, blind, or disabled individuals. Economically “needy” persons who are blind, disabled, or at least 65 years of age are eligible for monthly cash benefits. “Needy” blind or disabled children may also be eligible for SSI. As its name implies, Supplemental Security Income supplements a person’s income up to a certain level. The level varies from one state to another and can go up every year based on cost-of-living increases.

Income:
SSI is a means-tested program; therefore, income and resource rules apply in determining eligibility and payment amounts. Income eligibility depends upon applicant’s living-arrangement category and whether he/she has any earned and/or unearned income. The amount of an individual’s income is used to determine both eligibility for, and the amount of, his/her SSI benefit. As countable income increases, an individual’s SSI benefit amount decreases. Generally, ineligibility for SSI occurs when countable income equals the Federal benefit rate plus the amount of applicable Federally-administered State supplementary payment. These benefit rates are adjusted annually (in January) to reflect changes in the cost of living. The individual or couple is allowed income equal to the maximum payment amount. In using the following income figures, make certain to consider all of the income exclusions and explanations of living arrangements, which are listed at the bottom of the table. Because of earned-income exclusions, particularly, applicants could have more than double the amounts shown and still be eligible for some SSI benefits.

Living Arrangement Monthly Countable Income/Maximum Monthly Payment 2008 - New York State (includes state supplement)

  Individual Couple
Living alone $ 724.00 $ 1060.00
Living with others $ 660.00 $ 1002.00
Congregate Care I    
Areas A & B $ 903.48 $1806.96
Area C $ 865.48 $1730.96
Congregate Care II    
Areas A & B $ 1072.00 $2144.00
Area C 1 1042.00 2084.00
Congregate Care III    
Areas A & B $1293.00 $2586.00
Area C $1113.00 2226.00 
Living in the household of another $$447.67 683.34
Medicaid Facility $$$35.00     ---

Area A is New York City
Area B is Nassau, Suffolk, Rockland, and Westchester counties
Area C is all other counties in New York State
The Social Security Act defines two kinds of income: earned and unearned. Earned income is wages and net income from self-employment. All other income, such as Social Security benefits, workers’ compensation or income received in-kind (i.e., food, clothing or shelter-related items), is unearned.

SSI is a program of last resort for the aged, blind, or disabled whose income and resources are below specified levels. Therefore, income and resource exclusions pertain to the SSI program.

Countable income is earned and/or unearned income after the following deductions or exclusions (partial list):

The principal earned income exclusions are:

• the first $65 per month plus one-half of the remainder,
• impairment-related work expenses of the disabled and work expenses of the blind,
• income set aside or being used to pursue a plan for achieving self-support by a disabled or blind individual, and
• infrequent or irregularly received income ($10 or less a month).

The principal unearned income exclusions are:

• the first $20 per month,
• income set aside or being used to pursue a plan for achieving self-support by a disabled or blind individual,
• state or locally funded assistance based on need,
• rent subsidies under HUD programs and the value of food stamps, and
• infrequent or irregularly received income ($20 or less a month).

It should be noted that the incomes of others on whom an applicant is dependent (spouse or parent) will be attributed or “deemed” to the applicant in considering SSI eligibility and in determining SSI benefit levels.

Living Arrangements are defined as follows:

A. Living alone includes recipients living either alone, with foster children, with an authorized homemaker, or with a family care home placed by an authorized agency. Also includes recipients living with others but either paying a flat fee for room and board or preparing their meals separately.

B. Living with others includes recipients who reside in a dwelling with others and either:
1. prepare food in common with at least one other person in the dwelling;
2. are members of a religious community; or
3. are children who have not been included in State living arrangement C or D.

C. Congregate care I includes recipients in non-medical family type homes and family care homes. These homes serve persons who are unable to function completely independently. Family type homes are facilities certified by the State Department of Health, supervised by local departments of social services, and operated for the purpose of providing long-term residential care for adults. Family care homes are private households that provide care for mentally disabled persons. Eligibility for care in these homes is based on certification of placement by a local office of the Department of Social Services, an office of the State Department of Mental Health (OMH) or the Office of Mental Retardation-Development Disability (OMR-DD).

D. Congregate care II includes recipients in residential facilities who are aged or have mental disabilities. Facilities at this level are certified adult care facilities and certified, privately operated facilities for the mentally ill or developmentally disabled which provide care and services that enable residents to continue to live in the community.

E. Congregate care III includes recipients in non-medical privately operated, State certified, nonmedical, residential facilities which are operated for the purpose of providing treatment, training, and education for mentally retarded or developmentally disabled individuals.

F. Living in the household of another includes all recipients in Federal code B and for New York State purposes is considered part of the living with others living arrangement.

G. Living in a Medicaid facility includes all recipients in Federal code D. An additional State-administered supplement is provided to those recipients in Federal code D who are New York State residents and reside in health facilities defined in Section 2801 of the New York State Public Health Law (e.g. nursing homes).

Assets:
An individual may have assets up to $2,000 in 2009; a couple may have up to $3,000 (even if only one member is eligible for SSI). Resources include cash; bank account(s), stocks, U.S. savings bonds; land; life insurance; personal property; automobile(s); anything else you own which could be changed to cash and used for food, clothing, or shelter; and deemed resources. Assets that are not counted include the home you live in and the land it is on; household goods and personal property that are not worth more than $2,000; one wedding ring and one engagement ring; burial spaces for you or your immediate family; burial funds for you and your spouse (each valued at $1,500 or less); life insurance policies with a combined face value of $1,500 or less; one car, regardless of value, if it is necessary for employment or medical treatment; or modified for use or transportation of a disabled person; or necessary because of climate, terrain, distance or similar factors to perform essential daily activities. If the use of the car does not meet one of these conditions, then the equity value of such vehicle is a resource. Property essential to self-support; and resources set aside to fulfill a plan to achieve self-support are both principal resource exclusions.

Age:
Must be 65 or older, unless blind or disabled.

Disability:
Must be disabled or blind, unless 65 or older. An individual is considered statutorily blind if his/her central visual acuity is 20/200 or less in the better eye, with the use of correcting lens. An eye which has a limitation in the field of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees is considered to have a central visual acuity of 20/200 or less.

A person 18 or older is considered disabled if he/she is unable to engage in any substantial gainful activity: due to any medically determinable physical or mental impairment, or combination of impairments, 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.

There is no minimum age requirement for SSI eligibility. A child must be disabled or blind to receive SSI. If 18-22, the adult disability definition applies. If the child is blind, the same definition of blind applies as for adults. A child under the age of 18, whether or not married or head of household, is disabled if he/she has a medically determinable physical or mental impairment or combination of impairments that: results in marked and severe functional limitations, and has lasted or can be expected to last for a continuous period of not less than 12 months or can be expected to result in death.

Presence of Spouse:
Not a condition. A spouse is eligible if he/she meets the same conditions of eligibility as pertain to an individual. Benefits and eligibility for a couple are different from those for two individuals.

Presence of Children:
Not a condition.

Prior Contribution:
Not a condition.

Exhaustion of Benefits from Other Programs:
SSI applicants must apply for any other benefits due them. Appropriate coordination of the SSI program with the Food Stamp, medical assistance, and temporary State assistance also are important in keeping individuals from sliding further into poverty. Generally, SSI recipients are categorically eligible for Medicaid. SSI recipients in all States, except California, may be eligible for food stamps. 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 the individual’s SSI benefits were suspended and subsequently reinstated (the interim period).

Job Search:
Not a condition.

Participation in Work Program:
Since the beginning of the SSI program, a number of SSI disabled recipients have worked and received SSI payments. All SSI disabled recipients who work are considered section 1619 participants. The 1980 amendments to the SSA established section 1619, and provided additional work incentive provisions to assist SSI recipients in entering the workforce. The law contained a number of special income exclusions that were intended as work incentives including: Plans for Achieving Self-Support (PASS) permit a recipient with an approved PASS to set aside earned or unearned income and resources for a work goal. The income or resources set aside are used to pay for goods or services needed to reach the goal, such as education, vocational training, starting a business, or purchasing work related equipment. The income and resources are set aside under a PASS are excluded from SSI income and resource tests.


The Ticket to Work and Work Incentives Improvement Act of 1999 (“the Ticket Legislation”) established a Ticket to Work program under which a disabled beneficiary will be able to obtain vocational rehabilitation, employment and other support services from a qualified private or public provider. 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/her dependence on cash benefits.
The Ticket program provides that as long as the beneficiary is “using a ticket” as defined by the Commissioner, SSA will not initiate a continuing disability review.

Individuals receiving SSI benefits, who improve medically and, therefore, are no longer considered disabled or blind can continue to receive SSI benefits if they are actively participating in the Ticket to Work program, or another approved VR program, and continuation or completion of the program would increase the likelihood that they will be permanently removed from the SSI rolls. SSI benefits and Medicaid generally continue until the rehabilitation services are completed or until the individual ceases to participate in the program.

School Attendance:
A child is defined for SSI purposes as an unmarried blind or disabled individual who is not the head of a household and who is either under age 18 or aged 18-21 and regularly attending school.

Citizenship:
Generally, noncitizens in one of certain immigration categories granted by the Department of Homeland Security, may be eligible for SSI if: they were lawfully living in the United States on August 22, 1996, and are blind or disabled; they were receiving SSI on August 22, 1996, and were lawfully living in the United States; or were lawfully admitted for permanent residence under the Immigration and Nationality Act (INA) and have a total of 40 credits of work in the United States. (A spouse's or parent's work also may count.)

Some other noncitizens who may be eligible for SSI payments are: Active duty members of the U.S. armed forces; Noncitizen members of federally recognized Indian tribes; Certain noncitizens admitted as Amerasian immigrants; and Cuban/Haitian entrants under the Refugee Education Assistance Act.

7-year limit for some noncitizens :
Some refugees and other noncitizens can get SSI for up to 7 years. If SSI payments are limited to 7 years because of particular noncitizen status, Social Security will send a letter advising when the 7 year period ends, as well as a letter explaining rights to appeal before payments stop.

Other Eligibility Conditions:
Modifications were made as to when redeterminations must be done for SSI recipients who turn age 18 and when continuing disability reviews are to be done for certain low-birth-weight babies. In addition, although not an SSI provision, States are required to provide Medicaid coverage for disabled children who were receiving SSI payments and would have continued to be eligible for such payments except that their eligibility terminated because they did not meet the more strict childhood disability criteria
The SSI drug addict and alcoholic provision was clarified and the applicability of the treatment and representative payee provision was expanded. Any individual who is receiving SSI based on a disability where drug addiction or alcoholism is a contributing factor material to the finding of disability must comply with the DA&A treatment requirements. Instances of noncompliance with the requirements result in progressively longer payment suspensions.

Type:
Monthly cash payments.

SSI benefits are not the only form of assistance available to “needy” aged, blind, or disabled individuals. Medicaid, food stamps, and temporary state assistance are also important in keeping individuals from sliding further into poverty. SSA plays a limited but important role in helping states with regard to administration of the Medicaid and Food Stamp programs, and provisions in the SSI statute ensure that payments made by states or under the Social Security program are not duplicated by SSI benefits. SSI recipients may be eligible for other financial assistance in NYS. This includes Emergency Assistance for Adults (EAA), which is a state program set up to help SSI recipients who have an emergency such as a utility shut off, or a lost, stolen or unreceived SSI check. There are other social services that are available to SSI recipients in NYS through local departments of social services. These include: homemaker and housekeeper services; personal care; money management; or assistance in making living arrangements in group residences or family-type homes.

Interim Assistance Payment:
 Some states and local subdivisions make “interim assistance payments” to people while they wait for a decision on whether they can get SSI. The state or local government is reimbursed from the person’s first SSI payment.

Level:
Benefit levels depend upon living-arrangement categories. In determining the actual benefit that a recipient gets, the Social Security Administration subtracts countable income from the maximum benefit for the recipient’s living-arrangement category. A recipient with no countable income gets the maximum benefit for his/her living-arrangement category.

Change in Recipient Status:
Redeterminations are reviews of all of the nonmedical factors of eligibility to determine whether a recipient is still eligible for SSI and still receiving the correct payment amount. There are two types of redeterminations: scheduled and unscheduled. Scheduled redeterminations are selected periodically depending on the likelihood of payment error in the case. Except for certain institutionalized individuals, all recipients are periodically scheduled for a redetermination. Unscheduled redeterminations are completed on an as needed basis when recipients report, or it is discovered, certain changed in circumstances that could affect the continuing SSI payment amount.

SSI recipients are required to have their nonmedical eligibility factors redetermined periodically depending on their specific situation. In addition to these nonmedical reviews, medical reviews are conducted on disabled or blind recipients in order to determine if they continue to be disabled or blind. For administrative efficiency the medical reviews are done most often on those disabled or blind recipients whose medical conditions are considered likely to improve. Medical reviews are required for disabled or blind recipients, for example, under the following circumstances:

• when earnings of recipients exceed the substantial gainful activity level;
• at least once every 3 years for recipients under age 18 whose medical conditions are considered likely to improve;
• within 12 months after birth for recipients whose low birth weight is a contributing factor material to the determination of their disability unless the Commissioner determines that the impairment is not expected to improve within 12 months of the child’s birth; and
• within 1 year after attainment of age 18 and using adult eligibility criteria, for recipients whose eligibility for SSI benefits was established under the disabled child eligibility criteria.
Changes in Benefit Levels:
Maximum Federal Supplemental Security Income (SSI) payment amounts increase with the automatic cost-of-living increases that apply to Social Security OASDI benefits. The latest such increase, 5.8%, became effective January 2009. The new federal amounts are $674 for an eligible individual, $1,011 for an eligible individual with an eligible spouse, and $312 for an essential person. Some states supplement the SSI benefit for certain categories of recipients. Not all states administer its own supplemental payments. If a state does then an application for the supplement must be made separately with the state agency.

Where and How to Apply:
 Individuals can make appointments to apply for SSI benefits at any one of the approximately 1,300 SSA field offices around the country or through SSA teleservice centers. The claims process includes the application interview, the obtaining of necessary evidence and documentation, and the adjudication of the claim. Although the eligibility requirements of the Social Security program and the SSI program are different, the application process is very similar. Many times, individuals file for benefits under both programs at the same time. Potential claimants initially contact SSA by phone, mail or in person. Field office personnel conduct an interview with the claimant and/or his/her representative.

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 on ways to obtain the needed information. Because of the special circumstances of the SSI population (for example, financial need, old age, or illness), SSA makes special efforts to assist claimants in obtaining the necessary proofs.

An applicant should supply the following documentation: Social Security card or a record of applicant’s Social Security number; birth certificate or other proof of age; information about the home of the applicant (mortgage, lease, or landlord’s name); payroll slips, bank books, insurance policies, burial fund records, other information regarding income and assets; names, addresses, and telephone numbers of doctors, hospitals, and clinics that have seen the applicant; and proof of U.S. citizenship or eligible citizenship status.

With regard to disability and blindness claims, SSA makes determinations of all of the nonmedical eligibility factors while each State’s Disability Determination Service (DDS) makes determinations of the medical eligibility factors.

The process for making the disability decision is the same for both Social Security and SSI disability claims. The definition of disability is the same. However, under the SSI program there is no statutory waiting period of five months. If the SSI claim is approved benefits are payable the first full month after the application.

If the person applying seems to meet all the requirements and needs money right away due to an emergency, the Social Security office may issue an emergency advance payment. Usually SSA collects the amount of the advance payment from the SSI back pay or the first six SSI payments. If, however, the person is not eligible for benefits, the advance payment may have to be repaid.

Financing
Expenditures by Different Levels of Government
Expenses incurred by the SSA in administering the SSI program are initially paid from the OASI and DI Trust Funds. The trust funds are subsequently reimbursed for such expenditures from the General Fund of the Treasury. Federal SSI payments and administrative costs are financed from Federal Government general revenues. Some states provide optional supplements to help persons meet needs not fully covered by Federal SSI payments. The State determines whether it will make a payment, to whom, and in what amount. These supplements, paid on a regular monthly basis, are intended to cover such items as food, shelter, clothing, utilities, and other daily necessities determined by the individual States. Some States provide optional supplementary payments to all persons eligible for SSI benefits. Others may limit them to certain SSI recipients such as the blind or residents of domiciliary care facilities, or they may extend payments to persons ineligible for SSI because of excess income. When a State chooses Federal administration of its supplementation, SSA maintains that State’s payment records and issues the Federal payment and the State supplement in one check. Since passage of the Omnibus Budget Reconciliation Act (OBRA) of 1993, States are required to pay fees for Federal administration.

Federal: Currently, in New York State, the federal government contribution amounts to 90% or more of assistance to recipients living in households. For example, in 2009, a couple in the “living alone” category will get $1011 per month from the federal government and $104 supplementation from the State, for a total of $1038, the federal share being 90%. For congregate care, which is more expensive than community living, the state government pays a larger share.

State: Between 4% and 14% of the benefits for recipients not in congregate care is a supplement that is paid by the state government. The state supplements for levels I-III in Congregate Care category amount to between 30% and 51%. The federal government pays the highest federal benefit rate for these congregate-care recipients, and the state pays the additional costs, which amount to more than the state supplement for recipients living in households.

Local: There are no local funds for SSI.

Types of Taxes:
Federal: Even though SSA runs the program, SSI is not the same as Social Security. SSI is a Federal income supplement program funded by general tax revenues (not Social Security payroll taxes) 89% of which were derived from individual and corporate income taxes (2005).

State: State general revenues are 95% of which are derived from:
income taxes (45%); sales tax (28%); charges for education, hospitals, etc. and miscellaneous taxes (22%) (2003-2004). The state of New York adds money to the federal payment. The state of New York and the federal government have agreed to include the amount in the federal payment. One payment is received during the first week of each month that includes both federal and state money. State general

Local: There are no local funds for SSI.

Administration:
The SSI program, including the state supplement in New York State, is administered by the Social Security Administration and the New York State Office of Temporary and Disability Assistance.

Money for SSI payments comes from the general fund of the U.S. Treasury, not the Social Security trust funds. The state of New York adds money to the federal payment. The state of New York and the federal government have agreed to include the amount in the federal payment. One payment is received during the first week of each month that includes both federal and state money.

Procedures for Appeal:
Recipients must be informed in writing in advance of adverse actions SSA plans to take and must be given the opportunity to request that their benefits continue pending a decision at the first level of appeal.

At any time, an individual may appoint a representative in any dealings with the Social Security Administration. If such a representative is an attorney, he/she must be in good standing, have the right to practice law before a court, not be disqualified or suspended from acting as a representative in dealings with Social Security and not be prohibited by any law from acting as a representative. If the individual is not an attorney, he/she must meet qualifications specified by the Commissioner (e.g., be of good character and able to provide valuable service to claimants).

A representative may charge and receive a fee for his/her services, but the SSA generally decides how much the fee shall be. While the Social Security Act does not establish a maximum fee, most attorneys use an options process that limits their maximum fee to the lesser of 25% of the retroactive payment or $5,300. A representative cannot charge or receive more that the fee amount authorized. The SSI program differs from the Social Security program in that amounts cannot be withheld from an individual’s SSI benefits to pay for attorney fees. SSI claimants are responsible for paying such fees directly to their attorneys.

Requests for an appeal must be in writing within 60 days from the date you receive
the letter. There are four levels of appeal. They are (1) reconsideration, (2) hearing by an administrative law judge, (3) review by the Appeals council and, (4) federal court review. When a letter is sent with a decision on a claim enclosed will be an explanation on how to appeal the decision.