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Social Security



Content

Definition of Disability

Disability in Children

Applying for SSI Benefits

Determination of Disability Eligibility for SSI

Social Security Benefits Accounts for Mentally Disabled Individuals will only allow the Mother to be the Representative.

Social Security Income Benefit Details and How It Can Be Used

Uniform Gift to Minors Act (UGMA) and the Uniform Transfer to Minor Act (UTMA)

Receipt and Record Keeping

Social Security Redetermination

Social Security Time Lag

Personal Notes

Differences between SSI, SSDI

Other Links

This link https://www.ssa.gov/disability/professionals/bluebook/ is the gateway to understanding how Social Security evaluates and determines eligibility for Supplemental Security Income (SSI) benefits, and subsequently how most states determine eligibility for Medicaid and Medicare if you have a disability.

Definition of Disability

For all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) 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. https://www.ssa.gov/disability/professionals/bluebook/general-info.htm

Disability in Children

Under title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months. https://www.ssa.gov/disability/professionals/bluebook/general-info.htm

Autism and Intellectual disabilities fall under mental disorders for both children and adults. On the left hand side menu of the webpage referred to above, are links in a user friendly explanation of all disabilities that Social Security considers eligible for SSI. At the bottom of this webpage is the link to the Code of Federal Regulations (CFR) in appendix 1 to subpart P of part 404 list the disability impairments making an individual eligible for SSI.

Applying for SSI Benefits

You can apply for disability benefits in person, by mail to your local Social Security office: Social Security Office Locater by zip code: https://secure.ssa.gov/ICON/main.jsp

The mail in/walk in application is found here: https://www.ssa.gov/forms/ssa-16-bk.pdf

By toll-free telephone number 1-800-772-1213. If you are deaf or hard of hearing, you can call us at TTY 1-800-325-0778.

By filing online: https://www.ssa.gov/disabilityssi/apply.html

If you are a person helping another person apply for disability benefits you should read this webpage: https://www.ssa.gov/planners/thirdparty.html

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Determination of Disability Eligibility for SSI

Disability applications for SSI are initially processed through your local Social Security field offices and state agencies (disability determination services (DDS)). Determination of disabilities through a state agency is the main reason why in many states if you qualify for SSI you automatically qualify for Medicaid. In California, the disability determination service is the Department of Developmental Services (DDS) http://www.dds.ca.gov/

Subsequent appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges in SSA's Office of Disability Adjudication and Review (ODAR). https://www.ssa.gov/appeals/about_odar.html

Documentation of the existence of a claimant's impairment must come from medical professionals defined by SSA regulations as "acceptable medical sources." Acceptable medical sources are for autism are:

- Licensed physicians (medical or osteopathic doctors);

- Licensed or certified psychologists. Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing intellectual disability, learning disabilities, and borderline intellectual functioning only;

- Qualified speech-language pathologists, for purposes of establishing speech or language impairments only. For this source, “qualified” means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence from the American-Speech-Language-Hearing Association.

Full list: https://www.ssa.gov/disability/professionals/bluebook/evidentiary.htm

Once the existence of an impairment is established, all the medical and non-medical evidence is considered in assessing impairment severity: Medical Evidence from Treating Source, Medical Evidence From Health Facilities (hospitals, clinics, or other health facilities) and other sources include public and private agencies, non‑medical sources such as schools (IEP), parents and caregivers, social workers (Regional Centers, in CA) and employers, and other practitioners such as naturopaths, chiropractors, and audiologists. Full explanation of evidentiary requirements: https://www.ssa.gov/disability/professionals/bluebook/evidentiary.htm

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Social Security Benefits Accounts for Mentally Disabled Individuals will only allow the Mother to be the Representative.

This is not talked about, but Social Security will set up a mentally disabled individual account (their social security number) so that only the mother can officially communicate with them. This makes it hard if there are two parents that are involved in the beneficiary’s life.

Social Security Income Benefit Details and How It Can Be Used

SSI starts immediately once approved.

Payments for SSI are made for the first day of the month, unless the first of the month is on a Weekend or a legal holiday, in which case the payment is made on the first day prior that is not a weekend or a legal holiday. The payments are made directly into a bank account in the recipient’s name. Parents and/or custodial name(s) can also be added to the bank account. The best type account is a checking account as you will be writing checks.

As of 2016 the base benefit amount is $733 for an individual. This benefit is redetermined yearly. In some states, supplemental payments are made by the state, increasing the cash assistance available through SSI. For example, the state of California, through its State Supplementation Program (SSP), increases the cash assistance, making the total 2015 SSI benefit $889.40 per month. SSI is to help meet the costs of basic needs of food, shelter and clothing. It can also be used to pay for the beneficiary’s medical, including needed medication and dental care not covered by health insurance. It can be used for recreational costs once basic needs are met.

If the individual is placed in a group home the Federal part of the SSI will be used to help pay the cost of the group home. In a group home situation in California, the State Supplementation Program increased amount to SSI is used by the group home in a Personal and Incidentals Account (P&I). It is used for items that SSI is used for except towards housing. The SSI payment is deposited into the beneficiary’s bank account and you will have to write a check to the group home. Social Security will not pay the group home directly.

If an SSI beneficiary is placed in a school or group home outside of a state that gives increased cash assistance to the SSI payment, like California, the increased cash assistance stops. This happens even if the out of state placement is made by the school district and/or states social agency and the parents/guardians live within the state and the person is still considered a dependent. The federal portion of SSI does not reduce in such an out of state placement.

To receive or continue to receive SSI, a beneficiary must not have resources worth more than $2000.00. Some items that can be bought by other people and given to the beneficiary or with the SSI (like an expensive TV or a car) could cause the beneficiary to lose their SSI benefits. Check with social security before making major purchases or receiving an expensive item.

Any SSI money that accumulates in the beneficiary’s account putting it over $2,000.00 can account as a resource. Usually what happens is that the SSI payment is suspended until the beneficiary’s resources go below $2,000.00. If by some chance SSI payment is overpaid for a month or two, Social Security will reduce payments over a number of months to recoup the overpayment. Once the overpayment has been recouped, the SSI payments go back to normal. Supposedly in the letter determining overpayment you can write a check for the overpayment and send it to Social Security. This has never worked for me. They do not cash the check so just let the reduced SSI amount happen.

If the beneficiary has any college saving account(s) in his/her name, 529 college saving plan or Coverdell Education Savings Account setup by you or other people like grandparents, these are considered resources. A person can still apply and be approved for SSI benefits but will have to spend down any accounts and resources below $2000.00 to start receiving SSI.

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Uniform Gift to Minors Act (UGMA) and the Uniform Transfer to Minor Act (UTMA)

Watch out if a child with autism has either of these two accounts and gets SSI. The value of the accounts will not count against their resources as a minor but when the disabled person turns 18 or 21 depending upon state and type of account the trust goes into their name. An Age of Majority and Trust Termination Table by state and custodial account type: http://www.finaid.org/savings/ageofmajority.phtml

UGMA and UTMA are custodial accounts (trusts) because in most states, minors do not have the right to contract, and so cannot own stocks, bonds, mutual funds, annuities and life insurance policies that are inherited or given (gifted) to them.

The Uniform Gift to Minors Act (UGMA) is established by state statue instead of a trust document for a minor to own securities. The Uniform Transfer to Minors Act (UTMA) is similar, but also allows minors to own other types of property, such as real estate, fine art, patents and royalties, and for the transfers to occur through inheritance.

A better way for a disabled person to hold assets is to establish a special needs trust. A special needs trust can be set up by you or a lawyer. See webpage on Special Needs Trusts.

A Guide for Representative Payees: https://www.ssa.gov/pubs/EN-05-10076.pdf

Receipt and Record Keeping

Keep all receipts in which SSI is used for the benefit of beneficiary. There is a good chance early in receiving SSI benefits you will be asked to come into your local Social Security office so they can examine your spending. Bring your receipts. They will look over them and make copies of some of them.

I keep a spreadsheet of all spending where the spending took place, what was bought, by date and by year. I have a column with the amount for all food expenditures and a column with the amount for all other expenditures. When you get a Social Security Redetermination questionnaire (more below) there is a section asking totals for the amount you spent for certain time periods and it is split on food and everything else.

Social Security Redetermination

If an individual receives SSI social security will send you a questionnaire every 3 to 7 years. The most important thing is to fill out this questionnaire as best as possible and send it in before the deadline even if it is incomplete. Failure to send it back could end SSI benefits.

The redetermination is automatically set when a disability claim is approved. The review is set based on whether the disability can improve depending on medical condition (not an issue with Autism or mental retardation) and how backlogged your local social security office is. Social Security sends the case over to your state’s disability determination services. If an individual gets SSI they will get the redetermination questionnaire it is just a matter of when, so do not feel you are being singled out.

Reviewing Your Disability Social Security Official Publication https://www.ssa.gov/pubs/EN-05-10068.pdf

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Social Security Time Lag

Be warned Social Security can be slow and time lags can be hair pulling. Often is the case where you will send something in on time like the redetermination questionnaire and then you get a threatening letter from Social Security saying that they have not received the questionnaire by the deadline and your SSI benefits may be stopped. It is good to call your local Social Security office to tell them that you sent the form in on time and that you got this letter because they will log the call. They log everything. The representative will tell you not to worry if you sent the form in on time. Of course that is easy for them to say.

Personal Notes

I find Social Security to be fair in the long run. They seem to be insular.

The best way to communicate with them is by fax for important information you want to communicate to them (changes in address, overpayment, etc.). Faxing seems to get further up the administrative ladder.

If you call on the phone or visit your local Social Security office, you will be communicating more with an information gatherer than a decision maker. The quality of information from this first tier representative can vary greatly depending on their experience. I have gotten misinformation. Social Security SSI rules and eligibility are complex.

Social Security will only talk specifically of about a beneficiary with people registered with them to talk on the beneficiary’s behalf, usually only the mother. They do not seem to allow fathers to be registered to talk on their child’s behalf unless the mother is not in the picture.

Social workers have no access to Social Security or a beneficiary’s account even if the beneficiary is in a group home. The regional centers in California have no access and cannot talk to Social Security about the beneficiary. I was once told on the phone by a Social Security representative that they communicate with the regional centers all the time, but this is not true. Medicaid representatives have limited access to the Social Security database.

Thomas started receiving SSI as a child when he was first placed in a crisis home, subsequently in a group home, got kicked out of the child group home, and eventually went to a residential school specializing in behavioral problems.

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Differences between SSI, SSDI

These are two separate programs that can confuse people as to what they are. They are both run by Social Security.

SSI- Supplemental Security Income is a program that is strictly need-based, according to income and assets, and is funded by general fund taxes. SSI is called a "means-tested program," meaning it has nothing to do with work history, but strictly with financial need.

SSDI- Social Security Disability Insurance is available to workers who have accumulated a sufficient number of work credits. It is funded through payroll taxes. Unless a disabled person is able to work and accumulate sufficient number of work credits they will not be eligible for SSDI

Other Links

Code of Federal Regulations (CFR) in appendix 1 to subpart P of part 404 lists the disability impairments making an individual eligible for SSI.

Code of Federal Regulations

Appendix 1 to Subpart P of Part 404—Listing of Impairments
https://www.ssa.gov/OP_Home/cfr20/404/404-app-p01.htm

Disability Evaluation Under Social Security
https://www.ssa.gov/disability/professionals/bluebook/

Understanding Supplemental Security Income SSI and Other Government Programs -- 2016 Edition
https://www.ssa.gov/ssi/text-other-ussi.htm

Social Security Disability and SSI Overview
http://www.ssdrc.com/hub1.html

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