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Social Security

Last revised 3/20/2018

Content

Program Operations Manual System (POMS)

Definition of Disability

Disability in Children

Applying for SSI Benefits

Determination of Disability Eligibility for SSI

Social Security Benefits Accounts for Intellectually 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

Social Security Insurance Overpayment

Personal Notes

Differences between SSI, SSDI

Other Links


Program Operations Manual System (POMS)

This is the manual that Social Security representatives use as a reference to make decisions.

Table of Contents

https://secure.ssa.gov/apps10/poms.nsf/partlist

This webpage is based on Program Operations Manual System (POMS). The difference is that this webpage gives pointers for better outcomes and helping everyone stay within the rules required for SSI payments.

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.

Social Security Insurance Overpayment

The purpose of reviews by Social Security representatives is to root out fraud and make sure social security funds are distributed according to regulations. This should be the same objective of an SSI recipient. Key is intent to communicate with Social Security and to correct any missed information or any actual over payment.

How SSI Overpayments Can Happen

For recipients of SSI payments, all bank account balances must total no more than $2,000.00 with the exception of ABLE accounts. You cannot save for something as an explanation of why you went over $2,000.00. I have heard of examples of people saving for dental work. While I am not sure what the circumstances were, you may be able to pay in installments to the dentist.

One danger of going over the 2,000.00 dollar limit is when a person is hospitalized and your SSI payments no longer continue to go toward your housing. The SSI payments keep coming and even if you notify social security, it can take a while for them to adjust payments to a correct amount.

Another common danger of going over 2,000 dollar limit is uncleared checks. This is covered below.

To give you an example, your child is in a group home but is hospitalized for injury to self or others. This aggressive action has resulted in him being kicked out of the group home. I use kicked out because that is what it feels like for the parent, but the group home will use a more institutional word.

The action of leaving the group home results in SSI payments for room and board to stop and accumulate in the SSI recipient’s account. Depending on the length of stay in the hospital institution or until a new living situation can be found and/or when social security adjusts payment because of the new situation, it can accumulate greatly. This can lead to dilemmas of going over the $2,000.00 and keeping the overpayment so you can pay it back when social security asks for it or trying to stay below $2,000.00 by buying things the recipient can use.

This does not cover all possibilities of how SSI overpayment can happen.

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The Nuts and Bolts of Social Security Overpayment and Review by Social Security

Review of Financial Account(s) Information for Overpayment

Social Security must have written permission from you to access account information.

Social Security determines your account balance by the balance of all your accounts on the first day of a month. An SSI payment before the first of the month for that month is not included in the total of your account balance for that month to determine whether your account is below the $2,000.00 limit. An SSI payment can happen at the end of a month for the next month if the first day of the month falls on a holiday, Saturday or Sunday. If you get a statement from Social Security saying that your account(s) is over the $2,000.00 dollar limit and you owe Social Security, check and make sure that the calculation is correct because the above can be a mistake found in their calculations. This can be corrected in the review process with Social Security.

Uncleared checks can cause an account to go over the 2,000 dollar limit. An SSI recipient’s check registry can be used to determine that a check was written at such a date and along with a statement that proves the check cleared the account in a following month, this is enough proof to deduct that amount from the balance for determining actual available funds. “Since there is evidence that the claimant has written the check and legally obligated those funds in the account, and the records provide a complete and consistent picture of the account, the CR can deduct the amount of the uncashed check from the May 1st of the month balance. The CR can deduct the uncashed check because SSI equity value rules state that in determining equity value, we deduct encumbrances from the current market value (CMV).” This from the last entry in the operational manual linked below. There is further information on this webpage explaining the process of determining account balance.

Program Operations Manual System (POMS)

SI 01140.200 Checking and Savings Accounts

https://secure.ssa.gov/poms.nsf/lnx/0501140200

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Notifying and Communicating with Social Security

If you think your recipient’s account balance is going to go over the 2,000.00 dollar limit in the future it is better to notify Social Security as soon as possible and the reason why. Because a common reason for an accumulation of money in an account is a change of living circumstances, you can tell Social Security of the overpayment problem along with notify them of any change of address. Change of address of a Social Security recipient must happen as soon as you know of the change. If the account balance goes over the $2,000.00 beginning of the month limit (minus any SSI payment as explained in the above paragraph) you have 10 days to notify Social Security.

If your account goes over the 2,000 dollar limit because of an actual overpayment, it would be good to visit your local Social Security office with an actual check in hand for the overpayment. It is unlikely that the Social Security office will accept the payment at the office, but the attempt to correct the overpayment will be very beneficial to the SSI recipient under the review process.

The best way to notify Social Security is by phone or in person. The reason for this is that all calls or in person visits are noted as to what was discussed and time and date stamped. The payee, usually the mom of a person with intellectual or developmental disabilities, must make the call. There are two other ways of notifying Social Security, writing a letter and faxing. Both letter writing and faxing are not necessarily time stamped nor do they make it into an SSI recipient Social Security folder. Social Security document retention of communications from people who receive Social Security benefits is not that good.

Keep track of any communications with Social Security because if it is missing on the Social Security side you can show them your log and communications. During a review, you can ask to sign an affidavit stating how, when, and the content of the communication of the missing communication on the Social Security side. Even though calling or visiting Social Security is the best way to communicate with Social Security, it is good to follow up with a fax or letter where you retain a copy so that you can show it later.

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How to Engage with Social Security if you receive a Letter of Overpayment.

Read the letter and note the time period that the letter states an overpayment occurred and the amount. Gather documents for the time period. The chances are you know why and how the account(s) went over the 2,000 dollar limit. If you disagree with the fact stated in the letter, the letter will give you two ways of challenging the Social Security assessment. One is the “Request For Reconsideration” (Form SSA-561). The other is a “Waiver Of Recovery or Change Repayment Rate” (form SSA-632). You can ask for both. There is no harm.

Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate Form SSA- 632

The intent of this form is for someone who knows that an overpayment has happened and is requesting a complete waiver of the collection of that overpayment or a change in the amount to be paid back each month. The change is requested because of hardship. Collection is done by a reduction in SSI payments.

A wavier of all the overpayment is unlikely to happen through this process. You will not get a reduction in the amount of overpayment to be collected. A wavier or reduction in the collection of overpayment can happen under the reconsideration process.

Request for Reconsideration Form SSA-561

This is the process where you appeal the original determination of overpayment. You can provide facts and documents that Social Security did not have in making their original determination. You can point out miscalculations like the SSI payment being included when it should have been excluded as explained previously.

There are three ways to appeal. While the “Case Review” may seem to be the easiest as you can mail in or fax documents and never visit the local social security office, it can actually consume more of your time and is the least likely to get a satisfactory determination if you have good justification that the overpayment is not your fault and that you have tried to remediate the overpayment.

The only real difference between an informal and formal conference is the ability to bring outside parties to support your case in a formal conference. Either way you will meet the person deciding your case. Having personal interaction with the person deciding your case can be beneficial if you remain calm and composed and your intent is to come to an equitable resolution. The Social Security representative meets many people who are less than calm, so being calm works in your favor.

Before an informal or formal conference takes place you have a chance to set up a meeting in which you get to see what documents Social Security has based their original decision on. You can ascertain any communication or documents that are missing. Often the person giving you the documents will be the person making the decision on your case. They probably did not make the original decision that Social Security overpayed SSI payment(s). You can talk to them about your case and ask questions. You can explain what information is missing by Social Security like communications or a check not cashed in a timely manner. You can ask them what they need from you to prove what you are saying is true. Be friendly and build up a relationship. This first meeting can make the second meeting go smoothly with a transfer of documents and missing information.

During the second meeting of a formal or informal conference, you will meet with the Social Security representative who will make the decision on the overpayment on your case. You can give them copies of missing communications and check registry if needed. If the communication was time sensitive and Social Security does not have a copy of the communication, you will be asked or can ask to sign an affidavit stating the date and time you sent the communications and a summary of what was contained in the communications. If part of the problem is a check written on a certain date, but not cashed until the following month, besides a copy of your check registry, also bring the actual check registry to show the representative. Again keep the meeting cordial and friendly, this will work in your favor.

The Social Security representative will not make the decision at the formal or informal conference. You will get a letter in the mail shortly thereafter stating the decision.

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The Perpetual Error That Social Security Calculations Make That Compounds Overpayment For Following Months.

Looking only at the beginning account balance of each month fails to look at the expenditures of the SSI recipient, if the overpayment had not been made or had been rectified earlier. Currently Social Security takes months to figure out SSI overpayment and calculates a lump sum, but if Social Security figured out the overpayment sooner, a recipient’s expenditures would reduce the beginning account balance more quickly.

So for example: With an account balance at the beginning of the month of $2,400. The SSI payment is $733.00 and the recipient’s expenditures for the month are $733.00. So an SSI payment is made in that month with a beginning account balance of $2,400 + $733.00 = $3,144.00 but the expenditures are subtracted $3,144 - $733.00= $2,400, and we are back to the original beginning balance this can go on perpetually as long as expenditures do not exceed $733.00 or Social Security stops paying for one month. If the above happens for 12 months, a recipient could owe 12 X $733.00= $8796.00 but they really do not owe that because that is not the true overpayment. Only the original first payment of $733 that put the account above $2000 is the overpayment. This becomes a big problem when an overpayment is held in order to pay back Social Security and waiting for Social Security to figure out an overpayment.

Furthermore, by saying a SSI recipient owes a lump sum after X number of months instead of looking at it as each month’s overpayment, you are actually penalizing them more than they are worth. To illustrate, take the above example for 6 months with an account balance at the beginning of the month of $2,400. The SSI payment is $733.00 and the recipient’s expenditures for the month are $733.00. The person would have an account balance of $2,400 for six months and on the six month they have an emergency expenditure of $500.00 which drops their account below $2,000. So lump sum they owe 6 months x $733.00 SSI= $4,398.00, but if $733.00 had been taken out each month and they still have to pay the fixed living expense of $733.00 each month, their account would be decimated to a negative $1,998.00. Overpayment is arbitrary to a good extent when Social Security is figuring out overpayment in lump sum and the X months of overpayment are determined to have stopped only when the beginning account balance goes below $2,000.00 or the time from reporting the overpayment by recipient and Social Security investigates and notifies. Thus poor people are penalized needlessly.

It is a “catch-22” situation for SSI recipients realizing their account will be over $2,000. Social Security will not take back the overpayment until they realize they have overpayed. An SSI recipient who holds onto the overpayment in their account will compound their overpayment problem. If they go out and spend the money on what they really do not need at the time to get below $2,000 in their account, they are out that frivolous spending amount and they will still owe the overpayment to SSI. This just makes them poorer often at no fault of their own.

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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.

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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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