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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
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
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