Supplemental Security Income (SSI) And Medicaid

1. Supplemental Security Income (SSI) And Medicaid Presented by Scott Leonard and Cathy Murahashi Department of Community and Human Services Developmental Disabilities Division

2. Social Security Administration

3. Social Security • Began in 1935: Social Security Act • Response to Great Depression • Protect workers from living in poverty after retirement • FICA taxes • 1954: *Disability Insurance (including for Disabled Adult Children) • 1974: Supplemental Security Income (SSI) • aged, blind, and disabled with economic need • managed by Social Security but not funded by FICA

4. SSA • The Social Security Administration, or SSA, is a federal agency. • Headquarters in Baltimore, Maryland • Over 60,000 employees.

5. Contacting SSA • Website: www.ssa.gov • Phone: 1-800-772-1213 • Local offices

6. SSA SSA administers two benefit programs for people with disabilities: • Supplemental Security Income (SSI); • Also known as Title XVI • Social Security Disability Insurance (SSDI); • Also known as Title II • Includes Childhood Disability Benefits (CDB);

7. What is SSI (Supplemental Security Income)? • Qualification: • Aged, blind, or disabled; AND • Typically limited work history; AND • Few resourcesand limited income. • Unable to perform substantial work at time of application. • Cash benefits Up to $674 / month. • Medicaid Managed by the State.

8. How does one apply for Benefits? • Internet: www.ssa.gov Only a partial SSI application can be completed online. • Call 1-800-772-1213 • Schedule face-to-face meeting; or • Schedule phone intake appointment

9. Application Age for SSI • If a person is under the age of 18, the parents’ income and resources will be considered. • If a person is over the age of 18, only the individual’s income and resources are considered.

10. SSI: When should I apply? • If a person intends to apply at age 18, she can apply as early as the 1st day of the month when she turns age 18.

11. SSI – AdultFinancial Eligibility • Earning less than $1,000 gross per month at time of application* • Resources: Less than $2,000. Exclusions apply. • Income: Earned and Unearned income allows for at least $1.00 SSI at time of application *Earnings can be greater if there is indication of a Subsidy.

12. Continuing Disability Reviews (CDR) • SSA must periodically review the disability status of all beneficiaries and recipients. • Most people who are clients of WA DDD receive a CDR every 3 to 7 years, though certain circumstances can trigger a new CDR.

13. SSI Redeterminations • In addition to the disability reviews, if a person receives SSI, SSA will conduct non-medical redeterminations to update income, resource, and living arrangement information. • These SSI redeterminations will occur every 12 months.

14. Appeals • People have the right to appeal an initial determination made by SSA, a denial of benefits, a reduction of benefits, termination of benefits, and overpayments.

15. Questions?

16. Top Ten List

17. SSA Top Ten List for SSI Recipients 10. When on SSI, it pays to work! 9. SSA offers work incentives. 8. Government systems don’t talk well with one another. 7. You are responsible for managing your own benefits. 6. Program rules are often not logical.

18. SSA Top Ten List 5. Read your mail and respond in a timely manner. 4. Never throw anything away. 3. Get organized! 2. It takes time to learn all of this information. 1. Stay connected and learn from other families.

19. SSI and Medicaid

20. How Much Is It? • Federal Benefit Rate (FBR). • For 2010 and 2011, FBR is $674. • Other states have additional State Supplemental Payments; WA does not.

21. SSI – What It Covers • The Federal Benefit Rate (FBR) - $674 - is considered the minimum amount that a person needs in order to live on a monthly basis.

22. SSI and Medicaid • SSI recipients in WA also receive Medicaid.

23. Medicaid

24. SSI and Medicaid • Enrollment is automatic • Managed by WA State DSHS Community Service Offices (CSOs) • Different types of Medicaid with different rules SSI Medicaid = Categorically Needy (CNP) Medicaid

25. Medicaid – Generally What It Covers • CNP Medicaid pays for mandatory health services such as: • Physician services, • Inpatient and outpatient hospital care; • Nursing home care; • Some Dental Care • Medicaid Personal Care; • Physical, occupational, and speech therapies; and • Prescriptions • Services under the DD Waiver

26. Medicaid • Medicaid is not the same as Medicare.

27. Lost Medicaid Card? • Call 1-800-562-3022; or • Visit https://fortress.wa.gov/dshs/npicaphrsa/P1WebForms/Default.aspx.

28. SSI General Ruleshttp://www.ssa.gov/pubs/11011.html

29. What Impacts SSI? In-kind Support Resources Income

30. In-kind Support

31. Rental Arrangement • SSI is for food and shelter costs. • If a person is receiving support and not paying a fair share of living expenses, then SSA can reduce that person’s SSI amount.

32. Rental Arrangement • Date of rental arrangement • Monthly rental amount • Is cost for just rent or a flat-rate for room and board? • Is this the same amount you would charge another? • If the tenant does not have enough money to pay for rent or room and board, will he/she owe it to you? • Repayment schedule • Cannot be based eligibility for a full SSI benefit check. • Signed by both tenant and landlord • Investigate tax implications

33. Resources

34. Resource Restrictions • To be eligible for SSI, a person must have less than $2,000 in resources ($3,000 if applicants are a couple and recipients of SSI). • Exclusions to this restriction include: • Personal home; • A car; • Money sheltered in a PASS; • Money and equity in a self-owned business; • Burial funds, up to a certain amount; • Retroactive SSA payments for a certain period; • Money sheltered in a Special Needs Trust.

35. Over-resources Example Jessica receives SSI. Her grandmother passes away, leaving her an inheritance of $10,000. What will happen to her SSI?

36. Example Continued • If Jessica does nothing, she will lose her SSI and Medicaid because she is over the $2,000 resource limit. • Jessica can spend down her $10,000; • Or, Jessica can shelter the money in a Special Needs Trust.

37. Special Needs Trust • A special needs trust preserves assets that would otherwise disqualify someone from SSI and Medicaid.

38. Special Needs Trust • One available trust is the Developmental Disabilities Life Opportunity Trust.

39. Income

40. Income vs. Resources Mr. Daniels wins a $5,000,000.00 lottery. • The moment he receives it, it is income (unearned). • The first moment of the first day of the next month, it is a resource.

41. Income Restrictions • “Earned” or “Unearned” • Earned Income: gross wages from a job. • Unearned Income: • SSDI; • Gifts; • Child Support; • Etc.

42. Income Exclusions Items that do not count as income • Food stamps; • Section 8; • Home Energy Assistance; • Assistance based on need funded by local government; • Small amounts of income received irregularly or infrequently; • Interest or dividends earned on countable resources or resources excluded under other Federal laws; • Grants, scholarships, or gifts used for tuition or educational purposes • Loans that have to be repaid • Work Incentives such as IRWEs, Student Earned Income Exclusion, and PASS. • Certain exclusions on Indian trust fund payments paid to American Indians who are members of a federally recognized tribe.

43. SSI and Earned Income

44. Earned Income and SSI If a person is working, SSA will adjust a person’s SSI amount based on his / her gross monthly wages.

45. Earnings and SSI - Reporting When first start working, you must notify SSA. Visit your local office, OR Call your local office. They will give you an info packet on how to report future wages.

46. Earnings and SSI - Reporting Ongoing reporting of wages: • Mailcopies of wage stubs to the local SSA office every month (Social Security will mail envelopes in which the wage stubs can be sent); OR • Call in wage information through a designated number.

47. Earnings and SSI - Reporting • Social Security takes wage information and reduces SSI accordingly. • This process takes 2 months. Wages in January will reduce SSI in March.

48. Calculation Example David receives $674 SSI. He begins working and gets paid $885 gross per month. What will be the new amount of his SSI?

49. Calculations Example $885 gross wages - $ 65 exclusion - $ 20 exclusion $800 $800 / 2 = $400 Countable Income $674 FBR* - $400 = $274 SSI.

50. Calculations Example If David is paid $885 gross/ month, he will receive a $274 SSI check, for a total of $1,159.