SSI is a federal program that provides monthly checks and medical coverage to people who are financially eligible and either 65 and older, or blind or disabled.
What are the medical eligibility requirements for SSI?
If you are blind or are over 65, and meet the financial and other rules, then you should be eligible for SSI. You will not get SSI automatically, however. You must apply for it from the Social Security Administration. Eligibility based on blindness or age should be fairly automatic. The following information covers general medical disability other than blindness.
In order to be found disabled under the SSI program, you must have a physical or mental condition or combination of conditions expected to last for 12 months or result in death. The mental or physical problem must limit your ability to function at work. For example, physical function is measured by your ability to lift, carry, sit, stand, walk and use your hands. Mental function can be your ability to concentrate, get along with co-workers or supervisors, maintain a schedule, and handle workplace stress. When Social Security assesses your ability to work, it evaluates your ability to keep a full-time job without special accommodation by the employer. Some disability situations can be complicated to sort out, and an attorney’s assistance is recommended. For example, people with drug or alcohol addiction or abuse problems must be able to show they are disabled without regard to the effects of current drug or alcohol use — benefits are not available if alcohol or drug abuse is a strong contributing factor to the disability.
What are the financial eligibility requirements?
SSI requires that you have both limited “resources” and limited “income.” The SSI financial eligibility rules are very complicated. An SSI financial eligibility worker will help you find out if you are eligible.
SSI requires that you have below $2,000 in countable resources, or, as a couple, below $3,000. Resources are things you may own, including cash, stocks, bonds and so forth. However, not all assets are countable. Your home does not count, no matter what its value. Personal belongings, household goods, insurance policies and cars may not count either, depending on their value and what they are used for. Resources you own but do not have the legal right to sell may not be counted, either. No matter how disabled you may be, if your resources are over the limit, then resources must be used or disposed of in a manner acceptable to the Social Security Administration before you can receive SSI.
The SSI income rules have categories of income such as earned, unearned and in-kind. In-kind income is the value of food, clothing or shelter. If you are given these things without having to repay anyone, then SSI will reduce your SSI monthly check by up to one-third. If you received a loan, instead of a gift, for food, clothing or shelter, then there is no one-third reduction in your check. Earned income, usually wages, is treated more favorably, reducing the SSI monthly check one dollar for every two dollars of earned income after the first $65 in earnings. Income such as VA benefits, Social Security Disability Insurance payments, rental income and pension benefits reduce SSI one dollar for every dollar of unearned income received.
What does the SSI recipient receive?
If you are found medically disabled, financially eligible, and there are no reductions for income, then the 2009 federal SSI monthly benefit is $674 for an individual and $1,011 for a married couple. SSI eligibility also makes you eligible for Medicaid health insurance, which provides basic health coverage. You must apply for Medicaid from the state of Oregon.
How do I apply?
The safest way to apply for SSI is to go to any Social Security district office in person. If it cannot take your application immediately, then you should ask for written proof that you attempted to apply while you were there, and then follow through with the instructions given to you for applying at a later date.
Social Security encourages people to call an 800-number to apply for benefits. But if you try to apply by any way other than going to a Social Security office, you may not be able to prove what date you first tried to apply. The date of the SSI application is very important since you cannot collect benefits until you apply — no matter when you became disabled — and your legal rights may change over time. If you cannot get to a Social Security office on the first day that you decide to apply, call (800) 772-1213 to apply, but still go to a Social Security office as quickly as possible to apply in person.
When you apply, you should provide as much information about your medical conditions as you possibly can. Get help from a friend, a lawyer or a social worker to help give the Social Security office a full picture of your problems. The more information the agency has, the quicker it can make a decision about your claim. Many applications are denied at first, however. Try not to be discouraged.
What happens after I file my application?
The SSI application asks you for information to determine medical and financial eligibility. Once the application is filed, it is sent to a state agency called Disability Determination Services. If your claim is denied, you should appeal quickly, as explained in the denial notice, and if possible, do so at the nearest Social Security office. Eventually you will have the right to see an impartial judge. You can present witnesses and other information to help the judge understand your health problems. A lawyer can represent you as well. You should talk to a lawyer as soon as your claim is denied, so you can find out how strong your case is and how much more evidence you will need to prove your claim. The lawyer cannot charge you for this help. If you win your claim on appeal, Social Security must authorize the lawyer’s fee.
Some things a person receiving SSI should know.
People who get SSI benefits must immediately report changes in income, resources, living arrangements and health. If changes are not reported to Social Security, or, sometimes even if they are, the Social Security Administration may issue more in SSI benefits than it should, causing an overpayment that the recipient might have to pay back. Changes should be promptly reported in provable ways. In other words, if you return to work and call Social Security to report your earnings, you will not be able to prove the telephone call was made. However, if you take your payroll check stub to the local office, and Social Security date-stamps a photocopy for you, then the photocopy is your proof that the income was reported.
Social Security is responsible for assuring that persons stop receiving SSI if they stop being disabled or financially eligible. You may receive questionnaires requesting medical records, or be required to see a doctor or psychologist for an examination from time to time.
Can an SSI recipient perform any kind of work?
It is sometimes possible for people receiving SSI to become partially employed without losing their right to benefits. A program representative can explain the rules, which are different for those who get SSI based on their age than for those who get SSI because of a disability.
Legal editor: Janay Haas, August 2009