social security disability and supplemental security...
TRANSCRIPT
Edward Dimayuga, Staff Attorney,
LEGAL AID SOCIETY OF THE OCBA, INC.
Social Security Disability and
Supplemental Security Income
Basics For Child Advocate Attorneys
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Conference
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https://crowd.cc/galdisabilities
PLEASE INTERRUPT AND
ASK QUESTIONS.
Before I forget to tell you,
1. What are these programs? Who do they help?
2. Eligibility: Medical and Financial
3. Application Process: How is eligibility determined?
4. Post-eligibility
• Retirement, Survivors,
Disability Insurance
• Supplemental Security
Income
Nixon on SSI:“It reaffirms and
reinforces America's
traditional efforts to assist
those of our citizens who,
through no fault of their
own, are unable to help
themselves. America has
always cared for its aged
poor, the blind, and the
disabled--and this bill will
move that concern to
higher ground by
providing better and more
equitable benefits.”
RIB/DIB
• “Social Security,” “Retirement,” Disability Insurance Benefits, SSDI, Title II
• Pays monthly income based on FICA contributions from working
• Eligibility: RIB=retired; DIB=Medically disabled
Medicare
• “The Red, White, and Blue ID card”
• Part A pays hospitals and limited nursing home, Part B pays doctors, Part C is HMO, Part D
covers prescription drugs
• Eligibility: 65 y/o; receive any DIB payment after 24 month waiting period
SSI
• “Supplemental Security Income,” Title XVI, T16
• Provides cash for food and shelter expenses
• Eligibility: Age 65, or a finding of RIB/DIB eligibility or a separate finding of medical eligibility plus less income than federal benefit and less assets than $2,000
Medicaid
• “The Gold Card”
• Pays doctors, hospitals, and other medical providers through HMO plans
• Eligibility: receipt of at least $1 of SSI triggers automatic eligibility
It’s possible to collect them all: Concurrent
Benefits
Monthly Cash Benefit from SSA Health Insurance from CMSIn
sura
nce
. FIC
A
contr
ibutions
Welf
are
. Needs-
bas
ed, 6
5,
medic
ally
dis
able
d a
nd p
oor.
How does a child benefit under RSDI
without work?
• When the parent is disabled or retired and entitled to RSDI benefits.
• When a deceased parent worked long enough in a job where he or she paid SSA taxes.
• And: unmarried; under 18 or under 19 if a full-time student.
2012 SSI Annual Report
“Highlights”
8.3 million people received in Dec. 2012
The average monthly payment in Dec. 2012 was $519
54% female
16% under 18; 25% over 64
86% based on disability
57% had no income other than SSI
Congenital
Abnormalities
5%
Endocrine
Disease
1%
Infections
disease
0%
Injury
1%
Mental
Disorders
67%
Neoplasms
1%
Diseases
14%
Other
8%
Unknown
2%
SSI Recipients Under Age 18; Diagnostic Groups
Total: 1,311,861
Source: SSI Annual Statistical Report, 2012
Autistic
Disorders
14%
Developmental
Disorders
31%
Intellectual
Disability
14%
Mood Disorders
5%
Organic
Mental
Disorders
3%
Schizophrenic
and other
psychotic
disorders
0%
Disorders not
elsewhere
classified
29%
Other
4%
SSI Recipients Under Age 18; Mental Disorders
Total: 901,804
Source: SSI Annual Statistical Report, 2012
Florida
• 103,016 children under the age of 18
receive SSI
• Average monthly payment of $613.09
ELIGIBILITY: MEDICAL
Definition of Disability for Children
• If you are under age 18, we will consider you disabled if you have 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. Notwithstanding the preceding sentence, if you file a new application for benefits and you are engaging in substantial gainful activity, we will not consider you disabled.
• 20 CFR § 416.906.
DISABILITY IS NOT A MEDICAL
DETERMINATION.
IT IS AN ISSUE RESERVED TO
THE COMMISSIONER OF
SOCIAL SECURITY.
Sequential Evaluation for Children20 CFR § 416.924
Substantial Gainful Activity
Severe, Medically Determinable
Impairment lasting 12 months or in
death
Meet, Medically Equal, or
Functionally Equal the Listings
Note: it’s quite different for adults
The Listings
• 20 C.F.R. Pt. 404, Subpart P,
Appendix 1
• The Child Listings are Part B
• Compassionate Allowances are
available for approximately 250
very severe illnesses
Functional Equivalence:
2 marked or 1 extreme
Acquiring and using
information
Attending and completing tasks
Interacting and relating with
others
Moving about and manipulating
objects
Caring for yourself
Health and physical well-
being
See also Social Security Ruling 09-01p et seq.
ELIGIBILITY: FINANCIAL
No more than $2000 in
assets…
Income
• Income and resources of people responsible
for the SSI recipient’s welfare considered
• Parent-to-child
• Calculations are complex
• Can cause ineligibility
THE APPLICATION PROCESS
Initial Application ReconsiderationAdministrative
Law JudgeAppeals Council Federal Court
This is an ALJ:
• Medical Records
• Educational Records
• Medical Source Statements
• Teacher Questionnaires
• Non-medical evidence
POST-ELIGIBILITY ISSUES
Representative Payees
• Required Duties:
• Determine the beneficiary’s needs and use his or her payments to meet those needs;
• Save any money left after meeting the beneficiary’s current needs in an interest bearing account or savings bonds for the beneficiary's future needs;
• Report any changes or events which could affect the beneficiary’s eligibility for benefits or payment amount;
• Keep records of all payments received and how they are spent and/or saved;
Representative Payees
• Required Duties:
• Provide benefit information to social service agencies or medical facilities that serve the beneficiary;
• Help the beneficiary get medical treatment when necessary;
• Notify SSA of any changes in your (the payee's) circumstances that would affect your performance or continuing as payee;
• Complete written reports accounting for the use of funds; and
• Return any payments to which the beneficiary is not entitled to SSA.
Master Trust Accounting
• 402.17, Fla. Stat.; 65C-17, Fla. Admin. Code
• DCF CF Operating Procedure No. 175-59
• “…To hold certain money and property for
the benefit of certain Family safety clients.”
• What happens at age 18? DCF v. RG, 950
So.2d 497 (Fla. 5th DCA 2007)
• New regulations?
Special Instructions for SSI Recipients
with Master Trust accounts
• Funds held must not exceed SSI asset limits at
any time
• If the balance exceeds $1500 at the end of a
quarter, DCM needs to develop an
expenditure plan for the next three months
within 10 working days
• Numerous Sample Pleadings at
DCF CF Operating Procedure No. 175-59
Income ReportingWHO REPORTS INCOME
If you receive SSI benefits, you must report any earnings from work or any other money or help that you,
your spouse or children living in your household receive.
If you are the representative payee for an adult who receives SSI benefits, you must report any income
that the individual, his or her spouse, or children living in the recipient’s household receive.
If you are the parent, stepparent, or representative payee for a child under age 18 who receives SSI
benefits, you must report any income that the child, his or her parent(s), stepparent, or brother(s) or
sister(s) receive.
WHAT INCOME TO REPORT
EARNINGS FROM WORK
Any jobs
When work starts
Amount of pay
How often paid
When work stops
Changes to your amount of pay
When you contact us, ask how to report money earned from
work over the telephone.
Submit pay stubs, a copy of the Federal income tax return for
self-employed individuals.
OTHER MONEY OR HELP
Any money or help received by family members who live with
the person who receives SSI
Type of money or help (see reverse for examples)
Amount of money or help
How often payments are received
When the payment or help changes or ends
Submit an award letter or proof of other monies or help.
WHERE AND WHEN TO REPORT INCOME
Call our toll-free number at 1-800-772-1213.
Your local Social Security office.
For the deaf or hearing-impaired, call TTY 1-800-325-0778.
Report new income or any change in income as soon as it
happens, but no later than the 10th day of the month following
the change. For example, if work begins May 22, report
immediately, but no later than June 10.
http://vcu-ntc.org
Look for the NTC Manual
Finding a way off Disability
Work Incentives Planning & Assistance
(WIPA/CWIC)• Brevard Achievement Center: Brevard, Flagler, Indian River, Lake,
Martin, Okeechobee, Orange, Osceola, Palm Beach, Putnam, Seminole, St. Lucie, and Volusia.
• Abilities, Inc. of Florida: Citrus, DeSoto, Hardee, Hernando, Highlands, Hillsborough, Levy, Manatee, Pasco, Pinellas, Polk, Sarasota, Sumter.
• Center for Independent Living Central Florida: Brevard, Charlotte, Collier, Glades, Hendry, Lee, Miami-Dade, and Monroe.
• Goodwill Industries of North Fla: Alachua, Bay Bradford, Calhoun, Columbia, Dixie, Escambia, Franklin, Gilchrist, Gulf, Holmes, Lafayette, Liberty, Marion, Okaloosa, Santa Rosa, Suwannee, Taylor, Union, Walton, and Washington.
• Independent Living Resource Center of NE Florida: Baker, Clay, Duval, Gadsden, Hamilton, Jackson, Jefferson, Leon, Madison, Nassau, Wakulla, and St. John’s.
Reasons for Termination:
Under Age 18: 2012
Excess Income 26,502
Excess Resources 3,012
Death 4,686
Whereabouts unknown 3,012
In public institution 944
Failed to furnish report 4,416
Outside United States 674
No longer disabled 13,103
Other 3,529
The Age 18 Redetermination
And Continuing Disability
Reviews
Remember: these benefits keep
families out of poverty
ANY QUESTIONS?
Edward Dimayuga
Legal Aid Society of the Orange County Bar Association, Inc.
407-841-8310