Federal entitlement programs for the aged,
blind, or
disabled have their roots in the original Act of 1935. The Act established an old-age social insurance program administered by the Federal Government and an old-age
means-tested assistance program administered by the States. Congress added similar programs for the blind or disabled to the Act in later years. Means-tested assistance provided a safety net for individuals who were either ineligible for Social Security or whose benefits could not provide a basic level of income.
This means-tested assistance comprised three separate programs —
Old-Age Assistance, Aid to the Blind, and Aid to the Permanently and Totally Disabled. Despite substantial Federal financing, these programs were essentially State programs. Federal law established only broad guidelines for assistance. The Federal Government provided matching funds to support whatever payment levels the States established, with no maximum or minimum standards. Consequently, each State was responsible for setting its own standards for determining who would get assistance and how much they would receive.
Beginning in the early 1960s, this State-operated, federally assisted system drew criticism directed at the “crazy quilt”
1 eligibility requirements and payment levels. Other criticism centered on specific requirements, such as lien laws and provisions that required certain relatives to bear responsibility for the maintenance of family members in need.
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Appropriate coordination of the SSI program with supplemental nutrition assistance, medical assistance, and other programs. 2
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Income and resource limit. If an individual’s income or resources go above the limit, he or she may not qualify for SSI assistance. The countable income limits for individuals and couples are equal to their respective Federal benefit rates (FBR) 3 and generally increase annually according to changes in the cost of living. For 2022, the FBR is $841 a month for individuals and $1,261 a month for couples. The resource limit is $2,000 in countable resources for individuals and $3,000 for couples.
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Definition of disability and blindness. The definitions for individuals age 18 or older are the same as those used for the Social Security program. In order to be considered disabled, an individual must have a medically determinable physical or mental impairment that is expected to last or has lasted at least 12 continuous months or is expected to result in death and: (1) if age 18 or older, prevents him or her from doing any substantial gainful activity (SGA); 4 or (2) if under age 18, results in marked and severe functional limitations. Individuals for whom addiction to drugs or alcoholism is a contributing factor material to the determination of their disabilities are not eligible for benefits. In order to be considered blind, an individual must have central visual acuity of 20/200 or less in the better eye with the use of a correcting lens or with a visual field limitation of 20 degrees or less in the better eye.
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a noncitizen who was receiving SSI benefits on August 22, 1996; or
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Certain immigrants lawfully residing in the United States for humanitarian reasons: 6
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Refugees (eligibility generally limited to the 7-year period after their arrival in the United States);
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Asylees (eligibility generally limited to the 7-year period after the date they are granted asylum);
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Noncitizens certified by the Department of Health and Human Services to be victims of certain types of human trafficking in the United States 7 (eligibility generally limited to the 7 years after a determination is made that they are trafficking victims); and
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Afghan citizens or nationals (or individuals with no nationality who last habitually resided in Afghanistan) who: (1) were granted parole into the United States between July 31, 2021 and September 30, 2022 or (2) were paroled into the United States after September 30, 2022 and are either the spouse, child, or parent or legal guardian (of an unaccompanied minor) of a person described in (1). The United States Citizenship and Immigration Services (USCIS) refers to these parolees as “Afghan Non-Special Immigrant Parolees.” 8 Eligibility for these individuals ends on the later of March 31, 2023 or when the person’s parole period ends.
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Students studying abroad for not more than 1 year also may continue to be eligible for payments if the studies are sponsored by a U.S. educational institution but could not be conducted in the United States.
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The Act requires us to consider an individual’s income in determining both eligibility for and the amount of his or her SSI benefit. We first compute an individual’s “countable” income (i.e., income less all applicable exclusions) on a calendar month basis. We then compute his or her monthly benefit by subtracting countable income from the applicable
Federal benefit rate (FBR).
9 Generally, ineligibility for SSI occurs when countable income equals the FBR plus the amount of an applicable federally administered State supplementation payment.
10
The Act defines two kinds of income—earned and unearned. Earned income is wages, net earnings from self-employment, remuneration for work in a sheltered workshop, royalties on published work, and honoraria for services. All other income is
unearned, including, for example, Social Security benefits, pensions, and unemployment compensation. The distinction between earned and unearned income is significant because different exclusions apply to each type of income.
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We use the Value of the One-Third Reduction (VTR) to determine the ISM value when a recipient lives throughout a month in another person’s household and receives both food and shelter from others living in the household. The VTR is equal to one-third of the FBR. This reduction is not rebuttable even if the individual can show that the actual value is less.
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We use the Presumed Maximum Value (PMV) to calculate the ISM value in all other cases (e.g. the recipient receives free food but not shelter, or free shelter, but must pay for food). The PMV is the maximum amount we can count as income and is equal to one-third of the FBR plus $20. Unlike the VTR, the PMV is rebuttable. If an individual can show that the actual value of the food or shelter received is less than the full PMV, then we count the actual value of the food or shelter received as unearned income.
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The first $20 per month; 11
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The Act also
requires us to consider the value of an individual’s resources in determining SSI eligibility for a given month.
12 In general, individuals who have countable resources, determined monthly, that exceed $2,000 ($3,000 for a couple) are ineligible for SSI. Our regulations define “resources” as liquid assets, such as cash, or any real or personal property that individuals, spouses of individuals, or parents of a child under the age of 18 own and could convert to cash for their support and maintenance; however, there are numerous and complex exceptions to this general rule.
If an individual disposes of resources at less than fair market value within the 36-month period prior to his or her application for SSI or at any time thereafter, he or she may be penalized. The penalty is a loss of SSI benefits for a number of months (up to a 36-month maximum).
13 The penalty does not apply if the applicant can show that the resources were disposed of exclusively for a purpose other than establishing SSI eligibility.
The principal resource exclusions
14 are:
As the “program of last resort,” eligible individuals receive SSI benefits only to the extent other income and resources do not satisfy their needs. After evaluating all other income and resources, SSI pays what is necessary to bring an individual to the statutorily prescribed income floor. In keeping with this principle, the
Act requires that SSI applicants and recipients file for all other payments for which they may be eligible, such as annuities, pensions, retirement or disability benefits, workers’ compensation, and unemployment insurance benefits.
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A physician certifies that the recipient’s stay in a medical treatment facility is likely not to exceed 3 months, and SSA determines that continued SSI eligibility is necessary to maintain and provide for the expenses of the home to which the individual will return. In this situation, the recipient may continue to receive the full benefit for any of the first 3 full months of medical confinement if he or she meets all other conditions for payment.
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When individuals enter medical treatment facilities in which Medicaid pays more than half of the bill, the law generally requires us to reduce their monthly FBR to $30 beginning with the first full calendar month they are in the facility. In the case of an individual under age 18, the $30 payment amount is also applicable if private insurance or a combination of Medicaid and private insurance pays more than half the bill. In these cases, the SSI program provides up to $30 a month for small comfort items not provided by the facility.
The Act requires us to count, in certain situations, the income and resources of others in determining whether an individual’s income and resources fall within the income and resource limits established by law. We call this process “
deeming”; it applies in cases where an eligible individual lives with an
ineligible spouse, an eligible child lives with an ineligible parent, or an eligible noncitizen has a sponsor.
16 In concept, the practice takes into account the responsibility of the spouse, parent, or sponsor to provide for the basic needs of the eligible individual.
When an eligible individual lives in the same household with a spouse who is not eligible for SSI, we deem the ineligible spouse’s income and resources to be available to the eligible individual. In determining the amount of income and resources available to the eligible individual, we use all applicable exclusions. We also deduct from the income available for deeming a living allowance for any ineligible children under age 18 (or under age 22 and a student) living in the household, which reduces the amount of income to be deemed.
17 Spouse-to-spouse deeming generally results in approximately the same amount of income available to the couple that would be available if both members of the couple were aged, blind, or disabled and eligible for SSI.
In the deeming computation, we first exclude from the parent’s income certain types and amounts of income that are not subject to deeming. We then subtract a living allowance for each ineligible child under age 18 (or under age 22 if a student).
18 Then we use any exclusions that apply to the remaining income (for example, the $20 general income exclusion), and subtract a living allowance based on the number of parents living in the household. Finally, we deem the remainder to be available to the eligible children in equal shares.
Under the old version of the affidavit, deeming of the sponsor’s income and resources lasts until the noncitizen has been in the United States for 3 years.
21 The law provides living allowances equal to the Federal benefit rate for the sponsor as well as allowances equal to one-half of the FBR for each of the sponsor’s dependents. The law also provides allowances for the sponsor and his or her family members in determining deemed resources. These allowances reduce the amount of the sponsor’s income and resources deemed to the noncitizen.
In calculating these expenses, amounts equal to the costs of certain attendant care services, medical devices, equipment, prostheses, assistive technology, vehicle modifications, residential modifications to accommodate wheelchairs, and similar items and services are deductible from earnings. The costs of routine drugs and routine medical services are not deductible unless these drugs and services are necessary to control the disabling condition.
The student earned income exclusion is an additional exclusion for an individual who is under age 22 and regularly attending school. Under current regulations, we exclude up to $2,040 of earned income per month but no more than $8,230 per year.
22
The Ticket to Work and Work Incentives Improvement Act of 1999 established a Ticket to Work and Self-Sufficiency program under which a blind or disabled beneficiary may obtain VR, employment, and other support services from a qualified private or public provider, referred to as an “employment network” (EN), or from a State VR agency. In addition, the Ticket to Work legislation provided that ENs would be compensated under an outcome or outcome-milestone payment system.
23 By expanding the pool of providers and giving the providers incentives for achieving success, this program seeks to expand a disabled beneficiary’s access to these services in order to assist the beneficiary in finding, entering, and retaining employment and reducing his or her dependence on cash benefits.
In 2008, SSA revised the Ticket to Work regulations to enhance beneficiary choice and improve the effectiveness of the program. The revisions extended the program to all adult OASDI disabled and SSI blind or disabled beneficiaries, removed disincentives for ENs to participate in the program, provided incentives for ENs to support beneficiaries through a more gradual return to work and positioned ENs to better support ongoing retention of employment. The regulations also encourage partnership between State VR agencies and ENs to provide long-term services to a beneficiary by allowing the beneficiary to assign a ticket to an EN after receiving VR services.
To meet the requirement of having become unable to perform SGA, previously entitled beneficiaries must also not be able or become unable to perform SGA because of the medical condition in the month of the request. In determining whether the individual is disabled or blind, the Medical Improvement Review Standard (MIRS) generally applies.
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SSI applications have no retroactivity and become effective in the month after the month of filing or the month after all eligibility requirements are met, whichever is later. Eligibility for payments in a month is based on resources owned as of the first day of the month and income received in that month, in addition to other criteria. We generally calculate the amount of the monthly payment using income in the second month preceding the month for which the payment is made.
26 However, at the start of a period of eligibility or re-eligibility, we determine the amount of payments for both the first and second months using the income received in the first month.
SSI recipient participation in direct deposit increased gradually in the 2000s after experiencing a period of sharp growth when it more than doubled from 24 percent in 1995 to 49 percent in 2000. Effective May 1, 2011, applicants filing for SSI benefit payments must choose direct deposit, the Direct Express® debit card, or an
electronic transfer account (ETA). Effective March 1, 2013, individuals must receive their SSI benefits electronically through direct deposit, the Direct Express® debit card, or ETA unless they qualify for an automatic exemption (e.g., based on age) or are granted a waiver on the basis of hardship. Examples of such hardship situations include inability to manage an account at a financial institution or Direct Express® due to mental impairment, or to living in a remote geographic location lacking the necessary infrastructure to support electronic financial transactions. As of March 2022, 96.6 percent of SSI recipients received their benefits electronically.
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When earnings of recipients exceed the SGA level; 27
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When SSI recipients are incapable of managing or directing others to manage their benefits, or are declared legally incompetent, we appoint representative payees for such recipients who receive the individual’s SSI benefits on their behalf. In many cases the representative payee is a spouse, a parent, or other close relative or individual who will act in the recipient’s best interest. In some limited cases, SSA approves an organization to serve as a payee. SSA authorizes certain types of organizations to collect a fee from the individual’s payment for acting as payee. The fee cannot exceed the lesser of 10 percent of the payment amount or a specified amount ($48 a month in 2022).
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Representative payees may use an SSI recipient’s benefit only for the use and benefit of the recipient and must account for all benefits received. The Act requires representative payees to report any changes that may affect SSI recipients’ eligibility and payment amount. SSA may hold representative payees liable for certain overpayments that occur. In cases in which a child is due a
retroactive payment that exceeds six times the FBR, including any optional State supplementation payments, the Act requires the representative payee to establish a dedicated account at a financial institution to maintain the
retroactive payment. Representative payees must make expenditures from the account primarily for certain expenses related to the child’s impairment.
Individuals who disagree with an SSA determination (e.g., eligibility for or the amount of SSI benefits) can appeal by filing an appeal request online
29 or by writing to their local field office. There are four levels of appeal: reconsideration, hearing, Appeals Council review, and Federal court review. If individuals do not agree with the decision they receive at one level, they may appeal to the next. A reconsideration is a complete review by SSA personnel (or DDS personnel if applicants are appealing a disability determination) who have had no involvement in the initial determination.
30 A hearing gives applicants the opportunity to appear before an administrative law judge (ALJ) who had no part in the initial determination or the reconsideration. The Appeals Council may dismiss a request for review, deny a request for review if there is substantial evidence supporting the hearing decision, decide the case itself, or remand the case to the hearing level for further action. A Federal district court may look at cases when applicants disagree with the Appeal Council’s decision or denial of the request for review.
With a limited exception, representatives must use one of SSA’s fee authorization processes to request a fee for their services.
31 They can request a fee by either submitting a fee agreement or filing a fee petition. SSA reviews the documents and authorizes the fee the representative may charge or receive. Under the statute, the fee under an approved fee agreement is the lesser of 25 percent of the past-due benefits or a maximum amount (currently $6,000) adjustable by the Commissioner at his or her discretion. There is no limit on the amount of the fee based on a fee petition; a reasonable fee is determined after reviewing the specific services provided by the representative. After SSA authorizes the fee, the representative may not charge or receive more than the amount authorized.
The SSI program previously differed from the Social Security program in that we did not withhold amounts from an individual’s SSI benefits to directly pay the representative his or her authorized fee. SSI claimants were responsible for paying such fees directly to their representatives. However, beginning February 28, 2005, Congress extended direct payment of both attorney and non-attorney representative fees to the SSI program.
32 As in the fee process for the Social Security program, we can withhold up to 25 percent of the individual’s SSI past-due benefits to pay an eligible representative’s fee directly. The law also requires that we charge representatives an assessment of the smaller of 6.3 percent of each authorized fee withheld or the flat-rate cap of $104.
33 This assessment applies to authorized fees withheld under the SSI program and the Social Security program; however, in concurrent cases, we only charge the assessment once based on the total fee we directly pay to the representative. We adjust the flat-rate cap based on annual cost-of-living adjustments that we round down to the next lower dollar.
In designing the SSI program, Congress recognized that States,
34 in many instances, may want to provide a higher level of income maintenance than the Federal SSI program provides. Thus, the law gives the States the option to supplement Federal payments based on their views of the needs of their citizens. Lawmakers also mandated that States not provide lower benefits under the Federal program than they had provided under the former State program.
The following paragraphs describe the current forms of State supplementation. Table III.H1 summarizes State-specific participation in these programs as well as other programs requiring State and Federal coordination as discussed in section
III.H.
In addition to optional State supplementation programs, in limited cases, States must pay mandatory supplementation payments. Congress requires States to maintain the December 1973 income levels of individuals who were transferred in 1974 from the former State adult assistance programs to the SSI program, with two exceptions: Texas, which has a constitutional bar against mandatory State supplementation, and West Virginia, because the SSI FBR in 1973 exceeded the applicable income standards under that State’s adult assistance programs. Over the years, many individuals who converted to SSI from the State benefit rolls have died and others have had their incomes increase above the December 1973 level. As a result, few individuals continue to receive mandatory State supplementation payments.
A State may administer its supplementary program or enter into an agreement under which SSA will make eligibility determinations and payments on behalf of the State. Under State administration, the State pays its own program benefits and absorbs the full administrative costs. Under Federal administration, States are required to pay SSA a fee for each supplementary payment issued. In fiscal year 2022, the fee is $13.16 per payment issued.
35 Fees increase in succeeding fiscal years based on increases in the Consumer Price Index for All Urban Consumers.
States that administer their own supplementary payment programs to SSI recipients establish their own eligibility criteria for the supplementary payments. States with federally administered programs may supplement the Federal benefit among a limited number of geographical and living arrangement variations for SSI recipients.
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To meet the passalong requirement, a State may either maintain each State payment level from year to year — the “payment levels” method — or it may spend the same amount of money, in the aggregate, that it spent for supplementary benefits in the 12-month period preceding the increase in the SSI benefit rate — the “
total expenditures” method. Currently, 38 States use the payment levels method and 9 States plus the District of Columbia use the total expenditures method. There are three States that do not pay State supplementary payments. West Virginia has no optional supplementary plan and the legislation did not require it to establish a mandatory plan because Federal SSI income standards exceeded all payments made under the State’s adult assistance programs in 1973. Arizona and North Dakota have no optional supplementary plan and no mandatory minimum State supplementation recipients remaining.
SSA also plays a limited but important role in helping States administer the Medicaid Program and the Supplemental Nutrition Assistance Program (SNAP).
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Table III.H1.—
SSI State Supplementation
a and Coordination with Other Programs
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