[Background Material and Data on Programs within the Jurisdiction of the Committee on Ways and Means (Green Book)]
[Program Descriptions]
[Section 3. Supplemental Security Income (SSI)]
[From the U.S. Government Printing Office, www.gpo.gov]
SECTION 3 - SUPPLEMENTAL SECURITY INCOME (SSI)
CONTENTS
Background
Trends
Basic Eligibility
Categorical Requirements
Citizenship and Residency Requirements
Prohibition of Payment to Felons and Fugitives
Income and Resource Requirements
Presumptive Eligibility for Persons with AIDS and HIV
Public Institution Requirement
Application to Other Programs Requirement
Eligibility for Social Security
Eligibility for Medicaid
Eligibility for Food Stamps
Self-Sufficiency and SSI
SSI Benefits
Federal SSI Benefit Standard
Benefits for Persons Living in the Household of Another
Benefits for Persons Living in a Medicaid Institution
Benefits of Former Recipients of State Assistance
Overpayments
Faster Initial SSI (and Social Security) Payments
State Supplementation
Maximum SSI and Food Stamp Benefits for Individuals Living
Independently
Comparison of SSI Payment Levels to Poverty Thresholds
Trends in the SSI Caseload
Number of Recipients
Characteristics of Adult Disabled and Blind Recipients
Characteristics of Recipients Receiving Benefits on the Basis of
Age
Characteristics of Children Receiving Benefits
Overview of Caseload Developments
Eligibility of Drug Addicts and Alcoholics
Eligibility of Noncitizens
Eligibility of the Homeless
Special SSI Provisions for the Working Disabled
Earned Income Disregards
Eliminating Work Disincentives
Special Benefits for Certain World War II Veterans
Measures of SSI Participation and Growth
SSI Participation Rates
Changes in Number of Recipients, 1970-2002
SSI Program Costs
Legislative History
104th Congress
105th Congress
106th Congress
107th Congress
References
BACKGROUND
The Supplemental Security Income (SSI) Program is a means-tested,
federally administered, income assistance program authorized by title
XVI of the Social Security Act. Established in 1972 (Public Law
92-603) with benefits first paid in 1974, SSI provides monthly cash
payments in accordance with uniform, nationwide eligibility
requirements to needy aged, blind, and disabled persons.
The SSI Program replaced the Federal-State Programs of Old-Age
Assistance and Aid to the Blind established by the original Social
Security Act of 1935 as well as the Program of Aid to the Permanently
and Totally Disabled established by the Social Security Amendments of
1950. Under the former programs, Federal matching funds were offered
to the States to enable them to give cash relief, "as far as
practicable" in each State, to eligible persons whom the
States deemed needy. The States set benefit levels and administered
these programs. The Federal-State adult assistance programs continue
to operate in Guam, Puerto Rico, and the Virgin Islands. Under the
Covenant to Establish a Commonwealth of the Northern Mariana Islands,
enacted as Public Law 94-241 on March 24, 1976, the Northern Mariana
Islands became the only U.S. jurisdiction outside the 50 States and
the District of Columbia authorized to operate an SSI Program.
The Congress intended the new SSI Program to be more than just a Federal
version of the former State adult assistance programs which it replaced.
In describing the new program, the report of the Committee on Finance
stated: "The Committee bill would make a major departure from the
traditional concept of public assistance as it now applies to the aged,
the blind, and the disabled. Building on the present Social Security
Program, it would create a new Federal program administered by the
Social Security Administration (SSA), designed to provide a positive
assurance that the Nation's aged, blind, and disabled people would no
longer have to subsist on below poverty-level incomes" (U.S. Senate,
1972, p. 384).
The SSI Program was envisioned as a basic national income maintenance
system for the aged, blind, and disabled which would differ from the
State programs it replaced in a number of ways. It would be
administered by SSA in a manner as comparable as possible to the way
in which benefits were administered under the Social Security Program.
While it was understood that modifications would be necessary to make
SSA's systems work for the new program, SSI was seen as an add-on
rather than a new system. SSA had a longstanding reputation for
dealing with the public on a fair and humane basis, but with scrupulous
regard for the requirements of law. Thus, it was expected that both
recipients and taxpayers would be pleased with the outcome.
Under the former adult assistance programs the amount of assistance
could vary from person to person according to an evaluation of the
individual's needs. The SSI Program, by contrast, represented a "flat
grant" approach in which there would be a uniform Federal income
support level.
In contrast to the former State programs with their provisions for liens
against property and relative support requirements, the SSI Program was
intended to have minimal barriers to eligibility other than a lack of
income. Even here, the new SSI Program incorporated more generous
provisions for disregarding income C particularly earned income C than
was provided under the Old-Age Assistance Program. The report of the
House Committee on Ways and Means stated that the SSI Program was
designed to provide incentives and opportunities for those able to work
or to be rehabilitated that would enable them to escape dependency
(U.S. House, 1971, p. 147).
For the most part, the nature of the SSI Program is expressed by its
title. It was conceived as a guaranteed minimum income for the aged,
blind, and disabled which would supplement the Social Security Program
and act as an income-related program to provide for those who were not
covered or minimally covered under Social Security or who had earned
only a minimal entitlement under the program.
It should be noted that even though SSA administers the SSI Program, SSI
is not the same as Social Security. The SSI Program is funded by
general revenues of the U.S. Treasury - personal income taxes, corporate
taxes, and other taxes. Social Security benefits are funded by the
Social Security taxes paid by workers, employers, and self-employed
persons. The programs also differ in other ways such as the conditions
of eligibility and the method of determining payments. In addition,
States have the option of supplementing the basic Federal SSI payment.
In some cases, State supplementary payments are administered by the
State instead of SSA.
TRENDS
Table 3-1 summarizes the trends in the SSI Program:
1. The number of recipients on SSI has risen from nearly 4 million
in 1974 to 6.8 million in December 2002. The number of SSI recipients
declined early in the program as the number of aged individuals on SSI
declined, but that trend reversed in the mid-eighties as rapid growth in
disabled recipients outstripped the minimal change in the elderly and
blind SSI populations.
2. Total annual benefits paid under the SSI Program rose from about
$5.2 billion in 1974 to $34.6 billion in 2002.
3. The monthly Federal benefit rates for individuals and couples
rose from $140 and $210 in 1974 to $552 and $829 in 2003 (2003 figures
are not in table), respectively. Nearly all of these changes resulted
from the statutory indexation of the Federal benefit rates to the
Consumer Price Index (CPI).
4. The proportion of SSI recipients receiving Social Security
benefits declined from nearly 53 percent in 1974 to 36 percent in 2002.
The fraction of SSI recipients receiving some other type of unearned
income rose slightly from about 11 percent in 1974 to 12 percent in
2002, and the fraction with earnings increased slightly from less than
3 percent in 1974 to more than 4 percent in December 2002.
5. The Federal benefit rate as a percent of the appropriate poverty
level for individuals has ranged from 72 to 77 percent and was 76
percent in 2002; for couples it has ranged from 86 to 91 percent and was
90 percent in 2002. Most States supplement the Federal benefit for at
least some participants.
6. The SSI Program pays benefits to children who are blind or have
other disabilities. Some of the increases in participation since 1991
reflect the revised definition of disability for children as a result
of the Supreme Court's decision in the Sullivan v. Zebley case. Public
Law 104-193 (enacted August 22, 1996) established a more restrictive
disability definition for children which is expected to result in a
slower rate of growth in the number of children receiving SSI benefits.
BASIC ELIGIBILITY
CATEGORICAL REQUIREMENTS
To qualify for SSI payments, a person must satisfy the program criteria
for age, blindness, or disability. The aged are defined as persons 65
years and older. The blind are individuals with 20/200 vision or less
with the use of a correcting lens in the person's better eye, or those
with tunnel vision of 20 degrees or less. Disabled individuals are
those unable to engage in any substantial gainful activity by reason of
a medically determined physical or mental impairment expected to result
in death or that has lasted, or can be expected to last, for a
continuous period of at least 12 months. The test of "substantial
gainful activity" in calendar year 2003 is to earn $800 monthly in
counted income, with impairment-related expenses subtracted from
earnings. Generally, the individual must be unable to do any kind of
work that exists in the national economy, taking into account age,
education, and work experience. Children may qualify for SSI if they
are under age 18 (or under age 22 if a full-time student), unmarried,
and meet the applicable SSI disability or blindness, income, and
resource requirements. Public Law 104-193, the Personal Responsibility
and Work Opportunity Reconciliation Act (PRWORA) of 1996, established
a new disability definition for children under age 18 which requires a
child to have "a medically determinable physical or mental impairment
which results in marked and severe functional limitations, and which
can be expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12 months."
TABLE 3-1--SUPPLEMENTAL SECURITY INCOME SUMMARY, SELECTED YEARS
1974-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Under pre-1996 law, low-income children could qualify for SSI benefits
in two ways: their disability could match one of the impairments in the
medical "listing of impairments" or they could be evaluated under an
individualized functional assessment disability determination procedure
(generally considered a less stringent process) that determined whether
an unlisted impairment seriously limited a child's ability to perform
activities normal for his age. Both methods were stipulated in Federal
regulations. Until the Supreme Court's 1990 ruling in Sullivan v.
Zebley, the medical listings were the only way to determine a child's
eligibility for SSI benefits. Adults, in contrast, could receive an
assessment of their functional and vocational capacities even if they
did not meet one of the listings. The Court ruled that sole reliance on
the listings did not satisfy the law's requirement to gauge whether
children's disorders were of comparable severity to impairments that
would disable adults. The 1996 welfare reform law discontinued the
individualized functional assessment and the "comparable severity"
standard upon which it was based. Many children on the rolls as a
result of an individualized functional assessment had their benefits
terminated, and future awards based on individualized functional
assessments were barred. Thus, the SSI Program for Children is
restricted to those who have impairments that meet or equal at least
one of the listings. Pursuant to the 1996 law, the listing of
impairments has been changed to reflect the new disability
definition for children.
CITIZENSHIP AND RESIDENCY REQUIREMENTS
To qualify for SSI a person must be a citizen of the United States or,
if not a citizen, be a refugee or asylee who has been in the country for
less than 7 years, or be a "qualified alien" who was receiving SSI as of
August 22, 1996 or who was living in the United States on August 22,
1996 and subsequently became disabled. Subsequent to 1996, changes were
made to the alien eligibility requirements that extended to certain
groups of aliens, added new categories to the list of qualified aliens,
exempted certain Native Americans from the eligibility limitations and
granted SSI eligibility to aliens who are determined to be victims of
"severe forms of trafficking in persons." (For more detailed information
on eligibility requirements for noncitizens, see Appendix J.)
In addition to the citizenship requirement, a person must be a resident
of the United States or the Northern Mariana Islands, or a child of a
person in the military stationed outside the United States, or a student
temporarily abroad; must apply for all other benefits to which she is
entitled; and must, if she is disabled, accept vocational rehabilitation
services if they are offered.
PROHIBITION OF PAYMENT TO FELONS AND FUGITIVES
The 1996 welfare reform law provides that, as of August 22, 1996, SSI
benefits may not be paid to individuals who are fleeing to avoid
prosecution for a felony crime, or fleeing to avoid custody or
confinement after conviction for a felony crime, or violating a
condition of probation or parole imposed under Federal or State law.
INCOME AND RESOURCE REQUIREMENTS
Income
Individuals and couples are eligible for SSI if their incomes fall below
the Federal maximum monthly SSI benefit, currently $552 for an
individual and $829 for a couple (calendar year 2003 standards). If only
one member of a couple qualifies for SSI, part of the ineligible
spouse's income is considered to be that of the eligible spouse (this
procedure is called "deeming"). If a couple separates, each person is
treated as an individual in the month following the month of separation.
If an unmarried child living at home is under age 18, some of the
parent's income is deemed to that child. If an immigrant is sponsored
into the United States, some of the sponsor's and the sponsor's spouse's
income may be deemed to that immigrant.
Income includes cash, checks, and items received "in kind" such as food
and shelter. Wages, net earnings from self-employment, and income from
sheltered workshops are considered earned income. Social Security
benefits, workers or veterans compensation, annuities, rent, and
interest are counted as unearned income.
An individual does not have to be totally without income to be eligible
for SSI benefits. Maximum SSI benefits are paid, assuming the other
conditions of eligibility are met, if the individual or couple has no
"countable" income in that particular month. If the individual or couple
has "countable" income, a reduction is made against the maximum payment.
Not all income is counted for SSI purposes. Since 1972, the major
exclusions have included the first $20 of monthly income from virtually
any source (such as Social Security benefits), and the first $65 of
monthly earned income plus one-half of remaining earnings.
Income received in sheltered workshops and work activity centers is
considered earned income and qualifies for the earned income exclusion.
Table 3-2 shows the maximum income that an individual and couple can
have, taking into account these income exclusions, and still remain
eligible for Federal SSI benefits.
TABLE 3-2--MAXIMUM INCOME FOR ELIGIBILITY FOR FEDERAL SSI BENEFITS, 2003
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Work-related expenses are disregarded (i.e., subtracted from income) in
the case of blind applicants or recipients and impairment-related work
expenses are disregarded in the case of disabled applicants or
recipients. The SSI Program also does not count income and resources
that are set aside as part of an approved plan for achieving
self-support (PASS). A PASS is an income and resource exclusion that
allows an SSI recipient who is blind or disabled to set aside income
and resources for a work goal. The money set aside can be used to pay
for such items or services as education, vocational training, or
starting a business.
The value of any in-kind assistance is counted as income unless such
in-kind assistance is specifically excluded by statute. Generally,
in-kind assistance provided by or under the auspices of a federally
assisted program, or by a State or local government (for example,
nutrition, food stamps, housing, or social services), will not be
counted as income. As described later, if an SSI applicant or recipient
is living in the household of another and receiving in-kind support and
maintenance from him, the SSI benefit standard for such an individual is
reduced by one-third. By regulation, SSA also has ruled that the value
of any in-kind support and maintenance received (other than in-kind
assistance received by reason of living in another's household) is
presumed to equal one-third of the Federal SSI benefit standard plus
$20. The individual can rebut this presumption. If it is determined that
the actual value is less than the one-third amount, the lower actual
value will be counted as unearned income.
In-kind support and maintenance provided by a private nonprofit
organization to aged, blind, or disabled individuals is excluded under
the SSI Program if the State determines that the assistance is provided
on the basis of need. Certain types of assistance provided to help meet
home energy needs also are excluded from income. For example, certain
assistance provided to an aged, blind, or disabled individual for the
purpose of meeting home energy costs by a home heating oil or gas
supplier, a utility company, or a private nonprofit organization also is
excluded. As countable income increases, a recipient's SSI benefit amount
decreases. Generally, ineligibility for SSI occurs when countable
income equals the Federal benefit standard plus the amount of State
supplementation, if any.
Resources
Since 1974 SSI eligibility has been restricted to qualified persons who
have resources of not more than $2,000, or $3,000 in the case of a
couple. The resource limit for a couple applies even if only one member
of a couple is eligible. If the couple separates, the person is treated
as an individual in the following month. If an unmarried child living at
home is under age 18, the parent's assets are considered to be the
child's (i.e., deemed to the child). In determining countable resources,
a number of items are not included, such as the individual's home, and,
within reasonable limits set by SSA, household goods, personal effects,
an automobile, and a burial space for the individual, spouse, and members
of the immediate family. Regulations place a limit of $2,000 in equity
value on excluded household goods and personal effects and exclude the
first $4,500 in current market value of an auto (100 percent of the
auto's value is excluded if it is used to obtain medical treatment or for
employment or has been modified for use by or transportation of a
handicapped person or is necessary to perform essential daily activities
because of distance, climate, or terrain). The value of property which
is used in a person's trade, or business, or by the person as an
employee also is excluded. The value of certain other property that
produces income, goods, or services essential to a person's self-support
may be excluded within limits set by SSA in regulations. SSI and Social
Security retroactive benefit payments may not be considered as a
resource for a period of 6 months after the month in which the
retroactive benefit is received. Resources set aside under a PASS also
are excluded.
The cash surrender value of life insurance policies if the total face
value of all policies is $1,500 or less is not counted toward the $2,000
or $3,000 countable resources limit. The entire cash surrender value of
life insurance policies, if the total face value of all policies on an
individual's life is greater than $1,500, counts toward the resources
limit, but may be excludable under one of the other resource provisions.
An individual and spouse may have excluded up to $1,500 each of burial
funds. However, the $1,500 maximum amount is reduced by the face value
of any excluded life insurance policies and the value of any irrevocable
burial contracts, trusts, or arrangements. If left to accumulate,
interest earned on excluded burial funds and burial spaces is not
countable as either income or resources for SSI purposes.
Individuals who give away or sell any nonexcludable resource for less
than fair market value may be subject to penalty. Also, such a transfer
may make the individual ineligible for certain Medicaid covered nursing
services. SSA must notify individuals of the penalty and provide
information upon request to the States regarding transfers of resources.
The Deficit Reduction Act of 1984 (Public Law 98-369) requires the
Internal Revenue Service (IRS) to furnish SSA with certain nonwage
information about SSI recipients. The IRS information consists primarily
of reports of interest payments submitted to IRS by financial
institutions but also includes income from dividends, unemployment
compensation, and other sources. In fiscal year 1987, computer
matches between IRS tax files and SSI records resulted in 239,000
matches. Only cases involving IRS reports of interest income of $51 or
more were examined. The resulting savings to the SSI Program were $64
million. As a result of SSA's evaluation of these cases, the tolerance
level was lowered to $41 beginning with fiscal year 1988 and 398,000
matches were identified. In fiscal year 1989, there were 508,000 matches.
SSA has evaluated and adjusted the tolerance levels several times over
the years. Effective October 1993, the tolerance level for income from
resources ''e.g., interest and dividends'' is $60. The tolerance level
for other nonwage income not from resources ''e.g., unemployment
compensation and pensions'' is $1,000. Also, a special tolerance was
developed for cases that had been matched before; if the current year's
resources are less than $10 more than the prior year's resource
indicators, the IRS report is not examined. All match information is
sent to Social Security offices for verification of the information.
For fiscal year 2002 there were 92,000 matches.
Based on a study of the 1993 matches, SSA decided to apply a statistical
profiling technique to the IRS matches. Statistical profiling increases
the cost effectiveness of the IRS process by targeting the more
error-prone matches and eliminating the less productive matches. The
resulting savings to the SSI Program were $45 million.
Prior to the 1984 Deficit Reduction Act, if in any month a recipient's
assets exceeded the asset limit, the individual was ineligible for
benefits in that month and the entire amount of the benefit paid for
that month was considered an overpayment subject to recovery.
Effective October 1, 1984, SSI law provides that in cases where
there is an overpayment based solely on an excess of assets of $50 or
less, the recipient is deemed to be without fault for purposes of
waiving the overpayment and the overpayment is not recovered unless the
Secretary finds that the failure to accurately and timely report the
excess was knowing and willful on the part of the recipient.
An individual may receive SSI benefits for a limited time even though he
has certain nonliquid property that, if counted, would make him
ineligible. These benefits are conditioned upon the disposal of the
property, and are subject to recovery as overpayments when the property
is sold. The 1987 Budget Reconciliation Act provides, in addition, for
the exclusion of real property if it cannot be sold because it is
jointly owned and sale would cause undue hardship to the joint owner due
to loss of housing, because there are legal impediments to its sale, or
because reasonable efforts to sell it have been unsuccessful.
Deeming of Income and Resources
The income of an ineligible spouse who lives with an adult SSI applicant
or recipient is considered in determining the eligibility and amount of
payment to the individual. The income of the parents of a child under
the age of 18 who is blind or disabled also is considered in determining
the eligibility and payment for the child. However, since 1990, children
with disabilities who are eligible for Medicaid at home under State home
care plans, who previously received SSI personal needs allowances (PNAs)
while in medical institutions, and who otherwise would be ineligible for
SSI because of their parents' income or resources, have been eligible
for the $30 monthly PNA that would be payable if they were
institutionalized, without regard to their parents' income and resources.
Effective October 1, 1993, an ineligible parent or spouse who is absent
from a household due solely to a duty assignment as a member of the
Armed Forces is considered, absent evidence to the contrary, to be
living in the same household as the SSI applicant or recipient for
deeming purposes.
By regulation, the Commissioner of Social Security has provided that in
determining the amount of the income of an ineligible spouse or parent
to be deemed to the SSI applicant or recipient, the needs of the spouse
or parent and other children in the household are taken into account. In
addition, the SSI earned and unearned income exclusions are applied in
determining the amount of income to be deemed to the SSI applicant or
recipient. If the combined countable income of an SSI applicant and an
ineligible spouse does not exceed the SSI benefit standard for an
eligible couple in that State (including any federally administered State
supplementary payment), the SSI applicant would be eligible to receive an
SSI and/or State supplementary benefit.
For example, in 2003 in a State with no supplementation, here is how the
deeming procedure would work in the case of an ineligible spouse earning
$600 per month living with an eligible individual with $200 of Social
Security benefits:
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Thus, the benefit for the eligible individual will be $381.50 (SSI law
requires that benefits be rounded down to the next lower dollar).
Without deeming and as an individual, the recipient would have received
$372 [$552 - ($200 less $20 exclusion)]. The $20 exclusion can be used
only once and is applied first to unearned income, which in this example
is the $200 of Social Security income. An individual's resources are
deemed to include those of the ineligible spouse (or in the case of a
child under the age of 18, those of the parents) with whom the
individual is living. Under SSI regulations, in determining the amount
of the spouse's or parents' resources that can be deemed, all applicable
exclusions are applied. In the case of a child, only the value of the
parents' resources that exceeds the applicable limits ($2,000 for a
single parent, and $3,000 for two parents) is deemed to the child.
Also, under regulations, pension funds of an ineligible spouse or
parent are excluded from deeming. In December 2002, there were about
167,970 children's cases in which deeming reduced benefits. This figure
does not take into account, however, the number of children who were not
eligible because of the deeming provision. (For a discussion of deeming
rules for noncitizens, see Appendix J.)
PRESUMPTIVE ELIGIBILITY FOR PERSONS WITH AIDS AND HIV
Section 1631(a)(4)(B) of the Social Security Act provides
that the Commissioner of Social Security may pay up to 6 months of SSI
benefits to a person applying for benefits based on disability or
blindness prior to the determination of the individual's impairment if
the individual is presumptively disabled or blind, and otherwise
eligible. A finding of presumptive disability or blindness may be made
at the Social Security field offices only for specified impairment
categories because the field office employees generally are not trained
disability adjudicators; however, at the State agencies where there are
disability adjudicators a finding of presumptive eligibility may be made
for any impairment category.
On February 11, 1985, acquired immune deficiency syndrome (AIDS), as
defined by the Centers for Disease Control, was added (pursuant to
interim Federal regulations) to the impairment categories, thus allowing
field offices to find presumptive disability for persons claiming they
had AIDS. These regulations were scheduled to expire February 11, 1988,
but were extended until December 31, 1989; and in 1989 they were
extended until December 31, 1991. In December 1991, a new more liberal
regulation was implemented. Under the new procedures, the Social
Security field offices may make a finding of presumptive disability for
any individual with the human immunodeficiency virus (HIV) whose disease
manifestations are of listing-level severity, rather than only for those
who have been diagnosed with AIDS.
SSA standards governing presumptive SSI eligibility for persons with
HIV disease have been challenged in court in at least one State on the
grounds that they discriminate against women. The contention is that the
listing of impairments reflects the course of HIV disease in men, while
women tend to have different symptoms and therefore are excluded. Others
have argued that the Centers for Disease Control definition and the
somewhat broader SSA listing have failed to keep pace with changing
manifestations of HIV disease.
PUBLIC INSTITUTION REQUIREMENTS
Public institutions are prisons, hospitals, nursing homes, or
any institution that is operated or administered by a governmental unit.
The governmental unit could be the Federal, State, city, or county
government, or another political subdivision of the State. Residents of
public institutions for a full calendar month are ineligible for SSI
unless one of the following exceptions applies:
1. The public institution is a medical treatment facility and
Medicaid pays more than 50 percent of the cost of care.
2. The individual is residing in a publicly operated community
residence which serves no more than 16 residents. Such a facility must
provide an alternative living arrangement to a large institution and be
residential (i.e., not a correctional, educational, or medical
facility).
3. The public institution is a public emergency shelter for the
homeless. Such a facility provides food, a place to sleep, and some
services to homeless individuals on a temporary basis. Payments to a
resident of a public emergency shelter for the homeless are limited to
no more than 6 months in any 9-month period.
4. The individual is in a public institution primarily to receive
educational or vocational training. To qualify, the training must be an
approved program and must be designed to prepare an individual for
gainful employment.
5. The individual was eligible for SSI under one of the special
provisions of section 1619 of the Social Security Act (see section on
"Special SSI Provisions for the Working Disabled") in the month
preceding the first full month of residency in a medical or psychiatric
institution which agrees to permit the individual to retain benefit
payments. Payment may be made for the first full month of
institutionalization and the subsequent month.
6. A physician certifies that the recipient's stay in a medical
facility is likely not to exceed 3 months and the recipient needs to
continue to maintain and provide for the expenses of the home to
which she may return. Payments may be made for up to the first 3 full
months of institutionalization.
To help institutionalized individuals return to
community living, the SSI Program includes a prerelease procedure for
institutionalized individuals. Some individuals are medically ready to
be released from an institution but are financially unable to support
themselves. The prerelease procedure allows such individuals to
apply for SSI payments and food stamps several months in advance of
their anticipated release so benefits can commence quickly after
release. A formal prerelease agreement can be developed between an
institution and the local Social Security office. However, an
individual can file an application for SSI under prerelease without
the existence of such an agreement. Under Federal law, residents of
public institutions for a full calendar month generally are
ineligible for SSI benefits. Prisons are considered public
institutions. The bar against SSI benefits to prisoners has been
enforced through an exchange of computerized data between SSA and
the Federal Bureau of Prisons, State prisons, and some
county prisons. According to the SSA's Office of the Inspector General,
these computerized arrangements generally covered about three-quarters
of inmatesCall Federal and State prisoners but only about 15 percent of
county prisoners. The agreements were voluntary and until recently
involved no payments to the institutions. However, the 1996 welfare
reform law (Public Law 104-193), required the Commissioner of Social
Security to enter into a contract with any interested State or local
institution (such as a prison, jail, or mental hospital) under which
the institution regularly would provide to the Commissioner the names,
Social Security numbers, dates of birth, and such other identifying
information concerning the inmates or residents of the institution to
help the Commissioner enforce the "prohibition of payments to residents
of public institutions" rule. To encourage such reporting so benefits
can be ended as Federal law intends, the Commissioner must pay the
institution up to $400 for each resident found to be wrongly receiving
SSI payments if the information is provided to the Commissioner within
30 days after such individual becomes a resident, or up to $200 for
each SSI - receiving inmate if the information is provided after 30 days
but within 90 days of the person's becoming a resident. Between March 1,
1997 and March 6, 2003, SSA paid $87.4 million for 240,105 incentive
payments.
In 1999, Congress acted to further tighten restrictions on the payment
of Federal benefits to prisoners. Public Law 106-170, signed into law on
December 14, 1999, expands the SSI Program's benefit suspension rules
and incentive payments regarding State and local prisoners to include
individuals receiving Old-Age, Survivors, and Disability Insurance
(OASDI) benefits. (Payments to prisons will be reduced by 50 percent
for multiple reports on individuals who receive both SSI and OASDI
benefits.) Public Law 106-170 also requires State prisons to provide
inmate information to Federal and federally assisted benefit programs,
including SSA. To help reduce fraudulent benefit payments of food
stamps, veterans benefits, unemployment benefits, and educational aid,
Public Law 106-170 directs SSA to share its prisoner database with
other Federal agencies and departments.
APPLICATION TO OTHER PROGRAMS REQUIREMENT
Since SSI payments are reduced by other income, applicants and
recipients must apply for any other cash benefits due them. SSA works
with recipients and helps them get any other benefits for which they
are eligible.
ELIGIBILITY FOR SOCIAL SECURITY
Since its inception SSI has been viewed as the "program of last resort."
That is, after evaluating all other income, SSI pays what is necessary
to bring an individual to the statutorily prescribed income "floor."
As of December 2002, 35.5 percent of all SSI recipients also received
Social Security benefits (57.8 percent of the aged, 34.3 percent of the
disabled, and 30.3 percent of the blind). Social Security benefits are
the single highest source of income for SSI recipients. The SSI Program
considers Social Security benefits unearned income and thus counts all
but $20 monthly in determining the SSI benefit amount.
ELIGIBILITY FOR MEDICAID
States have three options as to how they treat SSI recipients in
relation to Medicaid eligibility. Section 1634 of SSI law allows SSA
to enter into agreements with States to cover all SSI recipients with
Medicaid eligibility. SSI recipients are not required to make a
separate application for Medicaid under this arrangement. As of
January 1, 2003, 32 States and the District of Columbia chose this
option, and SSI recipients in these States account for approximately
79 percent of all SSI recipients nationwide.
Under the second option, States elect to provide Medicaid eligibility
for all SSI recipients, but only if the recipient completes a separate
application with the State agency which administers the Medicaid
Program. Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah and
the Commonwealth of the Northern Mariana Islands, affecting about
5 percent of SSI recipients nationwide, have elected this option.
The third and most restrictive option is known as the "209(b)" option,
under which States may impose Medicaid eligibility criteria which are
more restrictive than SSI criteria, so long as the criteria chosen are
not more restrictive than the State's approved Medicaid State plan in
January 1972. The 209(b) States may be more restrictive in defining
blindness or disability, and/or more restrictive in their financial
requirements for eligibility, and require a Medicaid application with
the State. However, aged, blind, and disabled SSI recipients who are
Medicaid applicants must be allowed to spend down in 209(b) States, if
the State uses more restrictive income criteria, regardless of whether
the State has a medically needy program. Currently 11 States use the
209(b) option for Medicaid coverage of aged, blind, and disabled SSI
recipients. About 16 percent of the SSI recipient population nationwide
lives in these 209(b) States. The 11 States that use this option are
Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New
Hampshire, North Dakota, Ohio, Oklahoma, and Virginia. An amendment
included in the 1986 SSI Disability Amendments (Public Law 99-643)
required, effective July 1, 1987, that 209(b) States continue Medicaid
coverage for individuals in section 1619 status if they had been
eligible for Medicaid for the month preceding their becoming eligible
under section 1619 (see section below on "Special SSI Provisions for
the Working Disabled"). The same legislation required States to provide
continued Medicaid coverage for those individuals who lose eligibility
for SSI on or after July 1, 1987 when their income increases because
they become newly eligible for Social Security benefits as an adult who
was disabled as a child (disabled adult child) or because of an
increase in their benefits as an adult who was disabled as a child.
"Disabled adult children" who otherwise would be eligible for SSI
continue to be considered SSI recipients for Medicaid purposes.
Protection against loss of Medicaid also is provided for certain blind
or disabled individuals who lose their SSI benefits when they qualify
for Social Security disabled widow or widower's benefits beginning as
early as age 50. The Omnibus Budget Reconciliation Act of 1990 provides
that such individuals, who otherwise would continue to qualify for SSI
on the basis of blindness or disability, will be deemed to be SSI
recipients for purposes of Medicaid eligibility until they become
eligible for Medicare.
ELIGIBILITY FOR FOOD STAMPS
Except in California, which has converted food stamp benefits to cash
that is included in the State supplementary payments, SSI recipients
may be eligible to receive food stamps. SSI beneficiaries living alone
or in a household where all other members of the household receive or
are applying for SSI benefits can file for food stamps at an SSA office.
If all household members receive SSI, they do not need to meet the Food
Stamp Program financial eligibility standards to participate in the
program because they are categorically eligible. However, SSI
beneficiaries living in households where other household members do not
receive or are not applying for SSI benefits are referred to the local
food stamp office to file for food stamps. These households must meet
the net income eligibility standard of the Food Stamp Program to be
eligible for food stamp benefits.The interaction with the Food Stamp
Program has important financial implications for a State which desires
to increase the income of its SSI recipients by $1. Because food stamps
are reduced by $0.30 for each additional $1 of SSI income including
State supplements, the State must expend $1.43 to obtain an effective
$1 increase in SSI recipients' total income.
SELF-SUFFICIENCY AND SSI
Section 1615(d) of the Social Security Act requires SSA to reimburse
State vocational rehabilitation agencies for reasonable and necessary
costs of services which resulted in disabled SSI recipients' being
successfully rehabilitated. The objective of vocational rehabilitation
for SSI recipients is to help disabled individuals achieve and sustain
productive, self-supporting work activity. SSA provides funds to
reimburse vocational rehabilitation agencies for costs incurred in
successfully rehabilitating SSI recipients. A successful rehabilitation
is defined by law as one in which vocational rehabilitation services
result in performance of substantial gainful activity for a continuous
period of 9 months. In 1999, Congress expanded the Vocational
Rehabilitation Program. Public Law 106-170, signed into law on December
17, 1999, creates a Ticket to Work and Self-Sufficiency Program. The
purpose of the program is to help recipients leave the SSI rolls through
greater accessibility to a broader pool of vocational
rehabilitation providers than was previously available to them.
Under the new law, the Commissioner of Social Security will provide
tickets to work to disabled SSI beneficiaries that they can use as
vouchers to obtain employment services, case management, vocational
rehabilitation, and support services from providers of their choice,
including State vocational rehabilitation agencies. The program is
implemented on a graduated basis, beginning within 1 year of enactment
at sites selected by the Commissioner and within 4 years of
enactment in every State. The program is permanently authorized.
The elements of the ticket system include program managers, employment
networks, individual work plans, program evaluations, and a Ticket to
Work and Work Incentives Advisory Panel composed of 12 members. The
Commissioner is required to contract with program managers (one or more
public or private organizations with expertise and experience in the
field of vocational rehabilitation or employment services) through a
competitive bidding process to help SSA administer the program. Program
managers are to recruit and recommend employment networks to the
Commissioner, ensure that adequate choices of services are available to
beneficiaries, ensure beneficiary access to services, and provide
assurances to SSA that employment networks are complying with
agreement terms.
The ticket to work law requires employment networks to consist of a
single public or private provider or an association of providers
combined into a single entity which assumes responsibility for the
coordination and delivery of services. Employment networks are required
to have experience providing relevant employment services and support
for individuals with disabilities and will have to provide an array of
such services under the program. Employment networks and beneficiaries
must develop an individual employment plan so that the beneficiary
can exercise informed choice in selecting an employment goal and
specific services needed to achieve that goal. Employment networks
prepare and provide periodic performance reports to beneficiaries
holding a ticket and provide periodic quality assurance reviews of
employment networks. The Commissioner is required to establish a method
for resolving disputes between beneficiaries and employment networks.
The ticket to work law also requires that State vocational
rehabilitation agencies and employment networks enter into agreements
regarding the conditions under which services will be provided when an
individual is referred by an employment network to State vocational
rehabilitation agencies. The Commissioner must establish a timeframe
for these agreements and a dispute resolution method. Payment to
employment networks is based on outcomes and long-term results by
providing one of two payment systems: an outcome payment system or an
outcome-milestone payment system. Under the outcome payment system,
employment networks are provided with up to 40 percent of the average
monthly disability benefit for each month benefits are not payable to
the beneficiary due to work (but not for more than 60 months). Under
the outcome-milestone payment system, the employment networks receive
early payments based on the achievement of one or more milestones toward
permanent employment. The total amount payable under the outcome-
milestone payment system must be less than the total amount that
otherwise would have been payable for an individual under the outcome
payment system. Regardless of which payment system is used, SSI
beneficiaries forgo SSI payments to participate in the ticket to work
system, and instead receive earnings from work. Providers use the
ticket, or voucher, to claim payment from SSA for services they provide
to beneficiaries. Providers are paid for each month in which an SSI
beneficiary is not receiving benefits because the individual is working
or has earnings. The Commissioner is required to design and conduct a
series of evaluations of the payment system to assess the cost
effectiveness and effects of the program, in consultation with the
Advisory Panel, and report the findings to Congress.
SSI BENEFITS
FEDERAL SSI BENEFIT STANDARD
The Federal SSI benefit standard for 2003 is $552 a month for an
individual and $829 for a couple. As is discussed later, most States
supplement the Federal SSI benefit. The result is a combined Federal
SSI/State supplemental benefit standard against which countable income
is
compared in determining eligibility and benefit amount. However, many
States limit their supplementation to certain categories of individuals
based on specific indicators of needCespecially special housing needs.
Like Social Security benefits, Federal SSI benefits are
indexed to the Consumer Price Index (CPI). Indexing occurs through a
reference in the SSI law to the Social Security cost-of-living
adjustment (COLA) provision. Prior to the Social Security Amendments of
1983 (Public Law 98-21), the SSI and Social Security cost-of-living
increases occurred in benefits paid in July. Public law 98-21 delayed
the Social Security and SSI COLAs from July 1983 to January 1984.
However, in lieu of a COLA increase in the SSI benefit standard, the
Federal SSI benefit was increased in July 1983 by $20 a month for an
individual and $30 a month for a couple. Table 3-3 shows the Federal
SSI benefit from the beginning of the SSI Program until the present
time. In calendar year 2002, about 818,050 applicants were awarded SSI
benefits. Under previous law, new recipients received a prorated SSI
benefit for the month in which they applied. For example, a person who
applied on the 15th of the month could receive 2 weeks of benefits for
that month. (The typical applicant did not get that money immediately
because SSA might take several months to process the application.) The
1996 welfare reform law changes the effective date of an SSI
application to the later of the first day of the month following the
date the application is filed or the date the individual first becomes
eligible for SSI benefits.
BENEFITS FOR PERSONS LIVING IN THE HOUSEHOLD OF ANOTHER
SSI law provides that if an applicant or recipient is "living in another
person's household and receiving support and maintenance in kind from
such person," the Federal SSI benefit applicable to such individual or
couple is two-thirds of the regular Federal SSI benefit. As shown in
Table 3-3, the Federal SSI benefit in 2003 for those determined to be
living in the household of another is $368 for an individual and $552.67
for a couple.
Regulations specify the criteria for determining when this
reduced benefit applies. It does not apply to an individual who owns or
rents, buys food separately, eats meals out rather than eating with the
household, or pays a pro rata share of the household's food and shelter
expenses.
In December 2002 4.2 percent, or about 285,000 SSI recipients,
had their benefits determined on the basis of this "one-third reduction"
benefit standard. Sixty-five percent of those recipients were receiving
benefits on the basis of disability (See Table 3-4).
BENEFITS FOR PERSONS LIVING IN A MEDICAID INSTITUTION
When individuals enter a hospital or other medical institution in which
more than half of the bill is paid by the Medicaid Program, their
monthly SSI benefit standard is reduced to $30, beginning with the first
full calendar month of residence. This benefit, called a personal needs
allowance (PNA), is intended to take care of small personal expenses,
with the cost of maintenance and medical care being provided through
Medicaid. The 1996 welfare reform law requires that children (under
age 18) residing in medical institutions who have private medical
insurance be eligible only for the $30 SSI PNA, just like those with
Medicaid coverage. The Federal PNA benefit of $25 was increased to $30
a month on July 1, 1988Cthe first increase since the SSI Program began
in 1974. The annual cost-of-living increase for SSI does not apply to
the PNA. However, the 1987 Budget Reconciliation Act provides that if
a physician certifies that the recipient's stay in such a medical
institution is not likely to exceed 3 months and they need to continue
to maintain a home to which they may return, SSI benefits
will not be reduced and recipients will continue to receive full SSI
benefits for up to the first 3 months of institutionalization.
Approximately 143,636 or 2.2 percent of SSI recipients received
benefits as of December 2000 on the basis of this personal needs
allowance. The average benefit was $21.80. For those individuals whose
income from non-SSI sources exceeds the $30 benefit standard (including
those who were receiving both Social Security and SSI before entering
an institution), Medicaid regulations require States to allow SSI
recipients (and other non-SSI Medicaid eligibles) to retain no less than
$30 a month of their income as a "personal needs allowance" when their
income is applied, along with Medicaid reimbursement, to pay for their
institutional medical care. These regulations are applicable to
individuals whose income from non-SSI sources exceeds the $30 benefit
standard (including those who were receiving both Social Security and
SSI before entering an institution).
Nineteen State programs have exercised their option to supplement
the PNA. Prior to the 1985 Budget Reconciliation Act, SSI regulations
would not allow for Federal administration of State PNA supplements.
An amendment included in that legislation now requires SSA, at the
request of a State, to administer such State supplementary payments.
As of December 2002, California, the District of Columbia,
Massachusetts, Michigan, New Jersey, New York, Rhode Island, and
Vermont had opted for Federal administration. Approximately 30 States
allow some or all of those individuals affected by the Medicaid PNA
regulations to retain more than $30 a month.
BENEFITS OF FORMER RECIPIENTS OF STATE ASSISTANCE
The essential person payment is a Federal benefit for an individual who
was transferred to SSI from a former State Program of Aid to the Aged,
Blind, or Disabled. As shown in Table 3-3, the Federal benefits of
these persons are increased by up to $277 monthly in 2003 to take into
account an "essential person" living in the household.
Essential persons are those (generally an ineligible spouse or relative)
who live with the eligible individual and who are considered necessary
to provide essential care and services for the eligible individual and
whose needs were taken into account in December 1973 in determining the
need of the individual. Essential persons do not themselves receive SSI
payments; rather, the standard of payment to which an eligible
individual or couple is entitled is increased, and any income and
resources of the essential persons are combined with those of the
eligible individual
or couple in calculating the amount for which the individual or couple
is eligible.Eligibility for such increased payments apply only to a
person included as an essential person in December 1973 and ends when
the person no longer lives with the eligible individual, becomes
eligible for SSI in his own right, or becomes the eligible spouse of
an eligible individual.
Some States have categories of State supplementation similar to the
"essential persons" category for individuals transferred from the
pre-SSI Program.
OVERPAYMENTS
A provision in the 1984 Deficit Reduction Act established limits on
recovery by the Social Security Administration (SSA) of overpayments
made to SSI recipients. The amount of recovery in any month is now
limited to the lesser of: (1) the amount of the benefit for that month;
or (2) an amount equal to 10 percent of the countable income (plus the
SSI payment) of the individual (or couple) for that month. This
limitation does not apply if there is fraud, willful misrepresentation,
or concealment of information in connection with the overpayment. The
recipient may request a higher or lower rate at which benefits
may be withheld to recover the overpayment.
FASTER INITIAL SSI (AND SOCIAL SECURITY) PAYMENTS
Making initial payments faster for those who are presumptively or proven
eligible is a goal of the SSI Program. The provisions for a one-time
emergency advance payment continues to permit a faster response to
presumptive or proven eligibility in new claims with critical needs.
Pursuant to the 1996 welfare reform legislation, these emergency advance
payments must be repaid through proportionate reductions in SSI benefits
over a period of not more than 6 months. In fiscal year 2002, Social
Security offices made 7,459 emergency advance payments using their
third-party drafts in these new claims situations totaling $4,234,503
with an average payment amount of $569.
Beginning in October 1985, local Social Security offices were given the
authority to make "immediate payments" for Social Security and SSI cases
at management's discretion when the local offices found that benefits
were due but unpaid and an expedited Treasury payment would be too slow.
"Immediate" usually means while the beneficiary waits or the next day
at the latest. Payments are made using third-party drafts issued by the
local field office. Payments are limited to the maximum per beneficiary
of $999 or the amount due, whichever is less, once in a 30-day period.
The payment must be approved by office management. During fiscal
year 2002, 85,726 Social Security and 82,598 SSI immediate payments
were issued under this procedure. The total amount of these payments
equaled $93,326,975 for an average of $554 per payment.
STATE SUPPLEMENTATION
Mandatory State Supplementation
State supplementary payments are required by law to maintain
income levels of former State adult assistance recipients transferred to
the Federal SSI Program. The purpose of these mandatory State
supplements is to assure that no person suffers a reduction in income
as result of the transfer to the SSI Program.
TABLE 3-3--MONTHLY FEDERAL SSI BENEFIT RATES, 1974-2003
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-4--PERCENTAGE AND NUMBER OF PERSONS RECEIVING FEDERALLY
ADMINISTERED PAYMENTS, BY LIVING ARRANGEMENT AND CATEGORY,
DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Under mandatory supplementation rules, States are to
maintain recipients of the Programs of Old-Age Assistance, Aid to the
Blind, and Aid to the Permanently and Totally Disabled at their December
1973 income level. That level is the amount an individual received in
December 1973 under the terms and conditions of the State plan in effect
for the month of June 1973, plus her other income. Thus, State must
provide a supplementary payment to any individual who, because of
special needs or other reasons, had a December 1973 payment higher that
the amount she received under the basic Federal SSI Program.
To remain eligible for Medicaid Federal matching funds, States
were required to adopt a mandatory State supplementation program. In
February 2003, approximately 1,200 recipients or less than 0.02 percent
of all recipients were receiving federally administered payments based
in part or solely on the mandatory supplementation rule.
Optional State Supplementation
In addition to any mandatory supplementation States must provide, a
State (or political subdivision) may choose to provide an optional
supplement to Federal SSI payments. This optional supplement also is
intended to help individuals meet needs which are not fully met by the
Federal payment. The State determines whether it will make such a
payment, to whom, and in what amount. States have the option of
covering recipients of mandatory supplementation under their program
of optional supplementation.
At the present time, all but seven States and jurisdictions provide
some form of optional State supplementation. States that provide no
supplement are: Arkansas, Georgia, Kansas, Mississippi, Commonwealth
of the Northern Mariana Islands, Tennessee, and West Virginia. States
(or local jurisdictions) may elect to administer their supplementary
payments themselves or may contract with SSA for Federal administration.
Fourteen States and the District of Columbia have contracted with
SSA to administer the State optional supplementation program. Since the
SSI Program began in 1974, eight States have shifted from Federal to
State administration of their optional State supplementation program.
Section 1618 of the Social Security Act requires States that have chosen
to supplement the Federal SSI benefit to continue to provide
supplementation and to maintain the supplementary payments (or spending
for supplements) at specified levels. The purpose of section 1618 is to
require States to pass along to SSI recipients the amount of any Federal
benefit increase. Some States had not done this before the enactment of
section 1618 on October 21, 1976 (Public Law 94-585). Instead, when
Congress enacted cost-of-living increases in the Federal SSI benefit
amount, some States would reduce the levels of the State supplementary
payments by the amount of the Federal benefit increase. Congress
responded by enacting the section 1618 pass-along/maintenance-of-effort
provision for State supplementary payments.
Section 1618 allows States to comply with the pass along requirement by
either (1) maintaining their State supplementary payment levels for
specified types of living arrangements at or above March 1983 levels
(sometimes referred to as the payment level method) or (2) maintaining
their supplementary payment spending so that total annual Federal and
State expenditures will be at least equal to what they were in the prior
12-month period plus any Federal cost-of-living increase, provided the
State was in compliance for that period (sometimes referred to as the
total expenditures method). In effect, section 1618 requires that once
a State elects to provide supplementary payments, it must continue to
do so. Under section 1618, a State that is found to be out of
compliance under the maintenance-of-effort rules is subject to loss of
its Federal Medicaid reimbursement. In California's case, a further
"penalty" would be levied for failure to meet the pass along/
maintenance-of-effort mandate. It would lose permission to "cash out"
food stamp benefits for SSI recipients, and regular food stamp
allotments would have to be offered to them.
Variation in Payment Amount
In addition to categorical variations which may apply (i.e., aged,
blind, disabled), a State may elect a number of variations in optional
supplementary payments to account for specific differences in living
costs to a recipient. The type and amount of the variations selected
must be specified in the Federal-State agreement. A State may make
variations in its payments to account for both geographic and living
arrangement cost differences.
A significant number of the aged, disabled, and blind receiving SSI
cannot live alone because of mental or physical limitations and have a
need for housing which includes services beyond room and board. These
services often include supervision for daily living and protective
services for the mentally retarded, chronically mentally ill, or the
frail or confused elderly. Such nonmedical supervised and/or group
living arrangements generally cost more than the Federal SSI benefit
needs standard of $552 a month in 2003, and often more than the
combined Federal and SSI State supplementation for those classified as
living independently. Thus, all but 10 of the 50 States and the District
of Columbia have Federal- or State-administered State supplementation
which is specifically directed at covering the additional cost of
providing housing in a protective, supervised, or group living
arrangement.
These living arrangements are identified by a variety of terms
including: adult foster care homes; domiciliary care homes; congregate
care; group homes for the mentally retarded, and other terms. The
amount of supplementation by the State also varies a great deal. For
example, in 2001 in the State of Maryland under a State-administered
supplementation program, a "specialized and intensive supervision" group
living facility had a State supplementation of $666 a month in addition
to the Federal benefit of $552. Thus, the maximum total Federal and
State SSI payment in a month in Maryland is $1,218. In Oregon, for
example, the State supplementation is less than $2 a month for those who
need little supervision and care. However, in some States the cost of
supervised group living care also is partially met by direct State
funding of the staff. Some States make payments for nonmedical group care
directly to private residential facilities based on a rate negotiated by
the State with each facility. In such cases, there is often a PNA
payment made directly to or on behalf of the residents of the facility.
Administrative Fees
The Omnibus Budget Reconciliation Act of 1993 amended the State
supplementation provision to provide for State payment for Federal
administration of State supplementary payments. For fiscal year 1994,
the administration fee was $1.67 per payment. The rate per payment
rose to $3.33 for fiscal year 1995, and $5.00 for fiscal year 1996
and each succeeding year, or a different rate deemed appropriate for
the State by the Commissioner.
The Balanced Budget Act of 1997 (Public Law 105-33) increased the fee
charged by the SSA to administer a State's supplementary SSI payments.
For fiscal year 1998, the fee was $6.20. The rate per payment rose to
$7.60 for 1999, $7.80 for 2000, $8.10 for 2001, and $8.50 for 2002.
The fee for 2003 is $8.59 per payment. Each succeeding year, fees are
indexed to increases in the Consumer Price Index or set at a different
rate as determined by the Commissioner of Social Security. Amounts of
fees collected in excess of $5 per check are credited to a special
Treasury fund available for Social Security Administration
administrative purposes. Such amounts are credited as a discretionary
offset to discretionary spending to the extent that they are made
available for expenditures in appropriation acts.
Public Law 106-170 authorizes SSA to penalize States that are late in
paying their administrative fees. Specifically, SSA may charge a State
for whom it administers supplementary payments a penalty equal to 5
percent of the supplementary payment and administrative fees due if that
State has not paid SSA the administrative fees it owes. States must pay
SSA on the business day preceding the date that SSA pays monthly
benefits, or for the last month in a State's fiscal year, the fifth
business day following the date that SSA pays monthly benefits.
State SSI Supplement Levels Over Time
Throughout the period from July 1975 to January 2003, 22 States have
continuously provided supplemental SSI payments to aged individuals
living independently.
During the period from July 1975 to January 2000, no State increased
supplements faster than inflation for aged individuals living
independently or aged couples living independently (see Tables 3-5
and 3-6).
As of December 2002, there were 2,462,652 beneficiaries (36.3 percent)
receiving a State supplement. For those SSI recipients, other than those
receiving a State supplement because they are living in some type of
group living arrangement, the amount of State supplement ranges from
$1.70 a month to $362 a month for an individual. At present, 26 States
and the District of Columbia supplement the Federal standard for
individuals living independently.
MAXIMUM SSI AND FOOD STAMP BENEFITS FOR INDIVIDUALS LIVING INDEPENDENTLY
Table 3-7 for individuals and Table 3-8 for couples illustrate by State
the maximum potential payment from Federal SSI, State supplements, and
food stamps for persons with no income. Approximately 65 percent of SSI
households in the Food Stamp Program claim a shelter deduction for
shelter expenses exceeding roughly one-third of their monthly income.
About 3 percent of SSI households claim a medical cost deduction for
out-of-pocket expenses over $35 per month.
COMPARISON OF SSI PAYMENT LEVELS TO POVERTY THRESHOLDS
Table 3-9 compares the Federal SSI benefit for a single individual to
the Bureau of the Census poverty threshold. Both the poverty threshold
and the benefit level are indexed to the Consumer Price Index. (The
percentage increase for the poverty threshold and the SSI benefit
increase varies slightly because of a difference in the method of
calculation.) As a result of Public Law 98-21, SSI benefit levels were
increased by $20 per month for individuals and $30 per month for couples
in July 1983. They were further increased by 3.5 percent in January
1984. This explains why SSI benefits, in relation to the poverty level,
increased to approximately 76 percent in 1984 compared to 72 percent in
the 1975 to 1980 period. In 2000, benefit levels were 76 percent of the
poverty level. Table 3-10 presents the same information for a couple.
The SSI benefit for a couple is 90 percent of the poverty threshold in
2002.
TABLE 3-5--STATE SSI SUPPLEMENTS FOR AGED INDIVIDUALS WITHOUT COUNTABLE
INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-6--STATE SSI SUPPLEMENTS FOR AGED COUPLES WITHOUT COUNTABLE
INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-7--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED
INDIVIDUALS LIVING INDEPENDENTLY, JANUARY 2000
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-8--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED
COUPLES LIVING INDEPENDENTLY, JANUARY 2000
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TRENDS IN THE SSI CASELOAD
NUMBER OF RECIPIENTS
As shown in Table 3-11, in December 2002, nearly 6.8 million
persons received federally administered SSI payments. Of these, about
1.3 million received federally administered payments on the basis of
being aged, about 5.5 million on the basis of being disabled, and
78,000 on the basis of blindness. However, 743,800 of those receiving
benefits on the basis of disability or blindness were over the age of
65.
Table 3-11 also indicates that approximately 4.3 million of
those receiving federally administered SSI payments received only
Federal SSI payments, 2.2 million received a combination of Federal
and State payments, and 283,000 received State supplements only.
TABLE 3-9--COMPARISON OF COMBINED BENEFITS TO POVERTY THRESHOLDS FOR
ELIGIBLE INDIVIDUALS RECEIVING SSI; SSI AND SOCIAL SECURITY; AND SSI,
SOCIAL SECURITY, AND FOOD STAMPS, SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-10--COMPARISON OF COMBINED BENEFITS TO POVERTY THRESHOLDS FOR
ELIGIBLE COUPLES RECEIVING SSI; SSI AND SOCIAL SECURITY; AND SSI,
SOCIAL SECURITY, AND FOOD STAMPS; SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-11--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS,
TOTAL AMOUNT, AND AVERAGE MONTHLY AMOUNT, BY SOURCE OF PAYMENT AND
CATEGORY, DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Table 3-12 shows the trends in the numbers of persons receiving
federally administered SSI payments from December 1975 through December
2002, both by reason for eligibility and by age categories. There was a
steady decline in the number of SSI recipients from 1975 until 1983.
However, in the last 19 years the number of SSI recipients has increased
from about 3.9 million to about 6.8 million, an increase of 74 percent.
CHARACTERISTICS OF ADULT DISABLED AND BLIND RECIPIENTS
Major Disabling Diagnosis C As shown in Table 3-13, of the SSI
disabled ages 18-64, 23.5 percent were eligible on the basis of mental
retardation and 36.6 percent on the basis of other mental disorders.
Therefore, over 60 percent of all SSI disabled recipients are eligible
on the basis of a mental disability. The next three largest categories
are: diseases of the musculoskeletal system and connective tissues
''10.1 percent; diseases of the nervous system and sense organs''
8.4 percent; and diseases of the circulatory system'' 5.2 percent.
In December 2002, 1.4 million or 23.6 percent of the adult
disabled or blind receiving SSI benefits had a representative payee.
Representative payees are individuals, agencies, or institutions
selected by SSA to receive and use SSI payments on behalf of the SSI
recipient when it has been found necessary by reason of the mental or
physical limitations of the recipient.
Age C When a person who is receiving SSI on the basis of
blindness or disability becomes age 65, SSA does not convert the
individual to eligibility on the basis of age. As shown in Table 3-14,
16 percent of the SSI adult population receiving benefits on the basis
of disability are age 65 or older (25.3 percent of the blind were age
65 or older).
Sex C In December 2002, 59.1 percent of those receiving SSI
benefits on the basis of disability were women.
Race C In December 1999, the most recent available data showed
that 64 percent of those receiving SSI benefits on the basis of
disability were white; 30 percent were black; 6 percent other races.
(Note: This is the same information that was in the 2000 edition of
Green Book, and is still the most recent data available.) The 1999 race
data came from the Survey of Income and Program Participation, matched
to SSA program data on receipt of SSI benefits. They replace the
previous series of numbers, which were based on SSA program data. The
principle difference in the two sets of numbers is that Hispanics were
coded as "other" in the older series, and may be of any race in the
newer series.
Other Income C In December 2002, 30.3 percent of the disabled
and 34.3 percent of the blind on SSI also received Social Security
benefits. Table 3-15 shows the number of SSI recipients with other
sources of income, both unearned and earned.
TABLE 3-12--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI
PAYMENTS BY CATEGORY AND AGE, SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-13--DISABILITY DIAGNOSIS OF SSI AND SECTION 1619 DISABILITY
RECIPIENTS, DECEMBER 2002 1 [Percentage Distribution by Diagnostic
Group]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
CHARACTERISTICS OF RECIPIENTS RECEIVING BENEFITS ON THE BASIS OF AGE
Age C In December 2002, of SSI recipients receiving benefits on
the basis of age (65 or older), 35.7 percent were 80 years of age or
older (Table 3-14).
Sex C In December 2002, 70.1 percent of those receiving benefits
on the basis of age were women.
Race C In December 1999, 58 percent of those receiving SSI on
the basis of age were white; 26 percent were black; 16 percent were
other races. (Note: this is the same information that was in the 2000
edition of the Green Book and is still the most recent information
available). The 1999 race data came from the Survey of Income and
Program Participation, matched to SSA program data on receipt of SSI
benefits. They replace the previous series of numbers, which were
based on SSA program data. The principle difference in the two sets
of numbers is that Hispanics were coded as "other" in the older series,
and may be of any race in the newer series.
Other Income C In December 2002, 57.8 percent of SSI
recipients receiving benefits on the basis of age also received Social
Security benefits. Only 1.5 percent had earned income.
TABLE 3-14--NUMBER AND PERCENTAGE DISTRIBUTION OF SSI RECIPIENTS
RECEIVING FEDERALLY ADMINISTERED PAYMENTS BY CATEGORY AND AGE GROUP,
DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
CHARACTERISTICS OF CHILDREN RECEIVING BENEFITS
To be eligible for SSI payments as a child, an individual must be under
age 18 (or under age 22 if a full-time student), be unmarried, and meet
the SSI criteria for: disability or blindness; citizenship/residency;
and income and resources.
At the end of SSI's first year (December 1974), 71,000 disabled
and blind children received SSI benefits, less than 2 percent of the
total SSI caseload. By December 1980, payments were made to almost
229,000 blind and disabled children, 5.5 percent of the SSI caseload.
By December 1996, 1,018,000 blind and disabled children were eligible
for SSI payments, nearly a fourteen fold increase over December 1974.
These children made up 15.4 percent of SSI recipients, and represented a
fast growing segment of the SSI population.
Many analysts attribute the growth in the early and mid 1990s
to outreach activities, the Supreme Court decision in the Zebley case
(which mandated an individualized functional assessment process for
children under age 18), expansion of the mental impairment category,
and reduction in reviews of continuing disability.
The rapid growth in the number of children receiving SSI, as well as
the debate over the procedures by which children's eligibility should
be judged, led Congress to enact provisions as part of the 1996 welfare
reform law that changed the SSI Program with respect to disabled
children (Public Law 104-193). This law discontinued the individualized
functional assessment disability determination procedure. Under this
procedure, persons whose impairments were not equivalent to those in the
Federal "Listing of Impairments" were reviewed under a less stringent
process. The 1996 law established a new (separate) disability definition
for children (under age 18) which requires a child to have "a medically
determinable physical or mental impairment which results in marked or
severe functional limitations, and which can be expected to result in
death o which has lasted or can be expected to last for a continuous
period of not less than 12 months." Changes in the eligibility rules
applied to new applications and pending requests for administrative and
judicial review effective beginning August 22, 1996.
The 1996 law also required SSA to conduct one-time redeterminations of
the eligibility of children already on the rolls who might not meet the
new eligibility criteria. SSA also is required, on an ongoing basis, to
conduct continuing disability reviews (CDRs) of low birth weight babies,
all other children whose impairments are likely to improve, and 18 year
olds.
The Congressional Budget Office (CBO) estimated that the 1996 SSI
reforms affecting children would result in direct (mandatory) Federal
SSI savings of $7.4 billion over 6 years (fiscal years 1997-2002).
However, after writing the regulations implementing the 1996 children's
reforms, SSA estimated that about 135,000 children (13 percent of SSI
child recipients) would no longer qualify for SSI as a result of the
new regulations. SSA expected the average number of SSI children to
fall to 950,000 in fiscal year 1998, when the law became fully
implemented, before rising again in subsequent years. SSA estimated
that Federal program savings would amount to $4.8 billion over the
6-year period - not $7.4 billion as estimated by CBO.
SSA estimated that 288,000 children receiving SSI needed to be
redetermined under the new law. As of April 1, 2002, 101,000 (38
percent) of children who received notices of redetermination were
found to be ineligible for SSI benefits. Virtually all administrative
appeals on the redeterminations have been completed.
The number of children receiving SSI payments, and the percentage of
the caseload they represent, has declined from 955,174 (14.4 percent)
in December 1996 to 846,784 (12.8 percent) in December 2000, before
rising again to 914,821 (13.5 percent) in December 2002.
In December 2002, 64.7 percent of SSI children were 12 years
old or younger, and about 16 percent were under 5 years old. About
35.3 percent, an estimated 322,100 children, were between the ages
of 13 and 17. Child recipients were more likely to be boys than
girls by a ratio of about 3 to 2.
TABLE 3-15--PERSONS RECEIVING FEDERALLY ADMINISTERED SSI PAYMENTS AND
ALSO RECEIVING OTHER INCOME, AND AVERAGE MONTHLY AMOUNT OF INCOME,
BY SOURCE OF INCOME AND DISABILITY CATEGORY, DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
An estimated 81.9 percent of children lived in their parent's
household. Less than 2 percent of the children were patients in a
medical facility where more than half of the cost of their care was
covered by the Medicaid Program. Another 16.7 percent lived in other
hospitals, nursing homes, residential schools, foster care, or
independently.
The number of persons receiving federally administered SSI
payments and unearned income, by type of income, is included in Table
3-16.About 26.7 percent of the children had some type of unearned
income. The three major types of unearned income were: support from
absent parents (11.8 percent), Social Security benefits (7.1 percent),
and in-kind support and maintenance (7 percent). In addition, about 21
percent of children had income "deemed" from their parents.
TABLE 3-16--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI
PAYMENTS AND UNEARNED INCOME (OTHER THAN SOCIAL SECURITY) AND
AVERAGE MONTHLY UNEARNED INCOME, BY TYPE OF INCOME, DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
OVERVIEW OF CASELOAD DEVELOPMENTS
In summary, the trends in the nature of the SSI population show
the following:
- A steady decline in the number of persons receiving SSI benefits
on the basis of old age.
- A recent decrease in the number of blind and disabled children
under 18 receiving SSI; from a high of 14.4 percent of total SSI
recipients in December 1996 to 13.5 percent in December 2002.
- A continuing increase in the number of persons ages 18-64
receiving benefits on the basis of disability or blindness. Between
December 1989 and December 2002, this group of beneficiaries grew
by more than 1,595,000 persons (from 50 percent to 57 percent of the
recipient population).
ELIGIBILITY OF DRUG ADDICTS AND ALCOHOLICS
Under both the SSI and the Social Security Disability Insurance (DI)
Programs, disability is defined as a mental or physical impairment that
is so severe that it prevents an individual from doing any kind of work
that exists in the national economy, taking into account age, education,
and work experience. Prior to January 1997, drug addiction and
alcoholism were qualifying medical impairments under both SSI and DI.
Thus, a person whose drug addiction or alcoholism was a contributing
factor material to his disability was eligible for SSI. The SSI Program
required that payments for drug addicts and alcoholics be made to a
representative payee (i.e., a person or agency responsible for
managing the recipient's finances), that recipients participate in
treatment if available, and that the treatment be monitored.
SSI provisions relating to drug addicts and alcoholics were contained
in the original SSI law (Public Law 92-603). Initially, the Senate
sought to exclude these individuals from SSI by putting them in a
separate services program. During debate on the 1972 legislation,
Members of the Senate argued that these drug addicts and alcoholics
would need treatment, case management, and close monitoring so that
they would not use the SSI benefits to "support their alcoholism
or addiction." The Senate provision that excluded drug addicts and
alcoholics from the SSI Program was deleted in favor of the House
provision that required recipients to undergo treatment. The Senate's
concern about providing direct payments to substance abusers was
accommodated by the provision requiring that benefits be provided
through representative payees. Although virtually all SSI recipients
diagnosed as drug addicts or alcoholics received their payments via a
representative payee, most representative payees were family members
or friends of recipients, and it is suspected that some of them were
likely to give in to threats, coercion, or persuasion of the recipient,
thereby in some cases enabling recipients to obtain direct control of
their SSI payments.In 1994, Congress responded to concerns that
significant numbers of SSI and DI recipients were using their Federal
cash payments to support their addictions by passing legislation (Public
Law 103-296) that placed a 3-year time limit on program benefits to
persons disabled solely because of their addiction to drugs or alcohol,
extended requirements on treatment and monitoring to DI recipients,
required DI recipients classified as substance abusers to receive their
benefits through representative payees, encouraged organizations and
agencies to act as representative payees for recipients classified as
substance abusers, and temporarily or permanently ended benefits of
recipients who failed to comply with treatment requirements.
In 1996, Congress passed legislation that went even further by
terminating drug and alcohol addiction as conditions that qualify
individuals for SSI benefits. Under Public Law 104-121, individuals are
not considered disabled for either SSI or DI if drug addiction or
alcoholism is the contributing factor material to their disability. The
law mandated the Commissioner of Social Security to require that persons
who qualified for SSI or DI based on some other disabling condition, but
who are nonetheless determined to have a drug or alcohol condition and
are incapable of managing their own benefits, have a representative
payee and be referred for treatment. The preferred representative payee
for persons with a drug or alcohol condition who are not capable of
managing their own benefits is an organization. Public Law 104-121 also
authorized $50 million for fiscal year 1997 and $50 million for fiscal
year 1998 for drug treatment services. Recipients classified solely as
drug addicts or alcoholics became ineligible for SSI beginning
January 1, 1997. Applicants were no longer eligible for benefits
beginning March 29, 1996 if they were disabled solely on the basis of
drug or alcohol addiction.
Following the passage of Public Law 104-121, SSA notified
209,372 individuals who were receiving SSI or DI benefits based on drug
addiction and/or alcoholism. (According to SSA, approximately 90,000
recipients of DI ''about 47,000 of whom were also SSI beneficiaries''
were identified as drug addict and alcoholic beneficiaries in 1996.
However, historical data on DI beneficiaries does not exist as the
drug addict and alcoholic provisions of the Social Security Act were
not applicable until 1995.) As of April 2, 1999, approximately 140,978
beneficiaries responded to the notices. About 10,000 of these responses
did not require medical determination because of erroneous coding of
disability diagnosis or cessation of benefits before January 1, 1997.
Of all beneficiaries identified as having a drug or alcohol addiction,
SSA terminated benefits for 124,746 (59.6 percent) and continued
benefits based on another disability for 83,746 (39.9 percent). Another
859 individuals qualified for benefits based on age. [These figures
will change as the agency processes more appeals and hearing decisions.]
ELIGIBILITY OF NONCITIZENS
Although the 1996 welfare reform law (Public Law 104-193) barred most
noncitizens from receiving SSI, this prohibition was modified by
Public Law 105-33, the Balanced Budget Act of 1997, for legal immigrants
who were receiving SSI on August 22, 1996 and disabled legal immigrants
who were living in the United States on August 22, 1996. The Noncitizen
Benefit Clarification and Other Technical Amendments Act of 1998 (Public
Law 105-306) provided continuing eligibility for SSI for nonqualified
aliens who were receiving benefits on August 22, 1996. For more
information on provisions and issues related to noncitizens, see
Appendix J.
ELIGIBILITY OF THE HOMELESS
SSA field offices have established a variety of activities and special
procedures to reduce the problems faced by homeless individuals in
obtaining Social Security or SSI benefits for which they are eligible.
Field offices and DDSs throughout the nation also have established
liaisons with various organizations to assist homeless populations in
applying for and maintaining entitlement to DI and SSI benefits. In
support of the President's initiative to end chronic homelessness within
10 years, SSA participates in the Interagency Council on Homelessness.
SSA received $8 million dollars in the fiscal year 2003 SSI
appropriation to administer a competitive demonstration grants program
to provide outreach and application assistance to the homeless and other
underserved populations.
SPECIAL SSI PROVISIONS FOR THE WORKING DISABLED
EARNED INCOME DISREGARDS
Since SSI began in 1974, the first $65 of monthly earned income (or, up
to the first $85 if the recipient has no unearned income) plus one-half
of the remaining earnings have been disregarded in determining
eligibility for and the amount of SSI benefits. In addition, all
work-related expenses are disregarded in the case of blind persons and
impairment-related work expenses are disregarded in the case of disabled
persons. Finally, income and resources set aside under a plan for
achieving self-support (PASS) are excluded.
ELIMINATING WORK DISINCENTIVES
Prior to enactment of the section 1619 program in 1980 on a temporary
3-year basis (see below), a disabled SSI recipient who worked faced a
substantial risk of losing both SSI cash benefits and Medicaid. Work was
treated the same way it was under the Social Security Disability
Insurance Program: after a trial work period, work at the level of
substantial gainful activity ($800 or more of earnings per month; $300
per month before January 1990) led to the loss of disability status even
if the individual's total income and resources were within SSI Program
limits. Loss of SSI disability status caused loss of categorical
Medicaid eligibility as well. Thus, disabled individuals had a
disincentive to work because of their fear of losing SSI and Medicaid.
In response to this work disincentive, in 1986 Congress enacted
Public Law 99-643 which added section 1619 to the Social Security Act.
Under this provision, SSI recipients who work can continue to receive
benefits even if their earnings are at or above the level of substantial
gainful activity and as long as there is not a medical improvement in
the disabling condition. Under the income disregard formula, the amount
of their cash benefits is gradually reduced as earnings increase until
their countable earnings reach the SSI benefit standard or what is known
as the "break-even point." In a State with no supplementation, as shown
in Table 3-2, this earned income eligibility limit is $1,189 per month
in 2003 for a person who has no unearned income. People who receive
section 1619 benefits continue to be eligible for Medicaid on the same
basis as regular SSI recipients. If States supplement the Federal
benefits standard, the "break-even point" increases $2 for every $1
of State supplementation above the Federal benefit standard.
Under section 1619(b), blind and disabled individuals can continue to be
eligible for Medicaid even if their earnings take them past the SSI
income disregard "break-even point." In some 209(b) States, workers may
lose Medicaid eligibility before attaining 1619 (a) or (b) status if
they did not have Medicaid coverage the month before section 1619 status
began, thus making this provision inoperable for those workers. Special
eligibility status granted by section 1619(b), under which the
individual is considered a blind or disabled individual receiving SSI
benefits for purposes of Medicaid eligibility, applies as long as the
individual: (1) continues to be blind or have a disabling impairment;
(2) except for earnings, continues to meet all the other requirements
for SSI eligibility; (3) would be seriously inhibited from continuing
to work by the termination of eligibility for Medicaid services; and
(4) has earnings that are not sufficient to provide a reasonable
equivalent of the benefits (SSI, State supplementary payments, Medicaid,
and publicly funded attendant care) that would have been available if
he did not have those earnings.
In making an initial determination under the fourth criterion, SSA
decided to compare the individual's gross earnings to a "threshold"
amount. The threshold amount is the amount of gross earnings, after the
monthly $20 general income, $65 earned income, and one-half of the
remainder exclusions are applied, that it would take to reduce to zero
the Federal SSI benefit and State supplementary payment plus the average
Medicaid expenditures for disabled SSI cash recipients for the State of
residence. If the individual's earnings exceed this threshold, an
individualized threshold is calculated which considers the person's
actual Medicaid use, the State supplement rate for the person's actual
living arrangement, and the value of publicly funded attendant care
available to the person in the absence of earnings. In determining a
person's income to compare to the individualized threshold, any
applicable exclusions are deducted from earnings, including work
expenses if the person is blind, impairment-related work expenses,
and income set aside under a plan for achieving self-support.
In other words, Medicaid eligibility continues until the individual's
earnings reach a higher plateau which takes into account the person's
ability to afford both medical care and normal living expenses.
A disabled individual also has the ongoing protection of being able to
be reinstated to eligibility for cash assistance benefits under regular
SSI or 1619(a), or Medicaid only eligibility under 1619(b) if her work
attempt fails or the physical or mental disability causes a pattern of
erratic work. This protection is not indefinite, but SSA cannot
terminate the disability status of an individual for 12 months after
her most recent determination of eligibility for regular SSI or under
section 1619 (a) or (b). However, if the individual recovers medically,
a new application and new disability determination would be required to
establish a new period of eligibility once the individual has been off
the rolls for 12 months or more. The ticket to work law enacted in 1999
(Public Law 106-170) contains a number of provisions designed to
eliminate work disincentives that existed in the SSI Program. Under this
law an individual whose eligibility for SSI benefits, including
eligibility under section 1619(b), has been terminated due to 12
consecutive months of suspension for excess income from work activity,
may request reinstatement of SSI benefits without filing a new
application. To be eligible for this expedited reinstatement of benefits,
an individual must have become unable to continue working due to a
medical condition and must file the application for reinstatement
within 60 months of the termination of benefits.The ticket to work
law also requires SSA to establish a community-based Work Incentive
Planning and Assistance Program to provide individuals with information
on SSI work incentives. Specifically, SSA must establish a corps of
work incentive specialists within the agency and a program of grants,
cooperative agreements, and contracts to provide benefit planning and
assistance to individuals with disabilities and outreach to individuals
who may be eligible for the Work Incentive Program.
SSA is authorized by the ticket to work law to make grants
directly to qualified protection and advocacy programs to provide
services and advice to SSI beneficiaries about vocational
rehabilitation, employment services, and obtaining employment.
States have the option of covering additional groups of working
individuals under Medicaid. The ticket to work law allows States to
provide Medicaid coverage to working individuals with disabilities
who, except for their earnings, would be eligible for SSI and to working
individuals with disabilities whose medical conditions have improved.
Individuals covered under this new option could buy into Medicaid
coverage by paying premiums or other cost-sharing charges on a sliding
fee scale based on income established by the State. States are permitted
to allow working individuals with incomes above 250 percent of the
Federal poverty level to buy into the Medicaid Program.
SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS
Section 251 of Public Law 106-169, enacted on December 14, 1999,
provides special benefits to certain World War II veterans who served
in the U.S. military during the period beginning September 16, 1940
and through July 24, 1947, or who served in the organized military of
the Philippines during the period beginning July 26, 1941 and through
December 30, 1946. The special benefits are payable each month after
April 2000 that these veterans reside outside the United States.
In order to be eligible for the special benefits, an individual must:
(1) be age 65 or older on December 14, 1999 (the date Public Law
106-169 was enacted); (2) be a World War II veteran as described above;
(3) file an application for the special veterans benefits and be
eligible for SSI for that month; (4) be eligible for SSI in December
1999; and (5) not have other benefit income above 75 percent of
the current SSI Federal benefit rate.
Qualified veterans receive a monthly benefit equal to 75 percent of the
current SSI Federal benefit rate less the amount of their benefit income
for the month. The maximum benefit under this formula for 2003 is $414.
There is no provision for the payment of benefits to dependents or
survivors. "Benefit income" means any recurring payments such as
annuities, pensions, retirement, or disability benefits that the
veteran received during the 12-month period immediately before applying
for special benefits, or payments received later that are similar to
benefits received during the 12-month period.
MEASURES OF SSI PARTICIPATION AND GROWTH
SSI PARTICIPATION RATES
Table 3-17 shows several measures of Federal SSI participation among the
elderly and the total population. The numerator in the first three
columns is the sum of columns 2 and 4 in Table 3-19. Thus, the number of
SSI aged participants includes the disabled and blind population over
age 65. Column 1 simply divides the SSI aged participants by the total
number of elderly. That rate declined from 11.1 percent in 1975 to 6.5
percent in 1989, primarily as a result of increasing incomes among the
aged and decreasing participation among low-income elderly. The rate was
5.6 percent in 2001. Column 2 presents the number of elderly SSI
recipients divided by the number of poor elderly. This rate declined
from 76 percent in 1975 to 54 percent in 1982. Between 1982 and 1984,
this percentage increased, perhaps as a result of outreach efforts
mandated by the 1983 Social Security Amendments (Public Law 98-21).
Since 1985 the rate fluctuated between 53 percent and 64 percent and
was 58 percent in 200. This rate is a gross measure of participation,
in that it does not control for other SSI eligibility factors such as
assets or the under counting of income. The denominator for column 3 is
the number of individuals age 65 and older who live in aged-only
households and who would be in poverty without SSI benefits. This rate
has fluctuated between 73 percent and 60 percent since 1979, and was
68 percent in 2001.
TABLE 3-17--PERCENTAGE OF GENERAL POPULATION ENROLLED IN SSI, SELECTED
YEARS 1975-2001
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
The final column of Table 3-17 shows the number of SSI participants as a
percentage of the total population. The numerator for this calculation
is the first column of Table 3-19. The percentage of the entire
population receiving SSI benefits declined from 2.0 percent in 1975
to 1.7 percent for the 1982-85 time period, but increased to 2.5 percent
''its highest level ever'' in 1995 and 1996. In 2001, 2.4 percent of the
population received SSI benefits. Table 3-18 shows the percentage of a
given State's population receiving SSI benefits for selected years.
TABLE 3-18--PERCENTAGE OF GENERAL POPULATION ENROLLED IN SSI BY STATE,
SELECTED YEARS 1975-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
CHANGES IN NUMBER OF RECIPIENTS, 1970-2002
SSI is one of the largest cash assistance programs for the poor and,
until recently, was one of the fastest growing entitlement programs
(see Table 3-12 above); program costs grew 20 percent annually from
1991 through 1994. According to GAO, three groups accounted for
nearly 90 percent of the SSI Program's growth between 1986 and 1993:
adults with mental impairments, children, and noncitizens. These
groups grew at an annual average rate of 11.0, 16.4, and 15.5 percent,
respectively, from 1986 through 1993, compared with 4.9 percent for all
SSI recipients. The SSI recipient population also changed dramatically:
disabled recipients now account for nearly 80 percent of recipients.
The GAO report found that SSI recipients now tend to be younger, stay
on SSI longer, receive larger benefits, and depend more on SSI as a
primary source of income. Factors contributing to caseload growth
include the following: expansion in disability eligibility, notably
for mentally impaired adults and for children; increased outreach by
SSA; lack of effort to help recipients return to work; infrequent
reviews of cases to confirm that the disability is continuing;
immigration growth; and transfers from State programs, among others
(U.S. General Accounting Office, 1995).
Table 3-19 illustrates the changes in the number of individuals
receiving assistance under the federally administered SSI Program
and prior programs. The total number of individuals receiving
assistance was 3.1 million in 1970; this number increased to 4.3
million in 1975 and declined to 3.9 million in 1982. Since then,
the number of SSI recipients has grown each year. In 2002, there
were nearly 6.8 million SSI recipients. Despite this overall growth,
the number of aged receiving SSI has declined sharply since 1975 from
2.3 million (or 2.5 million if disabled and blind persons over age 65
are counted as aged) to 1.25 million individuals in 2002 (approximately
2.0 million if disabled and blind persons over 65 are counted).
Meanwhile, the number of blind or disabled receiving assistance
increased sharply.
TABLE 3-19--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI
PAYMENTS AND ADULT ASSISTANCE UNDER PRIOR PROGRAMS, SELECTED
YEARS 1970-2008
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
The number of persons receiving SSI payments, by State, in December 2002
is provided in Table 3-20.
TABLE 3-20--NUMBER OF PERSONS RECEIVING SSI PAYMENTS, BY STATE,
DECEMBER 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
SSI PROGRAM COSTS
Table 3-21 shows total expenditures for the SSI Program in each State
in 2002, including not only the federally administered Federal and
State supplementation payments but also the State-administered State
supplementation payments. Table 3-22 shows the total (Federal- and
State-administered) State supplementation payments by State for SSI
for selected fiscal years, 1986-2002.
TABLE 3-21--SUPPLEMENTAL SECURITY INCOME: TOTAL PAYMENTS, FEDERAL
SSI PAYMENTS, AND FEDERAL- AID STATE-ADMINISTERED STATE
SUPPLEMENTATION PAYMENTS, CALENDAR YEAR 2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-22--STATE SSI SUPPLEMENTATION PAYMENTS, SELECTED YEARS 1986-2002
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TABLE 3-23--FEDERAL AND STATE BENEFIT PAYMENTS UNDER SSI AND PRIOR ADULT
ASSISTANCE PROGRAMS, SELECTED YEARS 1970-2005
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Table 3-23 presents the total amount of Federal and State
benefit payments from calendar years 1970-87 and fiscal years 1988-2005.
From 1970-73, these were the benefits under the Old-Age Assistance, Aid
to the Blind, and Aid to the Permanently and Totally Disabled Programs.
In fiscal year 1999, Federal benefit payments totaled $28.1 billion and
State payments totaled $3.2 billion, amounting to an overall total of
$31.3 billion. In fiscal year 2000, total (Federal and State) SSI
benefits are estimated to total $29.5 billion and are projected to
increase to $32.7 billion in fiscal year 2002.
LEGISLATIVE HISTORY
104th CONGRESS
Public Law 104-121, the Contract with America Advancement Act of 1996,
among other changes, prohibits disability insurance (DI) and
Supplemental Security Income (SSI) eligibility to individuals whose
drug addiction and/or alcoholism (DAA) is a contributing factor material
to the finding of disability. This provision would apply to individuals
who file for benefits on or after the date of enactment and to
individuals whose claims are finally adjudicated on or after the date of
enactment. This provision also applies to current beneficiaries on
January 1, 1997. It stipulates that SSI must: (1) notify current DAA
beneficiaries of the new provisions within 90 days of enactment; and
(2) complete new medical determinations by January 1, 1997 for affected
current beneficiaries who request such a determination within 120 days
after the date of enactment.
Public Law 104-121 applies representative payee requirements to
DI or SSI beneficiaries who have a DAA condition, as determined by the
Commissioner, and who are incapable of managing benefits. The Social
Security Administration (SSA) would refer these individuals to the
appropriate State agency for treatment. The representative payee and
referral for treatment provisions would apply to applications filed
after the third month following the month of enactment. In addition,
the new law retains the $50 fee that representatives can collect for
beneficiaries who have a DAA condition. The legislation also authorizes
an appropriation of $50 million for each of fiscal years 1997 and 1998
to carry out activities relating to the treatment of drug and alcohol
abuse under the Public Health Service Act.
Further, Public Law 104-121 authorizes additional funds to SSA
for fiscal years 1996-2002 for the purpose of conducting Social Security
disability insurance continuing disability reviews (CDRs) and
Supplemental Security Income CDRs and disability eligibility
redeterminations. This new funding level is achieved by increasing the
amount of funds available for appropriations under the discretionary
spending cap. The Commissioner of Social Security must ensure that the
funds made available pursuant to this provision are used, to the
greatest extent practicable, to maximize the combined savings to the
Old-Age, Survivors, and Disability Insurance (OASDI), SSI, Medicare, and
Medicaid Programs. Moreover, the Commissioner is required to report
annually, for fiscal years 1996-2002, to Congress on the amount of money
spent on CDRs, the number of reviews conducted (by category), the
disposition of such reviews (by program), and the estimated savings over
the short-, medium-, and long-term for OASDI, SSI, Medicare, and
Medicaid Programs from CDRs which result in cessations, and the
estimated present value of such savings.
Public Law 104-193, the Personal Responsibility and Work Opportunity
Reconciliation Act (PRWORA) of 1996, signed on August 22, 1996, makes
several major changes in SSI law. These include:
Limited Eligibility of Noncitizens for SSI Benefits CPRWORA
prohibits SSI eligibility for all noncitizens except: refugees,
asylees, and noncitizens whose deportation has been withheld (limited to
their first 5 years of residence); certain active duty Armed Forces
personnel, honorably discharged veterans, and their spouses and
dependent children; and lawful permanent residents who have worked
for 10 years or more. For purposes of the exception based on work,
children are credited with all quarters worked by their parents, and
married individuals (including widows) are credited with work
performed by spouses during their marriage. However, after December 31,
1996, quarters of work during which an individual received Federal
public assistance are not countable toward this exception.
Deeming of Sponsors' Incomes and Resources-For purposes of
eligibility for sponsored noncitizens admitted under new, legally
enforceable affidavits of support, PRWORA deems all of the sponsors'
(and sponsors' spouses') incomes and resources to the noncitizen until
citizenship. However, deeming is not required for lawful permanent
residents who have worked for 10 or more years (not counting quarters
of work after 1996 during which the individual received Federal public
assistance), or for children and spouses of workers credited with work
performed by them.
Requirements for Affidavits of Support for Sponsorship
''Affidavits of support are made legally enforceable against the sponsor
until the noncitizen becomes a U.S. citizen. The agency that provides
assistance to a noncitizen must request reimbursement from the sponsor
for assistance provided.
Reporting of Illegal Immigrants to the Immigration and
Naturalization Service-The Commissioner of Social Security must
furnish to the Immigration and Naturalization Service the name, address,
and other identifying information of any individual that SSA knows is
unlawfully present in the United States.
SSI Eligibility Based on Childhood Disability ''The comparable
severity standard is eliminated and replaced by the standard that a
child is considered disabled if she has a medically determinable
impairment which results in "marked and severe" functional limitations
and which can be expected to result in death or which has lasted or can
be expected to last for a continuous period of not less than 12 months.
The Social Security Administration is directed to eliminate references
to maladaptive behavior in the domain of personal/behavioral function
in the listing of impairments for children and to discontinue the use
of individualized functional assessments in evaluating a child's
disability. SSA is also required to redetermine, using the new criteria
and by no later than August 22, 1997, the eligibility of recipients who
may be affected by the new criteria. Benefits for those recipients
who do not meet the new criteria would end on or after the later of
July 1, 1997, or the date of the redetermination.
CDRs must be conducted once every 3 years for child recipients
with nonpermanent impairments, and not later than 12 months after birth
for low birth weight babies. Representative payees must present evidence
to SSA that the recipient is receiving treatment that is medically
necessary and available, unless SSA determines that such treatment
would be inappropriate or unnecessary. An eligibility redetermination,
using the adult initial eligibility criteria, must be performed within
1 year after child recipients turn 18.
Funding-PRWORA authorizes the appropriation of an additional
$150 million in fiscal year 1997 and $100 million in fiscal year 1998
for the costs of performing CDRs and redeterminations.
Prisoner Reporting ''The law provides for incentive payments
($400 for information received within 30 days of confinement or $200
for information received from 31 to 90 days after confinement) to State
and local penal institutions that furnish identifying information to
SSA which results in suspension of SSI benefits to prisoners.
Modifying the Effective Date of Applications ''An individual's
application for SSI benefits would be effective on the first day of the
month following the date on which the application is filed, or on which
the individual first becomes eligible, whichever is later. (This change
effectively eliminates prorated payments for the month of application,
while continuing emergency advance payments and subsequent repayments
over several months in certain cases.)
Reduction in Cash Benefits Payable to Institutionalized
Individuals whose Medical Costs are Covered by Private Insurance-PRWORA
limits to not more than $30 a month, cash benefits payable to children
who are in an institution receiving medical care covered by private
insurance.
Installment Payments of Large Past-Due SSI Payments-A schedule
for paying large retroactive SSI benefit amounts at 6-month intervals
is established.
Dedicated Savings Accounts-PRWORA requires the establishment of
a bank account to maintain large retroactive SSI benefits, to be used
for education or job skill training, special equipment, medical
rehabilitation, or other appropriate items or services related to the
impairment of the child.Public Law 104-208, the Department of Defense
Appropriations Act for fiscal year 1997, includes the Illegal
Immigration Reform and Immigrant Responsibility Act of 1996, which
amends Public Law 104-193 with regard to noncitizens' eligibility for
SSI benefits.
Noncitizen individuals and their children who are battered or bused
are added to the list of "qualified aliens." Sponsorship affidavits of
support are made legally binding and sponsor-to-immigrant deeming of
income and resources in the SSI Program continues until noncitizens
become U.S. citizens or they, their spouses, or parents work 40 quarters
in the United States. The law also provides additional exceptions to
sponsor-to-immigrant deeming for indigent noncitizens whose sponsors do
not provide them with income sufficient to obtain food and shelter and f
or battered individuals and their children.In addition, Public Law
104-208 requires several reports to Congress. The Commissioner of
Social Security is required to report the aggregate number of Social
Security numbers issued to noncitizens not authorized to work but under
which earnings were reported and the extent to which Social Security
numbers and Social Security cards are used by noncitizens for fraudulent
purposes. These two reports are due no later than 3 months after the end
of each fiscal year, and within 1 year after the date of enactment,
respectively. The General Accounting Office also is required to report
to Congress and the Department of Justice within 180 days after the date
of enactment on the extent to which means-tested benefits are being
paid to noncitizens acting as representative payees who are not
"qualified aliens."
105th CONGRESS
Public Law 105-18, an emergency supplemental appropriations bill,
provides a 1-month extension for noncitizens who were receiving
benefits on the date of enactment of Public Law 104-193 (August 22,
1996) and who would not continue to be eligible under the noncitizen
restrictions in that law by changing the date by which SSI
redeterminations of eligibility had to be completed from August 22,
1997 to September 30, 1997. Public Law 105-33, the Balanced Budget Act
of 1997, made several major changes in SSI. These include:
SSI Eligibility for Aliens Receiving SSI on August 22, 1996 and Certain
Disabled Legal Aliens-Public Law 105-33 provides that, despite
restrictions in the 1996 welfare reform law, noncitizens lawfully
residing in the United States who were receiving SSI on August 22, 1996,
remain eligible for SSI. In addition, noncitizens lawfully residing
in the United States on August 22, 1996, are eligible for SSI if they
become disabled in the future. The law also provides that members of
Native American Indian tribes who are noncitizens are not affected by
the SSI restrictions in Public Law 104-193. In addition, individuals
who received SSI prior to January 1, 1979, continue to be eligible for
benefits if the Commissioner of Social Security lacks clear and
convincing evidence that such individuals are noncitizens ineligible
for benefits.Extension of Eligibility Period for Refugees and Certain
Other Qualified Aliens from 5 to 7 Years for SSI and Medicaid; Status
of Cuban/Haitian Entrants and Certain Amerasians-Public Law 105-33
extends from 5 years to 7 years the initial eligibility period for
SSI and Medicaid for refugees, asylees, and noncitizens who have had
their deportations withheld. In addition, Cuban and Haitian entrants
and Amerasian immigrants are added to the categories of noncitizens
who are considered "qualified aliens." These groups are eligible for
SSI for their initial 7 years, and are exempt from the 5-year
eligibility ban on noncitizens entering the United States after
August 22, 1996.
Exceptions for Certain Indians from Noncitizen Limitations on
Eligibility for Supplemental Security Income and Medicaid Benefits-
Public Law 105-33 exempts noncitizen members of federally recognized
Indian tribes or noncitizen Native Americans from the SSI and Medicaid
restrictions in the 1996 act.
Exemption from Noncitizen Restrictions on SSI Program Participation by
Certain Recipients Eligible on the Basis of Very Old Applications-
Public Law 105-33 exempts certain individuals who have been on SSI
rolls since before January 1, 1979, from the noncitizen restrictions
in the 1996 act.
Derivative Eligibility for Noncitizens for Medicaid and Food Stamp
Benefits-Public Law 105-33 provides that noncitizens who are otherwise
ineligible for Medicaid under the 1996 act may be eligible for Medicaid
if they receive SSI benefits and if the State's Medicaid plan provides
Medicaid eligibility for SSI recipients. The legislation also clarifies
that noncitizens who are otherwise ineligible under the 1996 act for
food stamps would not be made eligible for food stamps because they
receive SSI benefits.
Fees for Federal Administration of State Supplementary Payments-
Public Law 105-33 increases fees for SSA's administering State
supplementary payments, with added collections available for SSA
administrative purposes.
Timing of Delivery of October 1, 2000, SSI Benefit Payments-
In order to meet budget targets, Public Law 105-33 provides that the
October 2000 SSI check be paid on October 2, which is a Monday, rather
than on the last Friday in
September.
Medicaid Coverage for Certain Workers and Children, Public Law
105-33 gives the States the option of permitting individuals who had
been receiving SSI disability benefits, but are working, to buy into
Medicaid if their family income is less than 250 percent of poverty.
In addition, States are required to continue Medicaid coverage for
children who were receiving SSI disability benefits as of August 22,
1996, but whose eligibility would end because they do not meet the
new, more strict SSI childhood disability eligibility criteria.
Technical Amendments to the 1996 Welfare Reform Law -The
legislation makes a number of technical clarifications with regard
to the disabled children's redetermination and continuing disability
review requirements. Technical changes also clarify the meaning of
the term "final adjudication" with regard to SSI disability cases
based on drug addiction or alcoholism and expands the applicability
of provisions in Public Law 104-121 that require treatment referrals
and authorization of fees for organizations serving as representative
payees for SSI beneficiaries who have a DAA condition.
Technical corrections also are made that clarify when the
reporting incentives involving prisoners apply and that allow SSA to
charge a fee as a condition of processing requests for information by
law enforcement authorities regarding SSI recipients who are fugitive
felons and probation or parole violators. Clarifications are made
concerning SSI dedicated savings account funds and terminology relating
to medical treatment facilities and the applicability of the $30 SSI
payment limit are updated. Noncitizens technical correction provisions
include adding battered parents to the definition of "qualified alien"
and the exemptions from sponsor-to-immigrant deeming, clarifying that
veterans widow(er)s may be eligible for benefits, and authorizing SSA
to disclose noncitizens' quarters of coverage information to other
governmental agencies for the purpose of carrying out the noncitizen
restriction provisions.
Public Law 105-306, the Noncitizen Benefit Clarification and
Other Technical Amendments Act of 1998 provided continuing eligibility
for SSI for nonqualified aliens who were receiving benefits on
August 22, 1996.
106th CONGRESS
Public Law 106-169, the Foster Care Independence Act of 1999,
contains numerous provisions related to SSI fraud reduction and
overpayment recovery.
These provisions are summarized below.
Overpayments and Debt Collection-The law amends the Social
Security Act to make representative payees liable for the repayment
of Social Security benefit checks distributed after the recipient's
death. SSA will monitor these repayments using representative payees'
Social Security numbers. Beginning on December 14, 2000, SSA is
authorized to recover up to 50 percent of lump sum SSI benefit
payments made to individuals (or eligible spouses) who are themselves
liable for the repayment of SSI benefits. The law also authorizes SSA
to intercept Federal and State payments owed to individuals, use debt
collection agencies, and other techniques to collect overpayments.
Treatment of Assets-Public Law 106-169 changes the way assets
held in trusts are treated when determining SSI Program eligibility
and benefit amounts. (A trust is defined by SSA as a legal arrangement
involving property and ownership interests.) Assets and income in
irrevocable trusts may not be revoked or used by an individual for
personal support and maintenance. These trusts, previously exempt
from SSI resource limit calculations, will be counted toward the
resource limit for program eligibility and used to determine benefit
amounts. All trusts established after January 1, 2000-regardless of
the purpose of the trust, degree of trustee discretion, or restrictions
on distribution-will be affected by the law. However, the new law
allows the Commissioner of Social Security to waive the consideration
of a trust if doing so would create an undue hardship for an individual.
The criteria for undue hardship will be determined by the Commissioner.
Disposal of Resources-The law also imposes new rules regarding
resources disposed of at less than fair market value. Individuals or
their spouses who dispose of resources at less than fair market value
will be ineligible for SSI benefits from the "look-back" date (the
date the individual applied for benefits or, if later, the date the
individual disposed of resources for less than fair market value) for a
length of time calculated by SSA. The ineligibility period is
determined by dividing the total value of the disposed resources
by the maximum monthly benefit and the maximum applicable State
supplementary payment. This ineligibility period may not exceed 36
months. Similar restrictions on the treatment of assets and the
disposal of resources were already in effect for the Medicaid Program
before enactment of Public Law 106-169.
Certain resources are exempt from this provision: resources
transferred to a trust, if the trust is considered a resource available
to the individual; the transfer of a home to family members under
certain conditions; the transfer of resources to a spouse for the
spouse's sole benefit; or the transfer of resources to an individual's
blind or disabled child (under age 65). Furthermore, a resource may be
exempt if an individual proves to the Commissioner that he intended
to dispose of the resource at fair market value; or that the resource
was transferred for reasons other than to qualify for the SSI Program;
or if the Commissioner determines that denial of eligibility would
cause an undue hardship.
Penalties for False or Misleading Statements-The law contains
provisions authorizing SSA to establish a new administrative process
to determine whether individuals have fraudulently claimed benefits
in cases considered too small to prosecute in court. The law provides
for increasing penalties of 6, 12, and 24 months of ineligibility
depending on the nature of the case. However, the imposition of these
penalties will not impact an individual's receipt of other assistance.
The penalty procedure applies only to false and misleading statements
made after the date of the law's enactment, December 14, 1999. The
Commissioner is mandated to develop regulations detailing the
administrative process for imposing the penalties within 6 months of
enactment.
Health care providers and attorneys convicted of fraud or
administratively fined for fraud involving SSI eligibility
determinations are barred from participating in the SSI Program for at
least 5 years. SSA will provide individuals with reasonable notice and
opportunity for a hearing and judicial review. SSA will also notify the
State agencies that employ such individuals and the State licensing
agencies that license or certify them. Attorneys and health care
providers are required to inform SSA of any past violations or
convictions. The Commissioner or Inspector General of Social Security
may waive the exclusion from involvement with the SSI Program for an
individual who is the only provider of services to a community and may
terminate exclusions on a case-by-case basis.
Information Sharing Requirements-There are a number of
provisions regarding information sharing between Federal and State
agencies in the new law. SSA is authorized to obtain financial records
for SSI recipients to ensure that they meet SSI's resource restrictions
and remain eligible for benefits.
States are required to provide the Commissioner with information
for determining individuals' eligibility for Social Security and SSI
benefit programs. State prisons are also required to provide inmate
information to Federal and federally assisted benefit programs. To
help reduce fraudulent benefit payments to prisoners of food stamps,
veterans' benefits, unemployment benefits, and educational aid, SSA is
required to share its prisoner database with other Federal agencies and
departments.
The law directs SSA to conduct computer matches with Medicare
and Medicaid data maintained by the Department of Health and Human
Services on individuals who are residents of public institutions.
Data obtained from these matches may be used as a substitute for a
physician's certification that an individual's stay in an institution
will be less than 3 months. The Commissioner and the Secretary of the
Department of Health and Human Services will mutually determine the
terms of the data matching.
Study and Reporting Requirements-The law requires the
Commissioner, in consultation with the SSA Inspector General and the
Attorney General, to study and report to Congress on legislative and
administrative reforms that would reduce or prevent SSI and Social
Security DI fraud and overpayments. Furthermore, the Commissioner must
include an itemized account of the amount of funds required to support
efforts to combat fraud by applicants and beneficiaries in the SSA
annual budget. This requirement is effective for annual budgets
prepared after fiscal year 1999.
Public Law 106-170, the Ticket to Work and Work Incentives
Improvement Act of 1999, expands Medicaid coverage and provides work
incentives for disabled beneficiaries of SSI. The law also creates a
"ticket to work" system whose purpose is to expand the numbers and
types of providers that SSI beneficiaries may choose to assist them
in receiving employment and vocational rehabilitation services. In
addition, the law has several other provisions:
Greater Accessibility to Vocational Rehabilitation Providers-
Individuals on the SSI rolls are given access to a broader pool of
vocational rehabilitation providers. SSI recipients are provided with
"tickets" that they can use as vouchers to obtain employment services,
case management, vocational rehabilitation, and support services from
the providers of their choice, including State vocational rehabilitation
agencies. This program will be implemented on a gradual basis within
1 year of enactment at test sites and within 4 years in every State.
The law also authorizes the Commissioner to make grants of up to $7
million each year for fiscal years 2000-2004 to protection and
advocacy organizations providing information and advice about obtaining
vocational rehabilitation and employment services. The Secretary of
Health and Human Services is authorized to award grants to States to
design, establish, and operate infrastructures providing items and
services to support working individuals with disabilities, and to conduct
outreach campaigns to publicize the new benefits under the legislation
($20 million, $25 million, $30 million, $35 million, and $40 million for
fiscal years 2001-2005, respectively; for fiscal years 2006-2011, the
law authorizes the prior year's amount adjusted for inflation.)
Creation of Employment Network-Employment networks are required
to consist of a single public or private provider or an association of
providers combined into a single entity which assumes responsibility for
the coordination and delivery of services. Employment networks, which
must be experienced in providing relevant employment and support
services to individuals with disabilities will work with beneficiaries
to develop employment plans and employment goals. The employment
networks are responsible for providing periodic performance reports to
beneficiaries holding tickets and periodic quality assurance reviews.
The Commissioner will establish mechanisms for resolving disputes
between employment networks and beneficiaries. State vocational
rehabilitation agencies and employment networks must enter into
agreements with individuals referred by an employment network to a
State vocational rehabilitation agency for services.Payment to
employment networks is based on one of two payment systems. Under
the outcome payment system, employment networks are provided with up
to 40 percent of the average monthly disability benefit for each month
(up to 60 months) benefits are not payable to the beneficiary due to
work. Under the outcome-milestone payment system, employment networks
receive early payments based on the achievement of one or more
milestones toward permanent employment. The total amount payable
under this system may not exceed the total amount payable under the
outcome payment system. Regardless of the system used, beneficiaries
forgo their SSI benefit and instead receive earnings from work. The
cost effectiveness of the payment systems will be evaluated by the
Commissioner.
Limitations on Continuing Disability Reviews (CDRs) for Ticket
to Work Participants - The law prohibits the Commissioner from
initiating a CDR for a beneficiary participating in the Ticket to Work
and Self-Sufficiency Program. Further, if beneficiaries do not succeed
at their work effort, the law provides for the reinstatement of SSI
benefits without requiring re-application.
Medicaid Expansion - Under Public Law 106-170, States can opt to
cover persons with disabilities at higher income and resource levels
than otherwise permitted (i.e., over 250 percent of the Federal poverty
level and over $2,000, respectively), and whose medical condition would
not otherwise permit them to be covered. States can require these
individuals to "buy into" Medicaid coverage by paying premiums or other
cost-sharing charges on a sliding fee scale based on income, as
established by the State.
Demonstration Projects and Studies - The law extends Social
Security demonstration projects relating to disabled beneficiaries and
establishes a new demonstration project to test phasing out disability
benefits for earnings above a certain level of income. Further, the
General Accounting Office is required to study the effects of the
substantial gainful activity level on recipients who return to work,
and report on whether disregarding certain income for calculating
benefits is appropriate.
Other - The law permits the Commissioner to withhold an
assessment charge of 6.3 percent of the attorney's fees for the purpose
of recovering costs to SSA of withholding and payment of attorneys fees.
SSA is authorized to penalize States that are late in paying
administrative fees to SSA.
107th CONGRESS
Public Law 107-73, the Economic Growth and Tax Reconciliation
Act of 2001, was signed into law on June 7, 2001. The law increases
child tax credit amounts gradually from $500 for each child to $1,000
in 2010 and expands the child tax credit by making it refundable for
low-income workers. Previously, the child tax credit was refundable
in very limited situations. The credit will be excluded from income or
resources in determining eligibility for means-tested programs,
including SSI and is also excluded as part of resources in the month
of receipt and the following month. Public Law 107-116, Making
Appropriations for the Departments of Labor, HHS and Education, FY 2002,
was signed into law on January 10, 2002 and contained one provision
affecting the SSI program. The law provides that $7 million of the
funds appropriated for the Supplemental Security Income program are
to be used for outreach efforts under section 1144 of the Social
Security Act to identify individuals who may be eligible for Medicare
cost sharing under the Medicaid program.
Public Law 106-386, the Victims of Trafficking and Violence
Protection Act of 2000, provides that noncitizens who are victims of
"severe forms of trafficking in persons in the United States" shall be
treated as refugees for purpose of SSI and be eligible for SSI benefits
for the first 7 years they are in the United States.
Public Law 106-395, the Child Citizenship Act of 2000, provides
that certain blind and disabled children may become citizens of the
United States earlier than previously. This citizenship status would
provide them eligibility for SSI benefits.
Public Law 106-245, the Radiation Exposure Compensation Act
Amendments of 2000, would, among other things, exclude as countable
income for SSI purposes the compensation received under this statute.
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