Elder Law Library for the PublicSupplemental Security Income (SSI) The Supplemental Security Income (SSI) program is a federal-state needs based minimum cash monthly payment level for "categorically" aged, blind, and disabled individuals. The Social Security Administration (SSA) administers the program, and Massachusetts, as most states, adds to the base federal amount with a "state supplement" differing by category of eligibility and living arrangement. The aged person must be age 65, and the disabled and blind can be any age (including children), but must meet the Social Security definitions of disability or blindness. By being a "needs based" program, SSI eligibility is also based on limitations of income and assets. The actual monthly benefit amount payable to the individual is established by counting other income and considering the "living arrangement" of the individual. Some characteristics of the SSI program are:
2002 SSI Benefit Levels in Massachusetts The following chart shows the various 2002 SSI monthly benefit level amounts in Massachusetts, including the state supplement, divided by category, living arrangement, and marital status:
*each member of couple For example, in 2002, an aged individual living with another non-related individual in Massachusetts in the shared living expense category, would have a combined federal and state benefit level of $584.26. In some states such as New Hampshire, the state administers only the state supplement portion of the benefit, and applies somewhat different eligibility rules based on the former state aged, blind, and disability welfare program for that portion. Massachusetts also gives categorical eligibility for MassHealth Standard (a form of non-nursing home Medicaid) along with SSI eligibility. Since 1996, benefits may be limited for certain categories of immigrants. Each year, a cost of living adjustment is applied to the federal benefit, and sometimes to the state supplement. Counting Other Income Income is something received by the recipient that has value, and is determined to be "countable" or "noncountable". Generally, everything of value including cash, other Social Security benefits (including SSDI), alimony, gifted goods and services constituting food, clothing, or shelter, or work income would be considered countable income. Income is only counted the month that it is received, and becomes a "resource" or asset if it is retained the following month and thereafter. Examples of income that are not countable includes other needs based benefits such as food stamps, some child support, goods and services that are not food, clothing, or shelter, free medical care, and replacement of something by insurance. Countable income generally reduces an SSI benefit payment dollar for dollar, although some countable income may be "disregarded", or not cause a benefit reduction. Income of a parent or ineligible spouse living in the household of an eligible spouse or child under the age of 19 is "deemed" or counted as available to the child for eligibility purposes, although there are additional disregards for each additional person used in the computation. A special category of "in-kind" income, or purchase of goods or services on behalf of a recipient by any other party or trust is only countable if goods or services involve food, clothing, or shelter (known as "In-kind Support and Maintenance" or "ISM" by the SSA). Even then, the monthly benefit reduction is limited to the lesser of the ISM or $201.66 in 2002. The $201.66 amount is actually fixed each year at 1/3 of the maximum federal benefit amount plus $20 and is known as the "Presumed Maximum Value" or "PMV" calculation amount. As an example of how this complex system of income is counted, a disabled 61 year old man living alone in Massachusetts has an SSI payment level of $659.39 per month in 2002. If his only other income is a Social Security Disability Insurance (SSDI) benefit of $300 per month (considered to be countable income), after applying a $20 per month regular "unearned income disregard", his SSI check would be $379.39 per month. Receipt of any other countable monthly income would decrease his SSI check dollar for dollar accordingly to the point that his SSI would be terminated when his countable unearned income reached $679.39 per month (the SSI payment level plus the $20 of disregarded unearned income amount in this example). If in the example above, a trust pays $500 towards his monthly rent, and leases a vehicle for him with insurance, fuel, and repairs valued at $400, only the rent would be counted because the vehicle and related expenses are not ISM. The payment of rent on his behalf (ISM) would reduce his monthly SSI benefit by the maximum additional $201.66 per month, or he would get a balance $177.73 in SSI benefits (659.39 + 20 - 300 - 201.66 = 177.73). If he decides to work, the first $65 and 1/2 of the remainder of gross regular work income is disregarded each month, although any work or potential to work can be used to determine ongoing disability status. If he earned $185 gross in a month, his monthly SSI benefit would be reduced by an additional $60 (the first $65 and 1/2 of the remainder of $185 is "disregarded"), leaving him with a monthly SSI benefit of $117.73. Note in the complete example that his total monthly income was actually $1,502.73 (300 + 500 + 400 + 185 + 117.73). Counting Resources "Countable" resources (assets) are limited to $2,000 for an individual, and $3,000 for a couple. Similar to the MassHealth program, many ordinary resources such as a primary vehicle, residence, irrevocable burial policy, and household furnishings, are not countable. Resources of an ineligible spouse or parent (for recipients age 18 and younger) living in the same household as the recipient may be counted or "deemed" as belonging to the recipient. Transfers For Less Than Fair Market Value Beginning December 14, 1999, the SSI recipient will receive a disqualification period of SSI eligibility due to transfer of resources or income to another party for less than fair market value that is not otherwise exempted. Exemptions are similar to those for nursing-home Medicaid: gifts to a qualified person such as a disabled child or other disabled individual; transfers into a qualified Medicaid payback trust; or transfers involving a residence to a caretaker child or co-owner sibling. However, the SSA may be interpreting the law differently then the Massachusetts Division of Medical Assistance in certain instances. The disqualification period is based on a divisor amount equal to the recipient's monthly SSI benefit level amount (including state supplement), but the disqualification period has a maximum of 36 months regardless of the amount transferred and regardless of when the application is filed. Trusts Trusts have become a complex area of income and resource eligibility determinations under SSI. Prior to January 1, 2000, a person could create and gift (without a transfer of resources disqualification period if gifted prior to December 14,1999) any asset into a special type of irrevocable trust administered by an independent trustee, with the creator of the trust as the beneficiary, and the trust principal and income would be non-countable as a resource for SSI eligibility purposes. Only actual distributions to or on behalf of the recipient might be counted as income (see above). The old rules remain for creation and funding third party trusts (those created and/or funded by anyone other than the SSI recipient), but a new set of rules similar to OBRA '93 apply to trusts created and/or funded by the SSI recipient after the law change. The principal new requirement for self-created/funded trusts is that the state Medicaid agency must be paid back for all benefits paid upon the death of the recipient prior to distribution for the recipient's funeral expenses or to remainder beneficiaries. Application, Reporting, and Termination As SSI is considered a program of last resort, the eligible person is required to apply for all other benefit programs for which he or she might be potentially eligible. An application for SSI or for any Social Security program should be considered as a protective filing for any potential benefits under either program. SSI benefits are only payable retroactive to the day of application. If income, resources, living arrangement, or other circumstances affecting payment amount or eligibility change while a person is eligible for SSI benefits, the person is required to immediately report the changed circumstances. Not reporting the changes may result in an overpayment, and in exceptional fraudulent circumstances, in civil and criminal penalties. Periodic scheduled reviews or "redeterminations" by the Administration, and automatic record checks, such as governmental tax filings or bank record matches, are designed to pick up changes not otherwise reported. Aside from counting work income (described above), the SSI program encourages disabled eligible persons to attempt to return to work and still retain benefits for a limited period, thereby eventually ending the disability by various work incentives. The benefits range from vocational rehabilitation programs to work expense credit exclusions to continuing Medicaid eligibility. Counseling for SSI recipients attempting to work can be obtained from the non-profit recipient advocacy related Disability Law Center located in Boston, telephone (617) 723-8455 or (800) 872-9992. The DLC website is www.dlc-ma.org. Sources of Information The SSI statute is found in Title XVI of the Social Security Act, or at 42 USC 1381, et seq. The regulations are codified at 20 CFR 416. The SSA uses a non legally binding operating manual called the POMS, which is the most commonly used source of information by the local office or advocate regarding interpretation of the law and regulations and examples of how the rules should be applied. Legal interpretations regarding particular situations of importance can be found in the Social Security Rulings (SSR) or acquiescence to court rulings in a particular circuit can be found in the Acquiescence Rulings (AR). The Social Security Office of Hearings and Appeals' operating manual is called the Hearings, Appeals, and Litigation Law Manual (HALLEX). There is an easy to read but outdated lay person's manual on all Social Security administered programs called The Social Security Handbook. All of these information sources can be found in the reference section of the SSA web site at www.ssa.gov. A short cut to the specific SSI POMS section is: http://policy.ssa.gov/poms.nsf/poms?OpenView&Start=1&Count=50&Expand=5#5 Since the state supplement portion of SSI differs by state, information regarding state specific information is usually obtained from a local office, which is transmitted in written form through Program Circulars and other internal transmittals. Information regarding a particular case can be obtained from the local SSA office once the advocate files form SSA 1696, Appointment of Representative, which like all official forms, can be obtained on the SSA web site. If you are patient, you can obtain a limited amount of specific information through the Social Security tele-service at (800) 772-1213. This is a phone bank, and you will be linked with a person who may be in another part of the country, but has some knowledge of Social Security procedures and access to the Social Security computer system for a particular case. |
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