ODDC- SSA - Delivering on the Promise

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TITLE: Delivering on the Promise: U.S. Department of Social Security Administration Affairs Self-Evaluation to Promote Community Living for People with Disabilities

AUTHOR: Specific author unknown (KACW 3/26/03)

INTRODUCTION: The Social Security Administration (SSA) operates two major cash benefit programs for people with disabilities. The Social Security Disability Insurance (DI) program is a social insurance program with benefits based on prior earnings. The Supplemental Security Income (SSI) program is a means-tested income-assistance program. Ten million people with severe disabilities receive $6 ½ billion a month in DI or SSI benefits. People who receive DI benefits also become eligible for Medicare after a two-year waiting period, and most SSI beneficiaries are eligible for Medicaid. Staff who serve the public directly will receive training to emphasize the importance of key policies and procedures in promoting the goals of the President’s Executive Order.

SSI Benefits for Those Who Are Temporarily Institutionalized: Institutionalization does not affect the receipt of DI benefits but can affect eligibility for SSI. The Social Security Act provides that anyone who lives in a public institution is ineligible for SSI and anyone who lives in a facility where Medicaid pays more than half the cost of care is eligible for no more than $30 a month. Approximately 250,000 people live in Medicaid-funded institutions and 7,000 individuals have become ineligible for SSI in the past year because of entering a public institution, discouraging institutional living. An exception to the law states that, for up to three months individuals may continue to receive the same benefit enabling them to pay the expenses necessary to maintain their place of residence while they are in the institution. When SSA field staff record that an individual has entered an institution, they must know and record whether the payment exception for temporary institutionalization applies. SSA will provide additional training on this provision, emphasizing the importance of good relationships with local medical institutions and state welfare agencies to facilitate reintegration into the community so the staff will be able to determine length of stay.

A "public institution" does not include a publicly operated community residence where less then 16 people live, and individuals living in such facilities are eligible for the full federal benefit rate, promoting deinstitutionalization and the transition of people to services and programs available in the community.

Re-entering the Community: When a person receiving SSI leaves his or her home to enter an institution, the home remains an excluded resource as long as the individual intends to return. If the individual does not intend to return, the home remains an excluded resource as long as a spouse or dependent relative continues to live there, allowing the home to be kept in case his or her condition later permits a return to the community. When an individual who leaves an institution is ineligible for SSI or is subject to the $30 limit while institutionalized, but is eligible for SSI once he or she returns to the community, SSA processes an SSI application several months before the transition ensuring the individual can meet living expenses outside the institution. SSA will emphasize to local offices the importance of prerelease agreements, the requirement to review and renew prerelease agreements annually, and stress the importance of maintaining updated listings of community resources that can help people adapt to living in the community.

Emergency Payments: SSA recently refined its instructions on the immediate payment procedure and currently is upgrading its instructions on the emergency-advance-payment-procedure. Field offices can also issue an emergency advance payment, one-time only SSI payment that can be made to individuals who have applied for SSI benefits and been found eligible, or presumptively eligible, but whose initial benefit payment has not been made. Immediate payments, normally limited to less than $1,000 per person, can provide timely benefits for individuals with financial emergencies who otherwise might be prevented from establishing or maintaining a stable place of residence.

Enhancing the Representative Payee Process: Many people receiving benefits cannot manage them and need someone to do it for them. For people residing in institutions, the lack of a suitable representative payee to receive and manage his or her benefits outside the institution can be an obstacle to leaving the institution. When selecting a representative payee, SSA gives preference to family and friends. However, not everyone has a supportive network of family and friends who can be a representative payee. In this case, SSA must locate suitable organizations that are able to provide this service. Currently, SSA is designing an organizational campaign to recruit payees available to manage benefits for individuals. SSA also carefully monitors the performance of the representative payees it selects, by conducting periodic reviews to ensure that benefits are being used to meet the immediate needs of the beneficiary or that they are being conserved in a responsible manner.

Waiver of Parental Deeming Rules and Home Care Plans: Usually determinations of SSI eligibility and the payment amount for children who live with their parents, take into account parental income and resources. This process, called "deeming," can result in ineligibility for SSI and Medicaid. However under certain conditions, deeming does not apply to children with disabilities who live at home and qualify for Medicaid under a state home care plan. Home care plans provide Medicaid coverage for individuals with a disability who have been or are at risk of being institutionalized, but who can be cared for at home. Deeming does not apply if it would make the child ineligible for SSI and the child received SSI benefits subject to the $30 limit while he or she is in a medical facility. The waiver of parental deeming promotes deinstitutionalization by protecting a child’s Medicaid coverage at home and ensuring that the SSI payment is at least equal to the amount the child would receive if he or she were institutionalized. SSA will keep abreast of any expansion or other changes in the use of home care plans to identify situations where the waiver of deeming could apply. SSA will also upgrade its operating instructions to ensure that field offices apply this provision in all appropriate situations.

Exclusion for Individual Development Accounts (IDA): An IDA is a bank account used to save for education, the purchase of a first home, or to start a business. An individual can deposit money to an IDA from his or her own earnings. These deposits are matched at various rates with money from the state’s program of Temporary Assistance for Needy Families (TANF) or from a demonstration project. IDAs generally increase SSI benefits. When SSA determines SSI eligibility and payment amount, it does not count funds in a TANF or demonstration-project IDA as resources and does not count matching contributions as income. SSA also reduces countable income by the amount of any earnings that an individual deposits to a TANF or demonstration-project IDA.

Evaluating Individuals with Mental Disorders: Some individuals with mental disorders cannot tolerate the stress and complexity of substantial employment but can live satisfactorily in the community. SSA’s policies have provided that such individuals may qualify for disability benefits even though they are otherwise able to live independently. SSA will train state disability determination services, administrative law judges, quality reviewers, and other adjudicators on the Executive Order, stressing disability evaluation policies that are of particular relevance to individuals who do not reside in institutions.

Facilitating Community Living by Supporting Work: Technology is creating new kinds of work and new pathways to it, such as through telecommuting and home-based businesses. One of SSA's highest priorities is to assist disability beneficiaries in their efforts to take advantage of these opportunities. The Social Security Act has contained a variety of work incentives that encourage and reward work. The Ticket to Work and Work Incentives Improvement Act of 1999 improved a number of these incentives and added significant new ones.

Employment Support Programs: SSA recently established the Office of Employment Support Programs (OESP) to promote the employment of beneficiaries with disabilities by designing policies that make work pay, promoting research and program innovation, educating the public about programs and services that facilitate entry into the work force, and partnering with other public and private groups to remove employment barriers.

Ticket to Work and Self-Sufficiency Program: Under this program, a commitment of the President’s New Freedom Initiative, people will receive a voucher, or ticket, that they can take to an approved service provider of their choice. The provider, called an Employment Network, can be a private organization or public agency that agrees to provide vocational rehabilitation, employment, and other support services to help beneficiaries get and keep a job. Extensive public input has been and will remain an integral part of SSA’s implementation strategy for the Ticket Program. The Act contains other provisions to help people with disabilities take advantage of employment opportunities. For example:

A former DI or SSI disability beneficiary can request reinstatement of his or her benefits if the benefits were terminated within the past 60 months because the beneficiary went to work. Benefits can be reinstated when the beneficiary is no longer able to work because of his or her disability.
For most beneficiaries, Medicare coverage will continue for at least 93 months from the end of the trial work period, 4 ½ years longer than the previous coverage. States may provide Medicaid coverage longer for people that work. The trial work period allows a Title II beneficiary to work a total of 9 months, not necessarily consecutive, within a 60-month period before a review is done to determine whether the work activity should cease his or her benefits.
SSA will not conduct a continuing disability review (CDR) of a DI or SSI beneficiary’s medical condition while the beneficiary is using a Ticket to Work. Beginning January 1, 2002, SSA will not conduct a CDR of a beneficiary’s medical condition solely because of work activity if the beneficiary has received DI benefits for at least 24 months. Such individuals will remain subject to regularly scheduled CDRs not triggered by work.
Through cooperative agreements with 117 public and private organizations in each state, US Territory and the District of Columbia, SSA has established a program of benefits planning and assistance for beneficiaries who are working and those who want to work.
SSA has also awarded grants to the Protection and Advocacy systems in each of the states to provide information, advice, advocacy, and other services to beneficiaries with disabilities.

Plans for Achieving Self-support: A plan for achieving self-support (PASS) is a blueprint for achieving an individual’s occupational goal of choice specifying a job the individual wants or business the individual wants to start, identifies the expenses the individual considers necessary for getting the job or starting the business, and commits existing income and/or assets to these expenses. If SSA approves a PASS, it excludes the income and assets committed to the plan’s expenses when it determines eligibility for SSI. This permits eligibility for SSI or a higher SSI payment, which can help with the expenses in several ways. SSI benefits replace part or all of the committed funds, enabling the individual to pay or save for the expenses. Eligibility for SSI generally means eligibility for Medicaid, and income excluded under a PASS is excluded under the Food Stamps program and certain housing assistance programs. The PASS program permits the exclusion of, and the full or partial replacement of, income and assets used to pay for such things as: education and training; transportation, purchasing a vehicle, assistive technology; child care; attendant care; business inventory, equipment, and supplies; and business operating costs, for up to the first year after start-up. The PASS program can help overcome a number of major barriers to employment, such as insufficient access to or the unavailability of transportation, assistive technology, child-care, and attendant care. Finally, if earnings later replace SSI benefits, the individual can retain Medicaid coverage until it is no longer financially needed.

Impairment-related work expenses (IRWE) are expenses that a person must incur because of their disability in order to work. They can include the cost of attendant-care services, special transportation, medical devices, and prosthetics, if they meet certain criteria. SSA deducts IRWE when it determines whether the earnings of an individual who is disabled but not blind represent substantial gainful activity in the DI program. It also deducts them when it determines eligibility and payment amount for SSI.

When SSA determines SSI eligibility and payment amount for students who are under age 22 and not the head of a household, it excludes up to $1,290 a month in earnings, subject to a yearly maximum of $5,200. This policy encourages and rewards young SSI beneficiaries who attend school and work.

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