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Find answers to frequently asked questions.

Question:
Would someone who has life insurace policies with a cash value totaling $3,700 still be eligible for SSI?

SSA considers any life insurance policy with a face value of $1,500 or higher. The face value is how much insurance you're buying, (e.g., $5,000, $10,000, etc.). The cash value is what you'd get for the policy if you cashed it in.  Since this person’s policies are valued at $3,700, they are over the resource limit for an individual ($2,000). In order to fall below the resource limit, they would need to cash in one (or more) of the policies depending on what other resources they have.  They would need to use/spend that money to live on before becoming eligible for SSI.  

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Question:
What does it mean if an applicant receives a letter that says s/he has been found "not disabled as of a certain date"?

This letter applies to an individual’s eligibility for Social Security Disability Insurance (SSDI). SSDI is an insurance program that you pay into when you work through a portion of FICA payroll taxes. As such, when you stop working, you stop paying into this program and eventually your “insured” status will expire. The date your insured status for SSDI expires is known as the “date last insured.” For SSDI, applicants need to show that they were disabled before the date last insured in order to be eligible for benefits. For the letter in this question, it was found that the applicant was not disabled before his/her date last insured. If the applicant decides to appeal the decision, locating medical records the document an earlier onset of disability (if applicable) and checking the applicant’s earnings record to see if any earnings were missing are key strategies to pursue.

If the applicant’s disability arose after the date last insured, s/he may still be eligible for SSI, if h/she meets SSI resource and income requirements.

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Question:
If someone already receives SSI, is it possible that they might qualify for SSDI instead? Is it worth pursuing?

When an applicant files for SSI, they are automatically also considered for any SSDI benefits (or other associated benefits) for which they may be eligible at the time of application. If the applicant is not eligible at the time of application for SSDI, but is eligible for SSI, they may become eligible for SSDI in the future. This occurs one of two ways:

  1. If the beneficiary works and earns enough work quarters to qualify for SSDI based on their own earnings record, they could be moved to SSDI. The beneficiary can check their work quarter status by signing up for a “my Social Security” account.
  2. If the beneficiary became disabled before age 22 and was receiving SSI, they may be able to switch to SSDI based on a parent’s earnings record if the parent retires, becomes disabled, or dies.

If the beneficiary believes that he/she may be eligible based on the above situations, we encourage him/her to reach out to SSA to discuss their circumstances before filing the application. 

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Question:
If a child receives SSI, how does the family's income affect his/her benefits?

"We consider your child’s income and resources when deciding if your child is eligible for SSI. We also consider the income and resources of family members living in the child’s household. These rules apply if your child lives at home. They also apply if he or she is away at school but returns home from time to time and is subject to your control.

If your child’s income and resources, or the income and resources of family members living in the child’s household, are more than the amount allowed, we will deny the child’s application for SSI payments."

Source: https://www.ssa.gov/pubs/EN-05-10026.pdf

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Question:
What does "battery and cruelty" mean on the SSA-8000?

Question #13 about "battery and cruelty" on the SSA-8000 applies only to immigrants and refers to domestic violence or child abuse. The SSA policy and operations manual states: "The alien claimant, the alien claimant's child, or the alien claimant's parent, must be determined to have been battered or subjected to extreme cruelty while residing in the U.S..."

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Question:
Who do I contact to find out the status of a claim when the applicant is waiting for a hearing?

The second stage in the appeals process is when the applicant requests a hearing before the Administrative Law Judge (ALJ). These hearings are scheduled through the Office of Hearings Operations (OHO). Visit the SSA website to find the appropriate hearing office based on the applicant’s address or ask your local SSA field office. 

You can also take a look at Prior or Pending Applications and other Appeals resources in the SOAR Library.

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Question:
Can a person receive both unemployment and SSDI?

Technically, it is possible to receive both unemployment benefits and SSDI, but it gets tricky.

When you apply for unemployment benefits you attest that you are ABLE to work but you lost your job through no fault of your own and are actively looking for work. When you apply for disability benefits, you attest that you are UNABLE to work at a substantial gainful level.  There are certain circumstances where someone might be receiving unemployment and become disabled after becoming unemployed or became unable to work while they were employed due to an illness or injury on the job. These folks might apply to both programs but must actively seek work to maintain the unemployment benefit.

 

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Question:
How does SSA define homelessness for the Living Arrangement question?

Homeless/Transient (Living Arrangement): A transient is an individual with no permanent living arrangement, i.e., no fixed place of residence. A transient is neither a member of a household nor a resident of an institution. 

Examples:

  • a homeless individual (i.e., someone who sleeps in doorways, overnight shelters, parks, bus stations, etc.); or
  • a person who stays with a succession of friends or relatives and has no permanent living arrangement on the first moment of the month.

(Source: https://secure.ssa.gov/apps10/poms.nsf/lnx/0500835060)

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Question:
Does DDS use GAF (Global Assessment of Functioning) scores in their decision?

The disability adjudicators do not use GAF scores specifically in their assessment, since the disability criteria are not the same as the DSM. 

DDS basis their decision on the extent to which the “Listings” (Disability Evaluation Under Social Security) are met. For mental impairments they are looking for A) the diagnosis and B) the functional impairment. The main focus is on how the person's illness affects their functioning in four areas: Acitvities of Daily Living (ADLs); social; concentration, persistence and pace; and decompensation. DDS needs evidence that the person has marked impairment in at least two of these areas, or moderate impairment in at least three areas. It is more important for them to have clear, detailed descriptions with examples of how someone is functioning.

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Question:
How can we track Medicaid reimbursements?

Most SOAR programs that have a hospital collaboration will work with the hospital’s billing department to collect information on reimbursed expenses for each SOAR applicant approved. Some are able to separate out Medicaid and Medicare reimbursements; others have just a total for all reimbursements. The information isn't any more complicated than: "We helped 100 individuals get approved for SSI/SSDI and the hospital has been reimbursed $500,000 in the past year in Medicaid/Medicare expenses for these individuals."  It can be helpful to also collect the totals for unreimbursed expenses for those same individuals for the year prior to approval to use as a comparison.  One SOAR provider looked at emergency room usage for the year prior and the year after approval to see if there was a reduction. They found a 24 percent reduction in ER usage and 52 percent reduction in psychiatric ER usage.

Some SOAR providers will meet monthly with the billing department and collect reimbursement data, others will do it quarterly.  We would recommend doing whatever works best for the staff at the hospital and the SOAR staff.  

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