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Find answers to frequently asked questions.

Question:
I received a notice with a patient’s alcohol and drug abuse records that I could not “further disclose” the information. How can I send them on to SSA?

When providers of substance use services (drug and alcohol) release records, they are required to include the following notice from the CFR Title 42:2.32:

“This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.” Source: http://edocket.access.gpo.gov/cfr_2002/octqtr/42cfr2.32.htm

However, the law allows the records to be disclosed to any entity the person names in the consent. When you complete the SSA-827: Authorization to Disclose Information to SSA be sure that it specifically mentions the release of drug and alcohol treatment records.

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Question:
What is 1619(b) Status and how is it determined?

1619(b) is continued Medicaid coverage for those individuals that were receiving SSI benefits prior to returning to work. You can find more information on SSA's website here: http://www.socialsecurity.gov/disabilityresearch/wi/1619b.htm

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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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Question:
If an applicant is approved for SSI/SSDI, will they lose their medicaid and be placed on medicare? If they can have both, which would be their primary insurance?

If a person is approved for both SSI and SSDI they will maintain Medicaid because SSI benefits include Medicaid. However, some states require a separate Medicaid application, (https://www.ssa.gov/disabilityresearch/wi/medicaid.htm).

Medicaid coverage for services varies from state to state. Here is a link that will take you to your state's Medicaid agency: https://www.medicaid.gov/about-us/contact-us/contact-state-page.html.

SSDI benefits include Medicare, but there is typically a 24 month waiting period before the SSDI beneficiary can begin to have Medicare coverage (see Page 12 at https://www.ssa.gov/pubs/EN-05-10029.pdf).

Once the beneficiary has both Medicaid and Medicare, Medicare is typically the primary insurance.

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Question:
What is the monthly SSI benefit?

SSI has a monthly federal benefit rate that changes each year plus any available state supplement. You can find the current benefit amounts on our SSA Annual Updates page.

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Question:
How can someone receive SSDI (Title II) benefits if they have never worked?

If an individual becomes disabled before the age of 22 and one of his/her parents is either deceased or receives disability or retirement benefits, the "Disabled Adult Child" may receive benefits based on their parent's earnings record. SSA has an easy to use FAQ page about this topic: https://www.ssa.gov/planners/disability/qualify.html

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Question:
When people get large back-pay checks, how long do they have to spend the funds in order to get their resources below that $2,000 level and not impact future payments?

Generally, SSA will not count the retroactive (back-pay) SSI or Social Security benefits for up to nine months after the person receives them. This includes payments received in installments.

When the individual receives his/her award letter it should spell out the exact length of time s/he has to spend down the retroactive payments. If there is any confusion, definitely check with the local SSA office for specifics on the individual's case.  

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Question:
If someone might be eligible for unemployment but is also unable to continue working, should he apply for unemployment or SSI?

If he is eligible for unemployment and the amount is more than the Federal Benefit Rate (FBR)*, then he should take the higher amount (unemployment) as long as he can.  The medical approval for SSI will last for 12 months, so if the unemployment only lasts a few months, he can always reapply for SSI (the non-medical application) and SSA will use the medical decision from his last application. 

*This figure is updated annually and can be found at SSA Annual Updates.

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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:
I am looking for a contact at my local SSA office, who should I call?

You can contact your SOAR State Team Lead or Local Lead to find out if there is a designated SOAR liaison at your local SSA office.

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