ELIGIBILITY FOR SSI
Revised 4/2/03
Supplemental Security Income (SSI) is a benefit from the federal government. It is administered by the Social Security Administration (SSA). It is cash that helps pay for basics, such as shelter and food. It is available to people who are elderly, blind, or disabled, who have little income, and who have few assets. For an unmarried person, SSI’s current maximum payment is $552 a month.
This handout is about how disabled adults prove they are "disabled" for SSI. Disabled adults must show that their disability prevents them from earning enough to support themselves. If they are disabled but work and earn enough to support themselves, they are ineligible for SSI.
When applying for SSI, they will be asked if they work and , if so, how much they earn. As of January1, 2003, if they earn more than $800 a month, they cannot receive SSI.
When applying for SSI, "disability" must be proven. Two kinds of evidence can be used to prove disability. One kind is medical. This evidence is provided by physicians, psychiatrists, and psychologists. A second kind is functional. This evidence shows how the disability interferes with a person’s capacity for financial self-support. This kind of evidence is often provided by family members and others who know the applicant well.
All evidence is submitted to SSA. If the evidence is incomplete or superficial, a person who should be eligible might be ruled ineligible.
If a person’s application for SSI is denied, it can be appealed. Appeals are often successful, but can take more than a year to complete. Doing it right the first time might eliminate the need to appeal.
Evidence of disability can be established by meeting SSA’s regulatory definition for the disability in question. If, for example, a person’s IQ on the Wechsler Adult Intelligence Scale (WAIS), or another acceptable test, is 59 or less, he or she will be medically eligible for SSI as a person with mental retardation. (For regulatory definitions of other mental or physical disabilities, contact your local Social Security office.)
But what if a person applying for SSI does not satisfy the regulatory definition? A second way to show proof of disability is to document how the disability causes functional limitations.
You, or other people who know the individual well, can play an important role in providing this information. Make sure you give it! Document functional limitations in the following areas:
1. Activities of daily living. This includes a wide variety of activities such as cleaning, shopping, cooking, taking public transportation, paying bills, caring appropriately for one’s grooming and hygiene, etc. Establishing severity depends on how well the person who is disabled can start and participate actively in these activities independent of supervision or direction. The evidence should explain why the disability interferes with successfully completing activities of daily living.
2. Social functioning. This refers to the capacity to interact appropriately and communicate effectively with others. Impaired social functioning may be shown by a history of arguments, evictions, firings, fear of strangers, avoidance of interpersonal relationships, social isolation, etc. Social functioning in work situations may involve interactions with the public, responding appropriately to persons in authority, or cooperative behaviors with coworkers.
3. Concentration, persistence, and pace. Can the person who is disabled sustain focused attention long enough to permit the timely completion of tasks, at home or in the work setting? Document, with examples, if such attention cannot be sustained.
4. Deterioration or decompensation in work or work-like settings. This refers to repeated failure to adapt to stressful circumstances which cause the person who is disabled to either withdraw from that situation or to experience a worsening of the disorder’s signs and symptoms.
As an example, individuals with chronic psychotic disorders commonly have their lives structured to minimize stress and reduce their signs and symptoms. Such individuals may be much more impaired for work, or for functioning outside their structured environments, than their signs and symptoms would indicate. This information needs to be explained to SSA. Without it, SSA might deny eligibility that would otherwise be approved.
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1. Once accepted for SSI, a recipient’s total income can exceed $800 a
month. SSI has a financial incentive for people who work. As a person earns more from
work, his SSI payment is reduced. But the total – earnings from work and the SSI
payment combined – will be greater than if this person does not work and
relies solely on SSI. Here is an example: In 2003, the maximum, an unmarried recipient can
receive and not work is $552 a month. If the recipient gets a job that pays $200 a month,
he will lose $100 from SSI. This is because SSI is reduced when a person works. For each
dollar earned, SSI is reduced by 50 cents. In this example, the recipient’s SSI is
reduced from $552 to $452, but his overall income increases from $552 to $652.
2. These four areas are applicable for all mental disorders, not just mental
retardation. When, for example, the regulatory definition for a specific mental disorder
such as schizophrenia does not apply, the evidence should focus on how the disorder limits
the applicant’s ability to function in one or more of these four areas.