Category: SSI

Developmental Disabilities, SSI, and How to Get Approved

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The cornerstone of any plan created by parents for a child with a developmental disability who will not be able to support themselves as adults is ensuring eligibility for SSI and Medicaid are maintained. Why? Because those two programs provide the safety net that makes sure vulnerable people with disabilities have their basic needs met – food, shelter, and medical care. Once eligibility and access to those programs is protected through the use of tools such as special needs trusts, family estate planning, and ABLE accounts, then a plan to supplement the basics can be created. Developmental disabilities, SSI, is a crucial part of any plan.

What is SSI?

SSI stands for Supplemental Security Income.  It is a federal program run by the Social Security Administration (SSA) that provides monthly cash benefits to people who are disabled, low income, with few assets, who cannot work at all or enough to earn substantial wages toward their own needs. It is considered a “needs based” benefit program.  

What is Medicaid?

Medicaid is a program that provides both health insurance and long term supports and services for people with disabilities. Medicaid may pay for things like nursing homes or group homes, personal care assistance for people living at home, and long term therapies.  In most states, if you apply for and are approved for SSI, you will automatically get Medicaid as well.  In some states, there are two separate applications, but the eligibility requirements are similar.  

When is the right time to apply for SSI?

An adult can apply for SSI in the month after they turn age 18, or anytime after that. In most cases a person with a developmental disability should apply before they turn age 22, as it may be easier to qualify than if they wait until they are older. Family income is not considered in determining eligibility for anyone 18 or older.

Applying for SSI requires showing the following things:

  • The person has very little or no regular income, either from work or another source.
  • The person has less than $2000 in cash or property.  Some property may be exempt from consideration, such as a house or vehicle.  
  • The person has a disability within the meaning of the law – roughly defined as a physical or mental impairment that substantially affects one or more life functions, and that impairment is expected to last more than one year.
  • The person, because of the disability, is not able to hold a job that will earn a sufficient amount of money to provide for their basic needs (food and shelter). This is what SSA calls “substantial gainful activity.”

Successful applicants for SSI have done the following things:

  • Disposed of any assets over $2000 in an appropriate way (spent, placed in an ABLE account or a first party special needs trust)
  • Provided complete and detailed information about medical diagnoses, treatments, medications, and providers.
  • Provided information detailing the functional limitations that prevent the person from working to make a sufficient amount of money to provide for their own basic needs.  

Reasons SSI applications are denied:

  • The person is receiving too much income.  Calculating the amount that is “too much” is complicated, but if a person is not married and makes more than roughly $1700 a month from working, they may not qualify for SSI. If the person is making close to that amount, consulting with an attorney will help clarify if SSI is a possibility.
  • The person is not meet the definition of disabled.  For most people with developmental disabilities, a denial for this reason probably means that the SSA did not have enough of your medical information to make a proper determination.
  • The person is determined to be able to hold a job of some type.  This is the most likely reason a person with a developmental disability would be denied, but it often means the SSA did not have sufficient information in the application to get a good picture of the persons limitations.

Successful applications for SSI focus on the skills and abilities that are needed to work. 

This is far more than an ability to do the actual task involved in the job.  For example, a person may be able to do the actual job task, say unloading a delivery truck.  But to hold a job unloading delivery trucks, the person would have to be able to arrive at work on time, be able to understand and follow instructions, be able to communicate with co-workers or supervisors when needed, be able to understand when there is a problem that needs further guidance, be able to work in the environmental conditions present (heat, cold, noise, etc), and a whole host of other things that go into successfully holding a job.  For many people with developmental disabilities, these are the things that present sufficient difficulty to keep them from being able to hold a job at all or to work enough hours to make sufficient money. 

Further, it is those things that may not be readily apparent to the person at SSA determining eligibility, unless the applicant very clearly describes all the ways in which their disability interferes with the ability to hold a job.

That information can be provided to SSA in a number of ways, such as:

  • The person’s own description of their abilities, if possible
  • Information provided from those who know the person, like a parent, teacher, therapist or medical doctor
  • Information from school assessments
  • Record of work history and detailed description of why each job ended

Demonstration of failure is not required

An applicant for SSI does not need to have tried to work and failed before they can apply.  Some people will not know they are unable to work until they give it a try, but many people with developmental disabilities are very clearly unable to work and need not attempt to do so before their application is accepted. If the medical and educational information available shows the person does not have the necessary skills or abilities to hold a job of any kind, then that will be enough to have SSI approved.

Effect of a parent’s retirement or disability

When the parent of a person receiving SSI retires, or if the parent becomes disabled and receives social security disability benefits (which are different than SSI), then the person with SSI is eligible to receive a child’s benefit based upon their parent’s work record.  If the amount that they would receive is more than their SSI benefit (currently the maximum SSI benefit is $841 a month), then the person will receive the higher amount but will be able to keep their Medicaid benefit.  If the amount of the benefit from the parent is less than the person is currently receiving, they will receive that plus SSI up to the maximum amount of SSI.

What if the person receiving SSI later wants to try and work?

SSI does not require that you be completely unable to work.  If a person can work a few hours a week, or can work with a job coaches assistance, as long as their earning are less than about $1700 a month (the exact calculation depends on many factors) then they will continue to receive SSI.  The SSI amount paid is lowered in each month where there are earnings.  SSA also has programs that will allow a person to continue to receive SSI during a transitional or trial period if they are trying to reach independence through work.

Can a person receiving SSI get married?

Yes, of course, but there may consequences to the SSI.  Whether they can continue to be eligible for SSI, and whether their monthly benefit amount will be affected depends on many factors.  Anyone receiving SSI who is thinking about marriage should talk to an attorney or SSA before making a walk down the aisle.

Once a person is receiving SSI, what happens?

A person with SSI must promptly report any income to SSA.  Income includes wages from work but also any other regular payment to which the person is entitled or for which an expectation has been created.  Occasional cash gifts do not need to be reported, but a promise by dad or mom to give the person $XXX of every month does have to be reported. SSA will also periodically review the person’s case to determine whether they are still disabled. 

What if the person is not able to manage their own money?

SSA will appoint a Representative Payee to accept and manage the monthly SSI payment on behalf of any person who is not capable of managing their own money.  This can be done whether or not the person has a guardian.  The Representative Payee will be required to make yearly reports to SSA on how the money was used.

What else should families do to preserve the adult child’s SSI eligibility?

The primary reason a person with a developmental disability would lose their SSI and Medicaid is if they receive a large amount of money or property from inheritance or life insurance. Therefore it is very important for parents and grandparents to set up special needs trusts and have a will that leaves any gift they intend for the person to that special needs trust for their care. If money is gifted to a property drafted special needs trust, it will not cause the person to lose their SSI, and it will provide money to use to supplement their care.

Is there anything else families should do to preserve the adult child’s SSI eligibility?

Any person that intends to help support or provide gifts of any kind to a person receiving SSI must make sure their gift doesn’t unintentionally cause problems. Consulting with a special needs law firm, with attorneys who understand how to use ABLE accounts, trusts, and other tools to provide for a person without causing SSI problems, is the best way to protect that person.

Parker Counsel Legal Services is a special needs law firm with offices in Texas, Massachusetts, and New Jersey. Set up a consultation to answer your questions by scheduling a brief call, email legal@parkercounsel.com, or call 833-RED-BOOT (833-733-2668).

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SSI FAQ

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SSI: Supplemental Security Income for Adults

SSI is a federal program administered by the Social Security Administration (SSA) to provide monthly cash payments to people with disabilities who have little to no income and fewer than $2000 in assets. It stands for "supplemental security income" and is not the same as SSDI (social security disability income), which is a program for adults who become disabled after having worked and paid into the social security system. Children under age 18 can receive SSI, but family income is considered in the eligibility determination. Once a child turns 18, only income and assets belonging to the individual are considered.
An application can be started online, by phone, or in person at your local social security office. https://www.ssa.gov/benefits/disability/
Eligibility is based on two factors: financial situation and disability status. Disability, for SSI purposes, means that a person has a physical or mental condition that is expected to continue for at least a year or more, and prevents the person from holding employment sufficient to support themselves. Developmental disabilities frequently result in a disability for SSI purposes, but a diagnosis alone is not enough. Applicants must show medical, educational, or vocational evidence that they are not able to engage in meaningful work.
There are several types of information that may be needed to establish disability. Medical information, of course, will be needed - doctors, treatments, medications, etc will all be needed to establish that a physical or mental condition exists. The medical information will also establish the severity of the condition. In addition to medical information, some people may need to add other information in order to demonstrate that the person is not able to engage in meaningful employment. This could include documents from educational evaluations and special education reviews, information about attempts to engage in employment (if any), or statements from therapists and other professional providers.
If your child is under age 18, family income is considered when determining eligibility for SSI. If your child is 18 or older, ONLY the income the child earns is considered. Any support you provide in the way of housing or groceries is considered when determining your child's monthly SSI benefit, but family income is NOT considered to determine eligibility itself.
An adult disabled child whose disability began before the age of 22 and who receives SSI benefits, can receives benefits on their parent's account when the parent retires, dies, or becomes disabled. If the amount of benefits from the parent's account is more than the SSI amount, the child will receive the higher amount and no longer receive SSI. However, they will continue to receive Medicaid benefits. In addition, after two years of receiving the disabled adult child benefit, they will be able to obtain Medicare in addition to their Medicaid.
To be eligible for SSI, a person must have no more than $2000 in assets - cash, savings, stocks, savings bonds, etc. Some items are exempt - https://secure.ssa.gov/poms.nsf/lnx/0501110210 Any assets over $2000 must be spent or moved to an ABLE account or a special needs trust before applying for SSI.
To be eligible for SSI, a person cannot be able to engage in "substantial gainful activity." Basically, this means that are not able to work enough to make enough money to take care of themselves. SSI recipients are not prohibited from working altogether, though. If they are either 1) earning less than roughly $1700 a month, or 2) are enrolled in a social security program designed to transition them into regular work.

Parker Counsel Legal Services is a special needs law firm providing estate planning, special needs trusts, guardianship, and more to families with children who have developmental disabilities. Offices in Texas, Massachusetts, New Jersey. To see how we can help your family prepare for the future, schedule a short phone call here, or call 833-Red-BOOT (833-733-2668) or email at legal@parkercounsel.com.

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Myth vs Attorney

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As a special needs parent myself, I regularly tell our clients that getting connected to parent support groups is almost a necessity to get through life with a special needs child. Traditional sources of parenting wisdom and tips, like grandparents, the mommy group at the playground, and even the many many many parenting books at Barnes and Noble simply aren’t going to have the information we need for our differently abled and differently developing children. Special needs parent groups are a lifesaver.

But there are certain types of information that should still come from professionals. I frequently see bits of info regarding benefits and legal issues passed around in these groups that is just plain wrong. Much of it is ultimately harmless, but a lot of things I see can actually result in the loss of benefits and opportunities if the information is taken as true.

For example, recently this myth has been making the rounds: that individuals with disablities can only open an ABLE account if they are receicving SSI benefits. This is not true. You do not have to be receiving benefits in order to qualify for an ABLE account. And this is only the latest in a string of myths I see passed around about programs and benefits for kids and adults with special needs.

[The ABLE National Resource Center has a webinar coming up this Thursday, June 20, to bust that and some other myths about ABLE accounts.
https://zoom.us/webinar/register/WN_XBFVQO0TQBOyYT1iDCjOxg ]

Just as you must go to a doctor for a reliable medical diagnosis, you must go to experts for other types of reliable information. An attorney who deals with special needs issues is one great source, and our office is always willing to answer questions – the easiest way to get a question to us is by email legal@parkercounsel.com but you can also call and leave a message. We will get back to you. We are here to help as best we can.

Make sure you have accurate information about what help your child is entitled to and make sure you have accurate information about how to get those benefits.

Parker Counsel Legal Services provides estate planning, guardianship, special needs trusts, and other services to families who have children with developmental disabilities in Texas, Massachusetts, New Hampshire, and New Jersey. legal@parkercounsel.com 833-RED-BOOT (833-733-2668) or schedule a short information call at calendly.

Does your child need a special needs trust to get Medicaid?

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Children with developmental disabilities – cerebral palsy, Down Syndrome, autism, and any other condition that began in childhood – who are not able to work and support themselves are probably going to be able to get social security benefits and Medicaid (called MassHealth in Massachusetts) when they turn 18 years of age. In some cases, they can receive these benefits before 18, but in almost every case they can do so after 18. Social security provides a limited cash payment to persons with a disability who have very low or no income and assets. Even if a child with a disability continues to live at home with parents after they turn 18, if they have little or no income and little or no other resources like savings, they will probably be eligible for supplemental security income (SSI) and Medicaid.

SSI cash benefits are pretty low (currently $770 a month, with some states adding a little bit more), so it’s important to have a way to supplement the limited spending power of that SSI money. While parents are alive, they can buy “extras,” like computers, videos, vacations, even additional therapy or vocational training not covered by insurance. But when the parents die, an inheritance to a child receives SSI and Medicaid will almost always cause them to lose those benefits. People with developmental disabilities who are receiving, or will probably receive in the future, SSI and Medicaid benefits, should never be left an inheritance or be named as a life insurance or pension beneficiary because it will jeopardize their benefits.

That’s where the special needs trust comes in. If a parent or grandparent puts money into this very special type of trust, that money can be used to supplement the government benefits while keeping those benefits in place. A New Jersey special needs trust, a Massachusetts special needs trust, a New Hampshire special needs trust, even a Texas special needs trust, all work the same way to let parents, grandparents, and anyone else who wants to leave money to improve the quality of life of a person with a disability give them money without causing any problem to their government benefits.

So back to the original question: Do you need a special needs trust in order for your adult child to get Medicaid? There are two parts to the answer. First, you may need a special needs trust to get Medicaid at age 18 if the child already has significant assets in their own name. Those assets can be moved to a special needs trust so that the adult child meets the very low asset threshold for eligibility.

The second part of the answer is that even if the adult child initially qualifies for Medicaid without a trust, they will probably need a special needs trust in order to keep those benefits when their parents die. The trust can receive an inheritance, life insurance proceeds, or even pensions, and that money can be used to enhance the quality of life of the adult child without causing them to lose their Medicaid or SSI benefits.

Parker Counsel Legal Services serves families in Central Texas, Western Massachusetts, Northern New Jersey, and the New Hampshire Seacoast with special needs estate planning, special needs trusts, and guardianships. Contact us for a consultation at 833-RED-BOOT (833-733-2668) or legal@parkercounsel.com or schedule a short information call at calendly.