Developmental Disabilities, SSI, and How to Get Approved

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).