The Full Benefit, Too
A Consumer-Friendly, Self-Help Guide to Understanding SSI Appeals
for Adults with Intellectual and/or Developmental Disabilities (I/DDS)
Bet Tzedek Legal Services
3250 Wilshire Boulevard, 13th Floor
Los Angeles, CA 90010
Copyright ©2019 by Bet Tzedek Legal Services
Permission is hereby granted to reproduce this book or portions thereof, provided Bet Tzedek
is acknowledged in writing on each page reproduced and such copies are not offered for sale
in any manner.
Printed in the United States of America
Author: Ariana Cernius
The authors and publisher have done everything possible to make this booklet accurate, up to date, and in accord
with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors
or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in
regard to the contents of the booklet.
Important Note: The Full Benefit, Too is based almost exclusively on California law. It is intended for use by California residents, although some aspects may be applicable in other states. This guide is not a substitute for the independent judgment and skills of an attorney or other professional. If you require legal or other expert advice, please consult a competent professional in your geographic area to supplement and verify the information contained in this guide.
TABLE OF CONTENTS
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Chapter 1: Introduction to Supplemental Security Income (SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
What is Supplemental Security Income?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
How do I qualify for SSI?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Is SSI the same as “Social Security Disability Insurance” or SSDI?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Chapter 2: How Do I Apply for SSI?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
How do I qualify for SSI?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Categorical Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Financial Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Limited Conservatorships and Representative Payees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
How Much SSI Will I Receive?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
The Federal Benefit Rate (FBR) and State Supplementary Payment (SSP). . . . . . . . . . . . . . . . . . . . . . 10
Why Does My Adult Disabled Child Receive Less than the Maximum $931.72 Per Month? . . . . . . . 11
How Do I Apply for SSI?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Medi-Cal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Chapter 3: What is a Denial? How do I Appeal?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
What is a Denial?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Four Levels of Appeal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Table of Contents iv
1. Request for Reconsideration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2. Hearing Before an Administrative Law Judge (ALJ). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3. Appeals Council Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4. Filing a Case in Federal Court. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Getting SSI Benefits After Winning a Denial Appeal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 4: Terminations and Continuing Disability Reviews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
What is a Termination?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Two Types of Redetermination Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1. What is a Redetermination Review?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2. What is a Continuing Disability Review (CDR)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
My Benefits were Terminated. What Should I Do?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Will I Still Get Medi-Cal After an SSI Termination?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Chapter 5: Five Best Practices for Managing Your Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
1. Read and Respond to SSA Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2. Spend SSI Money in the Right Places. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3. Report Changes in Your Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4. Keep Good Records and Collect Evidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5. Use a Lawyer or Advocate Who Specializes in SSI Disability Cases. . . . . . . . . . . . . . . . . . . . . . . . . . 25
SSI Disability Law Specialists List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
v Table of Contents
Sources, Literature, and Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Chapter 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Chapter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Chapter 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
ACKNOWLEDGEMENTS
We would like to thank the following individuals for their support of this project:
Johanna Bauman, April Caires, Yolande Erickson, Nick Levenhagen, Spencer Lord,
and Jennifer Petrovich for their contributions to the development of this guide.
INTRODUCTION
This book is designed to assist adults with Intellectual and/or Developmental Disabilities (I/DDs) and their caregivers to better understand and access the government benefits to which they are entitled. One of these benefits is Supplemental Security Income (SSI) which provides cash support to people with disabilities who earn little to no income. I/DDs are long-term conditions which delay mental, cognitive, and/or physical development, impact day-to-day-functioning, and usually last a lifetime. Many I/DDs can dramatically impair a person’s ability to perform daily activities and to live a fully independent life.
The resulting financial effects can, sometimes, be overwhelming to an individual or a family. Receiving SSI because of a disability does not mean the person with disabilities will never be capable of working or living independently—only that he or she is not yet capable of doing so at the present time. The good news is that SSI benefits can help alleviate this financial strain and provide people with I/DDs enough support to allow them time and financial security to work towards achieving maximum independence in their lives.
INTRODUCTION TO
SUPPLEMENTAL SECURITY INCOME (SSI)
What is Supplemental Security
Income (SSI)?
Supplemental Security Income, or SSI, is a federal benefit program run by the Social Security Administration (SSA). It pays monthly cash benefits to adults who are blind, disabled or over 65, and have limited income and resources. Children with disabilities may also qualify for SSI.
The SSI maximum monthly payment, in 2019, is $771 a month for an individual or $1,157 a month for a couple. Most states offer supplemental payments. In California, in 2019, the state supplement amount is $160.72.
How do I qualify for SSI?
To qualify for SSI, you must have limited income and few assets. Social Security requires SSI recipients to have less than $2,000 in assets for a single person, and $3,000 for a couple.
Is SSI the Same as “Social Security Disability Insurance,” or SSDI?
SSI is different from Social Security Disability Insurance (SSDI). SSDI is a program that pays benefits to disabled adults who have worked and paid payroll taxes for a specific period of time. So, eligibility is based on disability and employment history for SSDI, instead of disability and income and resource levels for SSI.
You may be able to receive both SSDI and SSI if you are an adult with an I/DD who has a work history. If you have an I/DD adult child who just turned 18 and does not have many years of work experience, he or she will probably not qualify for SSDI on his or her own. However, they may qualify for SSDI as a qualified dependent adult. For more information on the rules, please refer to the following Social Security Administration publication:
www.ssa.gov/pubs/EN-05-10026.pdf.
