Title XVI Supplemental Security Income (SSI)

To qualify for SSI the child or youth must be a U.S. citizen or qualified immigrant. A child or youth must be medically determinable with physical or mental condition(s) that seriously limits his/her activities and the condition must have lasted, or expected to last at least one year or result in death. The child will undergo a Child Sequential Evaluation which is a three step process reviewed by the SSA examiner.

SSI is a “need based” public assistance program. The program is designed to provide income to a person with limited income and resources to meet basic needs for food, clothing and shelter.
SSI benefits are paid under three (3) categories:

Aged (over 65),
Blind (the benefits are higher), and
Disabled (at any age, including newborns).

Rates

The rates for SSI benefits are established by SSA. This includes any increases with cost-of-living adjustments. There is a FBR and an OSS. The OSS rate is also known in California as the SSP which is established for NMOHC. The current rates can be found in the Chart Book Chapter 6 “Disability Based Income [W & I Code 11451.51],”].

Note: In this chapter SSI/SSP benefits will be referred to as SSI.

Children under 18 are eligible for the NMOHC payments when the following conditions apply:

Blind residing in a state licensed facility,
Blind residing in the home of a relative who is not his/her parent or legal guardian/conservator,
Disabled residing in a state facility,
Disabled residing in the home of a legal guardian/conservator who is not his/her relative,
Disabled residing in the home of a relative who is not his/her parent,
Blind or disabled in a county certified or approved foster family home (includes relatives that are not parents and court dependent legal guardians), and
Youth in the participating in the EFC program at the age of 18 as NMD residing in a licensed/certified foster care home.

Note: NMDs in SILP may not be eligible for NMOHC payments because in many instances their are own payee for FC benefits.

Income and Income Limits

The value of countable resources must not exceed $2,000 except for dedicated accounts (Maintenance of Benefits). When income exceeds the maximum amount eligibility for SSI is lost. The SWC must ensure the SSI accounts do not exceed the income limits.

A child or youth in FC may have exempted unearned income in the amount of $20. When the child/youth is receiving SSI benefits and other unearned income, they may receive the maximum SSI (including SSP) rate plus an additional $20.

SSI Applications

An application for SSI Benefits is made at any time for a potentially eligible child or youth who enters the foster care system as a court dependent under the supervision of the DFCS, or a ward under the supervision of JPD.

When the child or youth is currently receiving SSI benefits and becomes a dependent or a ward of the court, the SWC with the assistance of the assigned SW/PO must complete an application to become the ARP of those benefits. Additionally, when a FC EW discovers a court dependent or ward is receiving SSI the FC EWs must begin completing the SSA-11-BK and submit it to the SWC for completion. The SWC will finish the application to become the ARP.

SSA considers a child disabled if:

The child has a physical or mental impairment (or combination of impairments):

That causes marked and severe functional limitations; and
Has lasted or is expected to last for at least 12 consecutive months or result in death.

A child is presumptively disabled due to:

Amputation,
Deafness,
Wheelchair or bed-bound,
Cerebral Palsy,
Downs Syndrome or obvious mental retardation,
Prematurity with low birth weigh, or
HIV/AIDS.

Protective Application Filing Date

The SSI protective filing date may be established based on the either a written statement of intent to file or oral inquiry about the SSI eligibility. When the SWC has determined that is appropriate to file an application for SSI, the SWC will complete a “Protective Filing Date Memo to SSA” (SCD 2455) and fax the memo SSA. This document will establish the filing date of the SSI application. The protective filing date provides the earliest filing date possible for the claimant. The protective filing date does not have to be the same date as the initial application. In most cases, the application is completed after the protective filing date, but the begin date of the claim is the protective filing date.

Early Filing of Applications for Youth Transitioning Out of Foster Care

In order to assist in the transition to adulthood, new applications for SSI benefits may be filed 90 days prior to the termination of foster care or turning 18 years old. The rule only applies to youth who have never applied for SSI.

All childhood SSI recipients must be re-evaluated at the age of 18. When there is an open claim with SSA and the youth is turning 18 an adult application must be done at least 30 days before their 18th birthday; the application will be placed on hold until after 18th their birthday. Normally before discontinuing benefits, SSA will notify the ARP when an adult application is needed.

SSI applications are submitted on-line at the www.ssa.gov after the SWC receives and reviews the required completed documents submitted by the SW/PO. Hard copies of the application and all of the supporting documents are mailed to SSA.

Non-Medi-Cal Out of Home Care (NMOHC)

California pays an OSS or SSP when an individual needs non-medical care or supervision in the following situations:

Children and NMDs Under Age 21:

Blind or disabled residing in a state licensed facility,
Disabled residing in the home of a relative (out of home placement approved by DFCS or JPD) who is not a parent, or
Blind or disabled in a certified or approved foster family home
Blind or disabled in a certified home approved by a FFA.

When a child is placed in out-of-home care (all FC placements), the SWC must submit the “Authorization for Non-Medical Out-of-Home Care” (SSP 22) along with the application. The SSP 22 is a request for a higher SSI rate and as a best practice must be submitted with all court ordered out-of-home placements. SSA will make the determination if the child/youth is eligible for the NMOHC benefit.

Eligible SSI Receiving Non-Federal AFDC-FC

Children or youth eligible for non-federal AFDC-FC funding can receive SSI benefits and AFDC-FC at the same time. Their SSI benefits are abated against the FC rate and any excess is passed-on to the provider with the joint efforts of the SW and the assigned SW/PO. The benefits are monitored by the SWCs.

Continuing Disability Reviews (CDR)

SSA periodically reviews eligibility for SSI benefits to decide if the claimant still meets the disability standard. The law requires SSA to perform medical CDRs approximately every 3 years. In some cases, the CDR is scheduled more often and in other cases in which the likelihood of improvement is small or not at all, the CDR may be waived.

When SSA performs a CDR they will ask the SWC to show evidence that the child is, and has been, getting treatment that is medically necessary and available for his or her condition.

Note: If the SWC is informed the child’s medical condition has changed, they must immediately inform SSA (Responsibilities of the Authorized Representative Payee (ARP).

Suspended Benefits Due to Excessive Income or Resources

Suspension of benefits payments is required when a recipient no longer meets the requirements of eligibility and termination does not apply. When the amount of countable income or resources of the child exceeds the SSI limit, then the SSI benefit will be put in “suspense.”

Countable Income may include the following:

Earned Income from wages that are more that $1780 per month for a student under 22, and
Unearned Income, including SSA benefits.

Resources Include the following:

Cash, and
Bank accounts, saving bonds.

Note: The above countable income and resources is an abbreviated list pertaining to children and youth in the foster care system. For complete list visit www.ssa.gov.

Suspension of payments due to ineligibility for benefits because excess of income is effective with the first month in which the “countable income” equals or exceeds the amount of benefits otherwise payable for such month. The rule applies regardless of the month in which the income is received.

SSI benefits can remain in suspense for 12 consecutive full calendar months. During the 12-month period, if the countable income becomes less than the SSI benefit rate, then the SSI payment will be reinstated or resumed without filing a new SSI application. The SWC is required to provide evidence that child or youth meets the requirement to have benefits restored.

ARP must contact SSA to provide the necessary information to re-establish benefits before the 12-month expires. In the event the SSI benefits remain in suspense for 12 full consecutive months, the SSI benefits will be terminated. The termination is effective with the start of the 13th month after the suspension began. At this point a new application is required.