By Harry Brenner
At Affleck and Gordon, we have represented individuals with many different claims for disability benefits. One of those types of claims is called SSI, and we have represented and won thousands of SSI cases for deserving and disabled individuals over 35 years of practice.
Applying for disability benefits can be a confusing maze of paperwork and different programs. Unfortunately, this process is not always fully explained by the Social Security Administration (SSA). When you apply for disability benefits, you will likely be presented with the option to file Supplemental Security Income, known as SSI.
NOTE: An SSI application must be done through a local SSA field office, either in person or on the phone. It cannot be completed online like an SSDI application can, although when filing online the SSA will ask you if you intend to file for SSI. As stated, this will require interaction with a local SSA field office.
To start, it is important to understand the name of the program, and how the very title of the program can be misleading.
Supplemental Security Income does not necessarily mean “additional income” for you when you file for disability benefits (SSDI). In reality, SSI is a program designed to allow someone who does not have enough “work credits” — known as “quarters of coverage” — to still apply for disability benefits if they meet certain income and asset requirements that can be very confusing.
NOTE: SSDI Disability’s definition of who has enough work credits can act like a statute of limitations. You typically need to have paid enough taxes 5 out of the last 10 years – also known as 20 out of the last 40 quarters – to qualify for the main SSDI program. The standard changes on a sliding scale for individuals aged 30 and younger. An individual who has worked for many years and paid in taxes, but also waits too long to file for their disability benefits after they stop work, will have to deal with a type of statute of limitations known as a Date Last Insured, which is covered in a separate article.
A qualified SSI recipient is entitled to monetary benefits not to exceed $771 as of 2019, as well as Medicaid. The Medicaid insurance is critical for many individuals without the income or assets to afford high priced insurance in the marketplace.
NOTE: For married couples, the “couples max,” or maximum allowed couple rate for 2019 is $1,157. This rule applies when either 1 individual is on SSI and the other is on SSDI; or when both individuals receive SSI benefits.
It should be noted that while a person who does have enough work credits can still qualify for SSI benefits if they meet those income and asset requirements, as soon as they begin receipt of monthly SSDI benefits, any amount of $771 per month or more in SSDI benefits will disqualify an individual from receipt of ongoing SSI benefits. There are exceptions for this rule but only in limited and very specific situations.
Now that you know that SSI is typically for someone that does not have enough work credits, or an individual who would qualify for SSDI but would receive under $771 a month, we can dive into the income restrictions.
NOTE: if an individual does get less than $771 a month in SSDI, and also meets the income and asset requirements for SSI, they will actually get “2 checks,” or 2 bank deposits, one for the SSDI amount, one for the additional SSI.
Example 1: Sarah gets $560 a month from SSDI based on her lifetime earnings. Depending on her income/asset situation, as seen below, she may qualify for an additional $211 a month in SSI benefits, and Medicaid as well. She would be entitled to Medicare based on her SSDI earnings, and Medicaid based on her SSI eligibility. Having both insurances is extremely valuable, especially to a disabled individual who requires significant and ongoing medical treatment.
The SSA must find that an individual or couple meets the income and asset requirements for SSI before an application can continue to the actual medical review. The SSA also takes into account a claimant’s spouse’s income. Further, the SSA can determine that two people who live together, but are not legally married, can be considered to be “holding out.” The SSA means this to be holding out to their community that they present themselves as a married couple in their way of life. This is viewed from a number of factors, including how a couple files tax returns, and even how a couple presents themselves to their neighbors, family, and community.
Example 2: Bobby applies for SSI benefits, as he does not have enough work credits to file for SSDI. He lives with Jane, who gets $1,340 a month in SSDI benefits as she is disabled herself. He and Jane have lived together for 25 years, and they have 2 children together, but they never married. They file taxes jointly. When they go to the grocery store, the employees greet them as Mr. and Mrs. Smith, which is Bobby’s last name in this example. After filing his application, the local SSA field office conducts a review and determines that Bobby and Jane are holding out as a married couple. Further, because of Jane’s SSDI amount being over the limit for a couple where at least 1 of the 2 individuals receive SSI, Bobby’s application is not allowed to proceed and he is denied for spousal income reasons on his SSI application. The SSA can and does go by these rules even in states where there is no more common law marriage, as the SSA’s rules are specific for their programs.
NOTE: The threshold amount of allowable household earnings your spouse contributes depends on whether it is “Earned” or “Unearned.” Earned income can be, for example, a job where the spouse gets a salary or hourly wages. Unearned income can be, for example, a spouse’s monthly receipt of SSDI benefits or other pension benefits. The irony in this distinction is that a person who gets SSDI benefits certainly earned their monthly amount, but the SSA classifies such money as “Unearned” because the individual is not actually working currently to get the SSDI monthly amount. Thus, as an SSI applicant, the amount of spousal contribution and the source of the spousal contribution makes a big difference in eligibility rules.
You now know that for an SSI application to proceed, a person must meet income and asset rules, and that your spouse plays a big role in that equation as well.
But what are those income and asset rules?
This is a very specific and complex area of SSA law, something that cannot be described in one article. However, there are some general rules that end up being the biggest obstacle for many SSI applicants. Here are the some rules that affect a large number of people.
1. – An individual cannot have more than $2,000 in countable resources; and a couple cannot have more than $3,000 in countable resources.
NOTE: This does not only refer to liquid assets such as cash and bank accounts. This can also refer to things, for example, as stocks, or certain types of life insurance policies that a person could receive monetary benefit from while they were alive. There are numerous things that can be considered as a countable resource.
2. – An individual cannot own a residence other than the one they live in. This rule holds that you can own 1 house, but if you do not live in the house you own, then its value will be counted against you in an SSI resource determination.
NOTE: This also applies to individuals who may have inherited only portion of a house; in that case their portion will be considered as a countable resource to be valued.
NOTE: Trying to get rid of one’s assets without getting the proper value back for them is not allowed by SSI rules and could result in significant penalties, including the inability to apply again for SSI for a number of years. There are ways to properly reduce an individual’s assets and/or resources in very specific situations, such as the entering into a special needs trust, or the proper “spending down” of an individual’s assets. We can address these issues when discussing your case with you.
3. – An individual or couple cannot typically own more than 1 car in the household. This includes cars that may not be running but could be sold for benefit to the owner. One exception to this rule is if the value of the cheaper car is low enough for SSI threshold amounts, in that case the 2nd car will not disqualify the individual or couple.
Now you know some of the most important aspects of how an individual can qualify to even apply for SSI benefits. It is important to remember that if you meet the income and asset requirements to file for SSI, you must then be found medically disabled to be eligible for benefits.
NOTE: The medical definition of disability under SSA rules is the same for both SSDI and SSI claimants.
At Affleck and Gordon, we can help you navigate the maze of SSI and help you get deserved benefits that could provide vitally needed income and medical insurance.