Transcript Medicare Drug Benefit

Social Security and SSI—
Everything But Disability
Diane Goffinet—Land of Lincoln Legal
Assistance Foundation
Thomas Yates—Health & Disability
Advocates
2005 Illinois Aid Advocates Conference
Session Goals
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Focus on who is potentially eligible
for cash benefits under Social
Security and SSI.
Common Issues Confronting Social
Security and SSI recipients.
Discuss issues in which Social
Security and SSI intersect with
other areas of legal services
practice.
Social Security Basics
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Key to Social Security Benefits—Insured Status
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Fully Insured Status—worker has at least one credit
for each calendar year starting at age 21
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Currently Insured Status—worker has at least six
credits in full 13-quarter period prior to death or
entitlement to disability benefits
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Disability Insured Status—worker has at least 20
credits in 40-calendar quarter prior to disability
Social Security Basics
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Credits (Quarters of Coverage)—Credits reflect
3-month periods in which a worker earns a
minimum level of wages, etc. In 2005, a worker
needs to earn $920 to obtain a credit.
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Different categories of Social Security benefits
require workers to earn enough credits to be
fully insured, currently insured or have disability
insured status to qualify for Social Security
benefits.
Social Security Basics—Categories of
Individuals Eligible for Social Security
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Retired Workers (age 62 and older)(FIS)
Disabled or Blind Workers (DIS for disability)
Spouses (and some divorced spouses) of Persons eligible
for Retirement or Disability benefits if spouse is 62 or older,
or caring for child under age 16 or disabled (FIS or DIS)
Dependent, unmarried children of persons who are
deceased or eligible for disability or retirement benefits who
are under age 18, under age 19 and full-time secondary
student; or age 18 or older with disability that began before
age 22 (FIS or DIS).
Widow/widower (may be surviving divorced spouse in some
circumstances) who is either 60 years or older; age 50 to
age 60 and disabled; or caring for child entitled to benefits
who under age 16 or disabled (FIS).
Dependent parents age 62 or older of deceased worker
(FIS).
Supplemental Security Income (SSI)
Basics—Categories of Persons Eligible
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Age 65 Or Older; or
Blind (defined as corrected vision no better than 20/200
or limited to a visual field of 20 degrees in the better
eye); or
Disabled Adult (defined as person age 18 or older who is
unable to engage in substantial gainful activity due to a
medically determinable mental and/or physical
impairment, which has lasted or is expected to last for at
least 12 months or result in death); or
Disabled Child (defined as person under age 18 who has a
medically determinable mental and/or physical
impairment that results in marked and severe functional
limitations and which has lasted or is expected to last for
at least 12 months or result in death).
SSI Basics—Eligibility Basics
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Residence—must reside live in the United States for at least 30 days;
Income below SSI levels;
Resources under SSI levels; and
U.S. citizens or noncitizens in certain categories including:
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Persons lawfully residing in U.S. and getting SSI benefits as of August 22, 1996;
Persons lawfully residing in U.S. as of August 22, 1996 who is disabled;
Refugees, asylees, persons whose deportation has been withheld,
Haitian/Cuban entrants for first 7 years after status granted;
legal permanent residents who have earned or can be credited with
40 qualifying quarters of coverage as defined by Title II of the Social
Security Act; and
noncitizens who are lawfully residing in any State and are veterans of
the United States armed services with a discharge characterized as
an honorable discharge and not on account of alienage; on active
duty in the United States armed services; and the spouses and
unmarried dependent children of veterans and persons on active duty.
Social Security/SSI Basics—Continuing
Disability Reviews and Age 18 Reviews
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Continuing Disability Reviews—beneficiaries
have 60 days to appeal
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Aid Paid Pending available for SSDI and SSI
recipients who appeal disability cessation
decisions at reconsideration and ALJ levels if
appeal filed within 10 days
Age 18 Reviews—All child SSI recipients will
have their claims reviewed under the adult
disability standard at age 18—appeal must
be filed within 60 days
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Aid paid pending is available at reconsideration
and ALJ levels if requested within 10 days.
Social Security and SSI Basics—
Overpayments and Waivers
SSA will attempt to collect back from a Social
Security or SSI recipient whenever that
individual is paid more in benefits that proper,
regardless of the cause of the overpayment.
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Right to Appeal--All individuals who are
responsible for repayment of an overpayment have
the right to appeal the determination of
overpayment. The appeal must be filed 60 days of
the date of recipiept of overpayment notice. To be
successful on appeal, an individual must show that
he or she was not overpaid. If the beneficiary was
overpaid, but it was SSA’s responsibility, the
beneficiary loses.
Social Security and SSI Basics—
Overpayments and Waivers
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Waiver--In addition to the right to appeal,
a beneficiary can request that repayment of
all or part of the overpayment be waived.
The waiver request may be filed at any
time. A request for waiver is a request for
release from the responsibility for
repayment. A waiver request should be
granted when the overpaid recipient is
without fault in causing the overpayment,
AND repayment would defeat the purpose
of title XVI; or be against equity and good
conscience; or impede effective or efficient
administration of the title XVI program.
Social Security and SSI Basics—
Overpayments and Waivers
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Negotiated Settlement and
Compromise Offers--Overpaid
beneficiary can negotiate a rate of
repayment on a monthly basis or
agree with SSA on a compromise
offer of payment of a lump-sum
amount to settle the debt.
Access to Health Benefits and
Social Security/SSI
Medicare
Medicaid
Social Security
Benefits not
based on
finding of
disability
Eligible for
Medicare as of
65th birthday
Social Security
Benefits based
on disability
Eligible for
Medicare in 25th
month of eligibility
for Social Security
benefits
Eligible for
Medicaid if
countable income
is less than 100%
of FPL and
countable
resources are less
than $2000 for
beneficiary and
$3000 for couple
Supplemental
Security
Income (SSI)
Not eligible for
Medicare
Consumer Issues and Social Security/
SSI
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Garnishment of Social Security and SSI
Benefits prohibited by ILCS 5/12-1001
Social Security and SSI Overpayments
may be bankrupted in Chapter 7 and
Chapter 13 actions unless the
overpayments are the result of fraud.
Filing of the bankruptcy petition results in
automatic stay in Social Security collection
for debtor.
Family Law and Social Security/SSI
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Family Relationships and Benefits—Generally,
SSA defers to state law to define marriage,
maternity/paternity. However, SSA usually
provides additional criteria to define
relationships, e.g., recognizes the equivalent of
common law marriage in determining financial
eligibility for SSI couples.
Child Support-
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SSI benefits not subject to garnishment, 5 C.F.R. §
581.104(j).
Social Security benefits subject to garnishment, 42 U.S.C.
§ 659.
Benefits for Family Members of Deceased
Social Security/SSI Claimants
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Social Security—SSA will pay underpayments based on
priority: widow(er) living with deceased or receiving benefits
on deceased’s earnings record; child(ren) receiving benefits
on deceased’s earnings record; parents receiving benefits
on deceased’s earnings record; widow(er), child(ren), parent.
SSI—SSA will pay underpayment to surviving eligible
spouse or surviving spouse who was living in the
same household with the underpaid person at any
time in the month of death or the preceding six
months; and if the underpaid person was a disabled
or blind child, underpayments are payable to a
surviving parent(s) who was living in the same
household with the child at any time in the month of
death or the preceding six months.
Criminal Law and Social Security/SSI—
Incarceration and Home Arrest
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Incarceration: Persons who are
incarcerated are ineligible for Social
Security/SSI for any month in which
they are confined, for all or part of a
month, in a penal institution.
Home Arrest: Persons who are on home
arrest who are responsible for their own
food and shelter costs are eligible for
SSI.
Criminal Law and Social
Security/SSI—Felony Convictions
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Felony convictions: Social Security
benefits may be halted for persons
convicted of subversive crimes
(e.g. treason, sedition, subversive
activities). Other than this, felons
are potentially eligible to receive
Social Security and SSI benefits.
Criminal Law and Social
Security/SSI—Fleeing Felons-I
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Social Security and SSI benefits
cannot be paid to fleeing felons,
probation and parole violators.
Good cause exception to stopping
benefits: mandatory good cause
and discretionary good cause
Criminal Law and Social
Security/SSI—Fleeing Felons-II
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Mandatory Good Cause—No
suspension and SSA must repay
withheld benefits if:
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Court found individual not guilty
Court dismissed the charges
Court vacated the arrest warrant
Court issued similar exonerating order
Beneficiary was “erroneously
implicated” due to identity fraud
Criminal Law and Social
Security/SSI—Fleeing Felons-III
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Discretionary Good Cause—Option
1:
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Offense was nonviolent AND not drugrelated; AND
Claimant attests not convicted of
another felony since date of warrant;
AND
Local law enforcement agency reports
that it will not extradite or is unwilling
to act on warrant
Criminal Law and Social
Security/SSI—Fleeing Felons-IV
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Discretionary Good Cause Option 2:
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Crime nonviolent AND not drug-related; AND
Claimant attests not convicted of another
felony since date of warrant; AND
Only existing warrant is 10 or more years old;
AND
One of the following applies:
 Medical condition impairs mental capacity to
resolve warrant; or
 Claimant is “incapable” or “legally
incompetent;” or
 Claimant has representative payee