Supplemental Security Income for People with Disabilities: Implications for Medicaid

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The federal Supplemental Security Income (SSI) program provides a cash payment to serve as a minimum level of income for people who have low incomes and limited assets and are elderly or meet strict rules from the Social Security Administration (SSA) that define disability. The maximum federal SSI benefit is less than the federal poverty level (FPL), $794 per month or about 74% of the FPL for an individual, in 2021. As a result of SSA's strict disability determination rules, not all people with disabilities qualify for SSI. States generally must provide Medicaid to people who receive SSI. 



This fact sheet describes the key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes to the SSI program for Medicaid, including the effects of the COVID pandemic. -19 and the resulting economic downturn and proposals endorsed by President Biden that Congress might consider. Key findings include the following:

 

Working people with disabilities experience disproportionate job loss during economic downturns compared to workers without disabilities, and SSI claims typically increase when the unemployment rate rises.

The COVID-19 pandemic has brought additional challenges not seen during other economic downturns, such as the closure of SSA offices due to social distancing measures.

People in households where someone experienced a loss of job or income were more than three times as likely to have applied or tried to apply for SSI during the pandemic, or plan to apply in the next 12 months, compared to those in households with no job or loss of income. .

Because SSI eligibility is generally a pathway to Medicaid eligibility, changes that affect the ability of people with disabilities to get or keep SSI may also affect the ability of people with disabilities to access Medicaid.

SSA expects disability claims (including SSI and SSDI) to increase by nearly 300,000 in the second half of tax year 2021 and by more than 700,000 in tax year 2022 compared to tax year 2020. SSA received fewer applications than expected in fiscal year 2020, due to office closures and other disruptions due to the pandemic. In addition, the Affordable Care Act (ACA) Medicaid expansion was not available during past economic downturns, so the extent to which individuals could forgo an SSI application ( as a means to access Medicaid) because they are eligible for Medicaid through the ACA expansion (in states that have opted to expand) remains to be seen. Finally, the extent of chronic disabling illness experienced by people with “long COVID” is not yet fully understood, but could result in a new population seeking SSI due to their inability to work.

 

Congress created the federal SSI program in 1972 as a "last resort" safety net program, providing a cash payment to serve as a minimum income level for poor people who are elderly or disabled and meet strict federal rules.1 To be eligible for SSI, recipients must have a low income, limited assets, and be age 65 or older or have a limited ability to work at a substantial gainful activity level as a result of a significant disability.2 SSI is a program separate from Social Security Disability Insurance (SSDI), which provides cash payments to people who previously worked but can no longer work due to disability.3 In particular, states generally must provide Medicaid to people who receive SSI .4 In contrast, eligibility for SSDI generally triggers eligibility for Medicare after 24 years. -month waiting period; unlike SSDI and Medicare eligibility, there is no waiting period before an individual enrolled in SSI becomes eligible for Medicaid.5 Box 1 explains other key differences between SSI and SSDI.

 

The maximum federal SSI benefit is less than the federal poverty level (FPL), $794 per month, or approximately 74% of the FPL for an individual, in 2021.6 A couple where both spouses are eligible for SSI receives a joint maximum federal payment of $1,191 per month, which is one and one-half times the amount of the individual benefit.7 Because SSI payments are reduced to take into account any earned or unearned income, as well as support that is considered or received in kind Others, the average federal SSI payment is approximately $586 per month, as of April 2021.8 States have the option of making supplemental payments to SSI enrollees, which can vary based on income, living arrangement, and other factors.9 This informative summary describes the key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process (with additional details contained in the Appendix), and cons Considers the implications of changes to the SSI program for Medicaid, including the effects of the COVID-19 c pandemic and the resulting economic downturn, as well as proposals supported by President Biden that Congress might consider.

 

What is the difference between SSI and SSDI?

 

SSI is a federal program administered by the Social Security Administration (SSA) that guarantees a minimum level of income for poor people who are elderly or disabled. To qualify, SSI enrollees must have low income, limited assets, and be age 65 or older or have a limited ability to work at a substantial gainful activity level according to strict federal rules.10 Unlike SSDI (described below ), SSI is available to people regardless of their work history. The maximum SSI benefit is set by Congress.11

 

SSA also administers Social Security Disability Insurance (SSDI), a separate program from SSI.12 Unlike SSI, there are no income or asset limits on SSDI eligibility. Instead, to qualify for SSDI, enrollees must have sufficient work history (generally 40 quarters) and meet strict federal disability rules.13 SSA uses the same rules to determine disability for the SSI and SSDI programs. 14 In addition, some people with a disability may qualify for SSDI based on a relative's work history. For example, people whose disability began before age 22, known as “disabled adult children,” may qualify for SSDI based on the work history of their retired, deceased, or disabled parents.15

 

The amount of SSDI benefits is based on a person's earnings history.16 It is possible to receive both SSDI and SSI if a person's SSDI benefit amount is less than the maximum SSI payment. In those cases, the person may also qualify for SSI to cover the difference between their SSDI benefit amount and the maximum SSI benefit.

 

How does a person qualify for Supplemental Security Income?

 

In addition to meeting the disability criteria (described below), an individual enrolled in SSI must meet several non-medical criteria, including low income. The SSA has complex rules for determining financial eligibility. In general, income is everything received in cash, earned or unearned, that can be used to meet a person's food or shelter needs.17 Income is countable, except for some limited amounts that are not counted. account.18 Income also includes "in-kind" support. such as any food or lodging provided or paid for by another person. In-kind support is generally assessed at (and therefore reduces SSI payments by) one-third of the maximum federal benefit amount.19 SSA also considers that a portion of the income of a spouse or parent/stepparent person (for child applicants) is countable income.20 To qualify financially for SSI, an individual's countable income cannot exceed the maximum federal benefit rate ($794/month for an individual in 2021), and the amount of SSI an individual person actually receives is the maximum federal rate reduced by the amount of their countable income.21 These rules apply to SSI enrollees of all ages.

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