When applying for SSI, it is vital to understand each step in the process to receive support for many individuals and families. One such aspect, often overlooked but immensely significant, is the SSI Essential Person status.
This guide aims to unravel the complexities surrounding this status, offering readers a comprehensive overview of its background, purpose, eligibility criteria, and application process.
Social Security Disability Insurance (SSDI) is a federal insurance program funded by payroll taxes in the United States. Managed by the Social Security Administration, SSDI is designed to provide monthly benefits to individuals who have a medically determinable disability, either physical or mental, that restricts their ability to work. The program does not offer partial or temporary benefits. Instead, it only pays full benefits in situations where the disability is expected to last at least a year or result in death. Compared to disability programs in other Organization for Economic Co-operation and Development (OECD) countries, the SSDI program in the U.S. has stringent eligibility requirements.
It's common for people to confuse SSDI with Supplemental Security Income (SSI). While SSDI payments are based on contribution credits earned through previous work, SSI is a means-tested program in the U.S. designed for disabled children, disabled adults, and the elderly who have income and resources below certain thresholds. A legitimately disabled person, based on legal and medical justification, can receive SSDI regardless of their income level.
The SSDI program has informal names such as Disability Insurance Benefits (DIB) and Title II disability benefits, derived from the chapter title of the governing section of the Social Security Act. The original Social Security Act of August 1935 did not include SSDI. It was only after two decades of policy debates that SSDI was implemented in July 1956.
The concept of an "essential person" in the context of Social Security benefits refers to an individual whose presence in a household is deemed necessary for the well-being of a person receiving Supplemental Security Income (SSI). This could be due to the individual providing care, support, or other essential services to the SSI recipient. When determining the amount of SSI benefits, the income and resources of the essential person may be considered, potentially affecting the benefit amount.
To apply for an essential person status:
Application Process: An application must be filed with the Social Security Administration (SSA). This can be done by calling SSA's national toll-free number, contacting a local Social Security office, or submitting an online application. The SSA will determine if the applicant is insured for Social Security disability benefits based on their work history and contributions to Social Security taxes.
Initial Determination: The decision about disability is based on a sequential evaluation of medical and other evidence. This includes determining if the applicant's impairment is severe, if it meets the severity of impairments in the Listing of Impairments, and if the applicant can perform past or any work in the economy. Medical evidence demonstrating the applicant's inability to work is required.
Appeals: If an applicant is initially denied, the SSA provides three levels of administrative appeal. This includes requesting a reconsideration of the initial decision, a hearing before an Administrative Law Judge (ALJ), and a review by the Appeals Council of the SSA. If all administrative appeals are exhausted, the case can be appealed to federal courts.
Legal Representation: Applicants can hire a lawyer or non-attorney representative to assist with their application or appeal. Most SSDI applicants have a disability representative for their appeal. The fee for representation is set by law and is limited to 25% of the retroactive SSDI benefits awarded.
Wait Time: The time it takes for an application to be approved or denied varies. In fiscal year 2019, the average wait time for an initial decision was 120 days. However, certain cases, such as those with extremely severe medical conditions, can be expedited and processed in under 30 days.
Eligibility is a cornerstone of any benefits program. For those considering the SSI Essential Person status, understanding the criteria is paramount. Let's delve into the specifics of what makes someone a qualified individual or an eligible spouse in the eyes of the Social Security Administration.
A qualified individual for the purpose of having an essential person (EP) is defined by the following criteria:
The individual must have been a recipient of aid or assistance for December 1973 under a State plan approved under title I, X, XIV, or XVI of the Social Security Act.
The State must have taken into account the needs of another person when deciding the need for State assistance for December 1973.
The other person was living in the home of the recipient in December 1973.
The other person was not eligible for State assistance for December 1973.
An essential person (EP) is defined by the following criteria:
The person has continuously lived in the home of the same qualified individual since December 1973.
The person was not eligible for State assistance for December 1973.
The person has never been eligible for SSI benefits as an eligible individual or as an eligible spouse.
State records indicate that under a State plan in effect for June 1973, the State took that person's needs into account when determining the qualified individual's need for State assistance for December 1973.
Federal Benefit Rate (FBR): The FBR of a qualified individual is increased if he or she lives with an EP.
Benefit Amount: The benefit amount is the rate for an eligible individual or eligible couple plus an increment for each EP in the household. This amount is reduced by any countable income of the individual or couple and EP(s).
Number Of EPs: A qualified individual can have more than one EP as long as each EP meets all the requirements.
Income And Resources: Any income and resources of an EP are considered available for the support of the qualified individual. The resources must not exceed the limit for eligibility purposes, and the income must not exceed the sum of the FBR and the proper number of EP increments.
Income Deeming: For detailed computation rules and examples, refer to SI 02001.015. For deeming of income, see SI 01320.000.
Resources Deeming: For resources deeming, refer to SI 01330.000.
Manner Of Payment: The qualified individual is paid, not the EP, because the EP is not an SSI recipient. For benefit rates and payment determinations, refer to SI 02001.015 Supplemental Security Income (SSI) Essential Person Increment and SI 01320.800 Deeming of Income from Essential Persons.
To qualify for SSI benefits as an essential person, the income and resources of the individual and their family play a crucial role. The Social Security Administration (SSA) has set specific limits on both countable income and resources to determine eligibility.
Earnings
Social Security checks
Pensions
Non-cash items such as food, clothing, or shelter.
The amount of income an individual receives each month directly affects the SSI payment they can receive.
Bank accounts
Stocks
Bonds
Property
However, certain items usually do not count as resources. These include personal belongings, the family home, and the family car.
It's essential to note that the Social Security Administration reviews every SSI case periodically. This ensures that recipients are still eligible based on disability and are receiving the correct amount. SSI recipients (or their payees) must report any changes in their situations, such as changes in income, resources, household composition, school attendance, marital status, and any improvement in medical conditions.
Unearned income is any income that an individual receives without directly working or providing services for it. This can include Social Security benefits, pensions, state disability payments, unemployment benefits, interest income, and gifts from friends or relatives. The SSA has specific limits on unearned income for SSI essential persons.
According to the regulations, the first $20 of most income received in a month is not counted, and the first $65 of earnings and half of the earnings over $65 received in a month are not counted. However, it's essential to consult the SSA's official guidelines or a legal expert to understand the exact limits and how they might apply to an individual's situation.
SSI provides crucial financial support for lower-income families who care for children with developmental and behavioral disabilities, as well as physical impairments. Children with developmental disabilities, such as autism and intellectual disability, and other behavioral health impairments like bipolar disorder and schizophrenia, may qualify for SSI.
Families of children with disabilities often face higher out-of-pocket costs and additional demands on their time. For instance, children with disabilities might need extended periods in diapers, require behavioral incentives to learn new skills, or need specialized equipment not covered by insurance. Monthly SSI payments help alleviate the financial challenges these families face.
Furthermore, SSI can facilitate a child's access to health insurance. In most states, individuals receiving SSI are automatically eligible for Medicaid. Medicaid covers essential long-term services and support that might not be available through private insurance. This includes services like personal and home care assistance, eyeglasses, hearing aids, wheelchairs, lifts, and supportive housing services. These services and modifications enable family members to care for children at home, ensuring they receive the necessary care.
SSI plays a pivotal role in supporting children with disabilities and their families by offering financial assistance and access to Medicaid.
Applying for an SSI Essential Person involves a series of steps to ensure that both the SSI recipient and the essential person meet the necessary criteria. Here's an overview of the application process:
Determine Eligibility: Before starting the application process, it's crucial to determine if the person in question meets the criteria for an essential person. This includes checking if they were an essential person as of December 1973, if they have lived with the SSI recipient since that time, and if they have never been eligible for SSI benefits or state assistance in December 1973.
Gather Necessary Documentation: Prepare all necessary documents that prove the essential person's status, such as proof of residence since December 1973, any medical or care-related documentation, and financial records.
Contact The Social Security Administration (SSA): Reach out to the SSA to begin the application process. This can be done online, over the phone, or in person at a local SSA office.
Complete The Application: Fill out the application form provided by the SSA, ensuring all details are accurate and all required sections are completed.
Attend An Interview: The SSA may schedule an interview to discuss the application in detail. This is an opportunity to clarify any questions and provide additional information.
Wait For A Decision: After submitting the application, there will be a waiting period while the SSA reviews the information. They will then make a decision on whether the person qualifies as an essential person.
Appeal If Necessary: If the application is denied, there is an option to appeal the decision. This involves providing additional evidence or clarifying any misunderstandings.
If you believe someone qualifies as an SSI Essential Person for you or a loved one, here's how to apply:
Understand The Definition: An SSI essential person is someone who lives with an SSI beneficiary and provides essential care. This could be a child taking care of a parent or a live-in caretaker. There are strict requirements around this definition, so it's crucial to understand them fully.
Check The Requirements: The person must have been an essential person as of December 1973, be a caregiver, have lived with the SSI recipient since December 1973, never have been eligible for SSI benefits, and not have been eligible for state assistance in December 1973.
Contact The SSA: Reach out to the SSA to inquire about the application process for an SSI Essential Person. They will provide guidance on the next steps.
Gather Necessary Documents: Prepare all required documents, such as proof of residence, caregiving responsibilities, and financial records.
Submit The Application: Complete and submit the application form to the SSA. Ensure all details are accurate to avoid any delays or issues.
Attend Interviews Or Meetings: The SSA may require an interview or meeting to discuss the application. Be prepared to answer questions and provide additional information.
Wait For Approval: Once the application is submitted, there will be a waiting period. The SSA will review the application and make a decision. If approved, the SSI recipient will receive additional benefits due to the essential person's status.
Stay Updated: Ensure that you stay updated with any changes in the SSA's policies or requirements regarding essential persons. Regularly check for any updates or changes to ensure continued eligibility.
Understanding the SSI Essential Person status can be a game-changer for many families. While the concept might seem intricate, with the right information and guidance, navigating this process becomes manageable. This guide aims to shed light on every facet of the SSI Essential Person, from its historical context to the modern-day application process. As you embark on this journey, remember that the primary goal is to ensure that those in need receive the support they deserve. Stay informed, be proactive, and always seek clarity when in doubt. Your diligence today can pave the way for a more secure and comfortable tomorrow.
Learn more about SSI and pension by checking out our detailed guide. Visit Benefits Aid and browse through the available resources to learn more.