Understanding Supplemental Security Income (SSI) & Medicaid

 March 7, 2013
Posted by M&LAdmin4

Thursday, March 7th, 2013

Those of you who read our blog and visit our website frequently are no doubt aware of our Workshop Series. Throughout the year, at various locations, we host these workshops free of charge to anyone wishing to attend. Last night, the Understanding SSI/Medicaid & SSDI/Medicare workshop was scheduled to be held at the DC Health Center. Unfortunately, due to circumstances outside of our control, we had to cancel that workshop. For those of you who had registered or were interested in attending this workshop, we decided to write a blog focused on this topic in lieu of an in-person presentation.

This week we are focusing on a discussion of Supplemental Security Income (SSI) and Medicaid. Next week, we will follow up with a discussion of Social Security Disability Income (SSDI) and Medicare.

What is Supplemental Security Income (SSI)?

Supplemental Security Income (SSI) is one of the largest Federal programs that provides assistance to people with disabilities. It is administered by the Social Security Administration (SSA), and is a program funded by general tax revenues. SSI is a needs-based program, and is means tested. It is intended to provide individuals with a disability with a monthly check for food and shelter only. In 2013, the monthly check is $710. To be eligible for SSI, one needs to be disabled and any age (one can qualify if they are at least 65 years old and not disabled), US Citizen or legal aliens who meet certain requirements, and have income and resources (assets) below certain limits.  In most states, Medicaid is automatic when an individual receives SSI.

As stated, SSI is a needs-based program. If eligible, SSI pays for food and shelter only. Individuals must meet SSA’s definition of disability, and be under the resource/assets and income limits to be eligible for SSI.

A child under the age of 18 has a different list of definitions for disabilities than an adult. For an adult, the disability must have been a severe disability that has lasted (or is expected to last) at least 12 months, or is expected to result in death, and  must prevent the person from doing “substantial” work. A blind person (vision no better than 20/200 in the better eye with glasses, or has a field of vision no greater than 20 degrees) is not subject to the “substantial” work test.

The resource/asset limit is $2000 for an individual and $3000 for a couple. If there is a child under the age of 18 who is disabled, the family total asset/resource limit is $3000. Once the child turns 18, the individual is an adult and SSA only looks at that individual’s assets/resources. If a child under the age of 18 has SSI, they need to go through a redetermination at the age of 18. As mentioned, SSA has stricter definitions for an adult versus a child in the definition of a disability.

If the family’s assets/resources are above $3000, it is important to remember to keep all assets/resources out of the child’s name so when they turn 18, they will be eligible for SSI regarding this one criterion. Resources include things like cash, bank accounts, stocks, bonds, investments, whole life insurance, retirement accounts, and property (other than the home the individual lives in). Regarding resources, SSI does not count the following for the individual who is trying to be eligible for SSI: the home the person lives in, one motor vehicle, life insurance with no cash value, certain burial funds; special needs trust and property used for a job or business.

To be eligible for SSI, there is also an income limit. This area gets really complicated and confusing. There are two kinds of income: unearned (pensions, child support, Social Security checks, etc) and earned income (wages or earnings from self-employment). Unearned income must be below $730/month and earned income must usually be under $1,505/month. These are 2103 numbers.

As mentioned above, the most a person can get is $710/month in 2013 for an unmarried person. Some states add on a state supplement. The person must be paying for food and shelter to get the full amount. If a person does not pay for food and shelter, the most he/she can get is $473/month for 2013. If a person has other income (earned & unearned) (besides SSI), he/she usually receives less that the maximum SSI amount.

For a full listing of these SSI eligibility requirements, as well as an explanation of disability eligibility requirements and statutory blindness, please click here.

SSI/Medicaid or Medical Assistance In most states, a person receiving SSI automatically becomes eligible for Medicaid, or Medical Assistance. Medicaid has different names in different states. Medical Assistance covers most medical expenses, and the person pays nothing except a very small co-payment for prescriptions ($3.20 for name brand drugs, $1.10 for generic). The person who is receiving SSI is responsible for finding healthcare providers who accept Medicaid.  If the person has other insurance, Medicaid will sometimes cover costs that the other insurance does not. For more information on Medicaid, please click here.

I think one of the most important benefits of SSI/Medicaid, is the person is now eligible for Medicaid waivers which in most cases are mandatory for adult services.

NOTE: The Social Security Administration provides an Online Benefits Eligibility Screening Tool to help those determine which government benefits they may qualify for. Please click here to access this tool.

How do I apply for these benefits?

The good news is that M&L Special Needs Planning, LLC can help you apply for these benefits. If you would like to begin the application process, please contact us! This is a complicated process and most applications are denied due to lack of documentation. You do not want your loved one to be denied for any government benefit. It is a hassle and sometimes can take years to fix. We have an excellent track record of helping families apply for benefits, and they become eligible the first time around.

You are also able to apply for these benefits by contacting your local Social Security office (1-800-772-1213 for voice or 1-800-325-0778 for TTY) to make an appointment. Please note that some forms can be prepared in advance. For more information on how to apply for SSI, please click here.

For those of you who would like to learn more about SSI and Medicaid, we are also hosting the Understanding SSI/Medicaid SSDI/Medicare workshop on April 2, at the TLC Treatment and Learning Center in Rockville, MD.  Please click here to register for this free workshop.

Thanks so much for dropping by our blog today. We strive to offer a meaningful, coherent analysis of topics related to special needs planning, financial planning, and the special needs community. If you have any questions, suggestions, or comments about this or any other topic, please don’t hesitate to drop us a line – we love hearing from you!





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  1. |

    Howdy! This is my 1st comment here so I just wanted to give a quick shout out and tell you I truly enjoy reading your posts. Can you recommend any other blogs/websites/forums that deal with the same topics? Thank you so much!

    • specialneeds

      Hi Maryann,

      There is a lot of information filtering around on this topic; however, I cannot recommend any other blogs/websites/forums. Social Security’s website http://www.socialsecurity.gov has the best information available.

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