Three Big Differences Between SSI and SSDI

Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are both federal programs that provide cash payments to people who meet the federal definition of “disabled.”  But the similarities between the two programs end there.  Here are the three main differences between them.

SSI Is a Means-Tested Program, SSDI Is an Entitlement Program

Although both SSI and SSDI are administered by the Social Security Administration, the two programs have vastly different financial requirements.  SSI is designed to meet the basic needs of elderly, blind and disabled individuals who would otherwise have a hard time paying for food and shelter.  Because SSI is narrowly tailored for this particular set of people, it has a very strict set of financial requirements, making it what is known as a “means-tested” benefit.

SSDI, by contrast, is an entitlement program that is typically available to any person who has paid into the Social Security system for at least ten years, regardless of his current income and assets.  (Younger beneficiaries and disabled adult children of retired or deceased workers may have to meet different requirements.)  In theory, all qualified workers are potential SSDI recipients, even high-income earners.

SSI Beneficiaries Typically Receive Medicaid, SSDI Provides Access to Medicare

In most cases, a person who receives SSI immediately qualifies for Medicaid benefits.  Because Medicaid is a joint state and federal health care program that typically provides very comprehensive coverage for its beneficiaries, many people may apply for SSI primarily because of the health care that comes with it.

On the other hand, SSDI beneficiaries are eligible to receive Medicare two years after they are deemed eligible for SSDI benefits.  Medicare is a federal health insurance program that covers routine hospital services and most but not all primary medical care.  Medicare is not as comprehensive as Medicaid, and many Medicare beneficiaries purchase what are known as private “Medigap” policies to fill in the holes in their primary Medicare coverage.

The Financial Benefits Can Be Very Different

Finally, SSI and SSDI benefits vary widely when it comes to the amount of money provided.  In 2018, the federal SSI payment standard will be $750 per month for an individual (with most states adding a small supplementary payment), while the average SSDI payment for 2017 is $1,171 a month.  Since SSDI is based on the beneficiary’s earnings record, some SSDI recipients can receive much more than this.  In addition, SSI benefits are reduced by any other income received by an SSI beneficiary, so many SSI recipients will receive less than the $750 payment standard.  In most cases, if a person receives an SSDI benefit that is higher than the maximum SSI payment, she won’t be eligible for SSI at all.

Individuals With Disabilities Education Act (IDEA) – Special Education Law

The Individuals with Disabilities Education Act (IDEA) is arguably the most important federal law for children with special needs.  The law mandates that all eligible children and youth ages 3 through 21 years old be provided with a “free and appropriate public education” in the “least restrictive environment.”

To be eligible for services under the IDEA, a child must be identified as having a disability. A child is considered to have a disability if she has been diagnosed with:

  • Brain injury or mental impairment
  • Speech or language impairment
  • Hearing impairment including deafness
  • Visual impairment including blindness
  • Serious emotional issue
  • Orthopedic impairment
  • Autism
  • Identifiable Learning disability
  • Other serious health issues

There are approximately 6.6 million children and youth with disabilities in public schools across the United States, which is 13 percent of all public school students, according to the National Center for Education Statistics’ 2014-15 data.  Before the IDEA was enacted in 1975 as the Education for All Handicapped Children Act (EHA), only one out of five children with disabilities went to public schools.  Many lived in state institutions where they received little or no education.

The Law’s Key Components

There are several key components to the IDEA that every parent should know about.  They are: a free and appropriate public education (FAPE), least restrictive environment (LRE), and individual education program (IEP).

FAPE: The IDEA guarantees every child a free and appropriate public education. States must offer special education and related services to children with disabilities at no cost to the families in a public school setting (whenever possible) that meets the state’s educational standards and conforms to the child’s individual education plan.  If a public school cannot offer this, it will offer an alternative, such as the network of educational collaboratives or possibly a private institution, and the government will pay for it.

The U.S. Supreme Court recently expanded the meaning of “appropriate” in the case Endrew F. vs. Douglas County School District, holding that a “minimal educational benefit is not sufficient.”

LRE: Least restrictive environment refers to the educational setting. The IDEA says that “to the maximum extent appropriate” children with disabilities must be educated in a typical classroom with typical peers. Children may be educated in a special or separate class (whether in a district school or in an out-of-district program or facility) only when the nature or severity of the child’s disability prevents the child from being successful in a traditional classroom, even with special accommodations and services.

IEP: An Individual Education Program is a plan that includes: a statement of the child’s present level of performance in academics and functional skills, a list of measureable goals in these areas, a schedule of progress reports, the type and frequency of additional therapies and services, transportation, and any necessary accommodations. The IEP is developed by a team of people including a parent, the child’s teacher, a school district representative, any therapists or other professional who works directly with the child, and sometimes the child as well. The team meets at least once a year to prepare the IEP, but parents may request a team meeting to discuss a particular issue at any time. Parents must also receive regular progress reports on their child.

Other important components of the IDEA include: requirements that schools conduct appropriate evaluations of students with disabilities and that parents be included in all decisions regarding their child’s placement and education program; procedural safeguards that outline parents’ rights under the law; and a process for providing transition services to children to help prepare them for further education, employment and independent living.

If parents are not satisfied with the education program offered by the school, there is a process for resolving disagreements outlined in the procedural safeguards section. Parents can request a review by the state’s educational agency or request the services of a mediator, an unbiased person. If an agreement is not made, parents have the right to file a due process complaint and request a hearing to resolve the issue.

Further Information

The IDEA has four main parts: A, B, C and D.  Part A covers general provisions of the law. Part B outlines how children and youth ages 3 through 21 receive special education and related services.  Part C covers early intervention services for infants and toddlers, birth through age 2, with disabilities.  Part D focuses on the national program to support and improve special education for children with disabilities.

The full text of the IDEA is available online at Department of Education – IDEA website. Click on “Law and Policy” and “Statute/Regulations,” then scroll down to “View the Complete IDEA statute.”

For further information, visit U.S. Department of Education website.

What Expenses Can ABLE Accounts Pay For?

In passing the Achieving a Better Life Experience (ABLE) Act in 2014, Congress created a new way for potentially millions of people with special needs to save for disability related expenses without jeopardizing their eligibility for federal public benefit programs.

In fact, these savings plans, popularly known as ABLE accounts, may be used for an even broader array of products and services than many beneficiaries may realize – including housing expenses, bus fare, financial management services or even, potentially, a smart phone.

The ABLE Act itself defines “qualified disability expenses” as “expenses related to the eligible individual’s blindness or disability which are made for the benefit of an eligible individual who is the designated beneficiary.” It then goes on to list a range of categories of potential uses for funds set aside in ABLE accounts, including:

“Education, housing, transportation, employment training and support, assistive technology and personal support services, health, prevention and wellness, financial management and administrative services, legal fees, expenses for oversight and monitoring, funeral and burial expenses, and other expenses, which are approved by the Secretary under regulations and consistent with the purposes of this section.”

In subsequent proposed regulations released in June 2015, the Treasury Department and Internal Revenue Service (IRS) reiterated that the term “qualifying disability expenses” should be “broadly construed” to include any benefit related to the designated beneficiary “in maintaining or improving his or her health, independence, or quality of life.”

This means that there is no requirement that the benefit be medically necessary, such as is the case when determining health care services covered by Medicaid, or that it benefit no one but the designated individual. As an example, the regulations specify that a smart phone could qualify as a covered expenses, provided that it serves as “effective and safe communication or navigation aid for a child with autism.”

Originally, the proposed regulations would have also required states to establish safeguards for ensuring that ABLE funds are only used for qualifying expenses, presumably by requiring beneficiaries to obtain pre-approval before distributing funds. In response to a backlash from disability advocates, many who feared that such requirements would be unduly burdensome, the Treasury Department and IRS rescinded this requirement in a notice issued November 2015 So as things stand now, you don’t need to get approval to withdraw funds and pay for a qualified disability expense.

The Obama administration, however, never issued final regulations, although the IRS has stated that “[u]ntil the issuance of final regulations, taxpayers and qualified ABLE programs may rely on these proposed regulations.”

To protect against future inquiries from the IRS, the ABLE National Resource Center recommends that beneficiaries maintain detailed records of expenses paid for by ABLE account assets, as well as how these expenses relate to their disabilities in case the expenditures are ever questioned by the IRS. Misuse of ABLE account funds could result in tax penalties and possible loss of public benefits.

For help in setting up an ABLE account or to find out whether something you want to use the account for is a qualified disability expense, contact your special needs planner.

Can I Apply For Disability With Spinal Stenosis?

Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs. Spinal stenosis occurs most often in the lower back and the neck.

Spinal stenosis symptoms are often characterized as:

  • Developing slowly over time, or slow onset
  • Coming and going, as opposed to continuous pain
  • Occurring during certain activities (such as walking for lumbar stenosis, or biking while holding the head upright) and/or positions (such as standing upright for lumbar stenosis)
  • Feeling relieved by rest (sitting or lying down) and/or any flexed forward position.

The goals of treatment for spinal stenosis are to relieve pain, numbness, and weakness in the legs, to make it easier for you to move around, and to improve your quality of life.

Treatments include:

  • Home treatment, such as exercising, using over-the-counter pain medicines, and losing extra weight.
  • Prescription medication.
  • Physical Therapy;
  • Epidural steroid injections;
  • Surgery, although most cases don’t need this treatment.

You may meet the criteria for disability if you meet the requirements of one of Social Security’s official disability listings.  Social Security publishes the criteria for a number of common illnesses to qualify for disability, and if you meet the criteria for your particular condition, you automatically qualify for benefits.

The listing for Spinal Stenosis is 1.04:

1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:

A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine);

OR

B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;

or

C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.

If you do not meet or equal the above listing, you can still qualify for disability benefits if the impairment prevents you from doing your past relevant work or other work based on your residual functional capacity that exists in significant numbers in the national economy.

Please call our office at (508) 421-4610 if you have any questions about applying for disability with spinal stenosis or the application process in general.

Am I Eligible For Disability With Sciatica?

What is sciatica?  Sciatica is a symptom that consists of pain caused by irritation of the sciatic nerve.  You might feel weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes.  Sciatica might be a symptom of a “pinched nerve” affecting one or more of the lower spinal nerves.

What Causes Sciatic Nerve Compression?

Several spinal disorders can cause spinal nerve compression and sciatica or lumbar radiculopathy. The 6 most common are:

  • a bulging or herniated disc
  • lumbar spinal stenosis
  • spondylolisthesis
  • trauma
  • piriformis syndrome
  • spinal tumors

Although it may be difficult to qualify for disability benefits with sciatica alone, most times the sciatica is caused by a condition listed above and an application is filed due to a combination of several conditions.  In addition, claimants will want to document their pain and any other limitations caused by these back injuries when applying for benefits.

You may qualify for disability benefits if you are not performing substantial gainful activity and if the impairment prevents you from doing your past relevant work or other work that exists in significant numbers in the national economy.

Why Life Insurance Is Important For Families With Special Needs

Although financial planning is important for every family, families with special needs family members may require more attention than the average family to maintain a stable lifestyle.  Planning for a family with a disabled child or other member with special needs requires traditional planning plus additional strategies to ensure your family member is financially secure and their needs are met.

Planning is critical to ensure your child is financially secure for their lifetime, especially after a parent is gone.  Life insurance is commonly used to provide the necessary funds to ensure these goals are met.  Care must be taken to make sure the appropriate type of policy is used.  Second-to-die policies are often used during this planning.  Care must also be taken to ensure beneficiary designations are appropriate and special needs trusts are established especially if eligibility for government benefits must be maintained.

Can I Qualify For Disability With Meniere’s Disease?

Eligibility for disability due to Meniere’s disease is possible if the symptoms are severe enough to impact your ability to do work related activities. According to the American Academy of Otolaryngology-Head and Neck Surgery, Ménière’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours.  As the symptoms can affect all types of work, even sedentary work, Social Security Administration (SSA) lists Meniere’s Disease as a listing to qualify for benefits.  Listing 2.07 applies to Meniere’s Disease:

2.07      Disturbance of labyrinthine-vestibular function (Including Ménière’s disease), characterized by a history of frequent attacks of balance disturbance, tinnitus, and progressive loss of hearing.  With both A and B:

A.  Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and

B.  Hearing loss established by audiometry.

If you do not meet or equal the above listing, you can still qualify for disability benefits if you are not performing substantial gainful activity and if the impairment prevents you from doing your past relevant work or other work that exists in significant numbers in the national economy.

 

 

Social Security Benefits For A Surviving Spouse

If you are receiving disability under the Social Security Disability Insurance (SSDI) program, your surviving spouse may be entitled to receive benefits on your record if you pass away.  The monthly benefit would be a percentage of the decedents Social Security benefit.  According to the Social Security Administration (SSA), the percentages allowed for the decedent’s dependents are as follow:

  • Widow or widower, full retirement age or older — 100 percent of the deceased worker’s benefit amount;
  • Widow or widower, age 60 to full retirement age — 71½ to 99 percent of the deceased worker’s basic amount;
  • Disabled widow or widower aged 50 through 59 — 71½ percent;
  • Widow or widower, any age, caring for a child under age 16 — 75 percent.
  • A child under age 18 (19 if still in elementary or secondary school) or disabled — 75 percent.
  • Dependent parent(s) of the deceased worker, age 62 or older:
    • One surviving parent — 82½ percent.
    • Two surviving parents — 75 percent to each parent.

If you are the divorced spouse of a worker who dies, you could get benefits just the same as a widow or widower, provided that your marriage lasted 10 years or more.  Also, note that if you remarry after you reach age 60 (age 50 if disabled), the remarriage will not affect your eligibility for survivors benefits.

In addition to the above benefits, a surviving spouse may receive a special lump-sum death payment of $255 if they were living in the same household or:

  • were already receiving benefits on the worker’s record; or
  • became eligible for benefits upon the workers death.

 

How Failing To Seek or Continue With Treatment Could Hurt Your Disability Case

Disability benefits are available for workers with impairments that preclude substantial gainful activity (SGA) for at least twelve months.  To qualify, an applicant for benefits must prove that they have a severe impairment that impairs their ability to work.  During the evaluation process, Social Security Administration (SSA) will review medical records, treatment notes and any other evidence that may assist with making a determination in regards to the ability or inability to work.  For obvious reasons, a claimant’s lack of treatment may cast doubt on the severity of injuries or limitations affecting work capacity.  Similarly, failing to follow prescribed treatment could negatively affect a claimant’s disability decision.

According to SSA, a failure to follow prescribed treatment determination may be made only where all of the following conditions are met:

  1. The evidence establishes that the individual’s impairment precludes substantial gainful activity (SGA) (or, age-appropriate activities for SSI children).
  2. The impairment has lasted or is expected to last for 12 continuous months from onset of disability or is expected to result in death;
  3. Prescribed treatment is clearly expected to restore capacity to engage in SGA (or gainful activity, as appropriate).
  4. The evidence of record discloses that there has been refusal to follow prescribed treatment.

There are certain circumstances where failing to follow prescribed treatment may be excused.  Acceptable justifications for failing to follow prescribed treatment include, but are not limited to the following:

  1. The specific medical treatment is contrary to the established teaching and tenets of the individual’s religion.
  2. The individual is unable to afford prescribed treatment, which he or she is willing to accept, but for which free community resources are unavailable.
  3. An individual’s fear of surgery is so intense that it is a contraindication for surgery.
  4. The prescribed treatment is cataract surgery for one eye, when there is severe visual impairment of the other eye that cannot be improved through treatment.
  5. Major surgery was previously performed with unsuccessful results and additional major surgery is prescribed for the same impairment.
  6. The treatment because of its magnitude (e.g., open heart surgery), unusual nature (e.g., organ transplant), or for some other reason is very risky.
  7. The treatment involves amputation of an extremity, or a major part of an extremity.
  8. An individual with a severe mental impairment is clearly unable to understand the consequences of failing to follow prescribed treatment.
  9. A treating source advises against the treatment prescribed for the currently disabling condition.

Dependent Benefits For Your Children When You Qualify for Social Security Disability

Workers who have sufficient work credits and are deemed disabled by the Social Security Administration will receive a monthly benefit under the Social Security Disability Insurance (SSDI) program.  As a result, certain family members may also receive dependent benefits.

Eligible children will receive benefits based on your work record if you are approved for SSDI benefits.  Your eligible child can be a biological child, adopted child or step-child.  In certain cases, a dependent grandchild may also be eligible for benefits.  To receive benefits, the child must be unmarried and:

  • Under 18 years old; or
  • 18-19 and a full-time student;  or
  • Over 18 years with a disability that started before age 22.

In most cases, benefits cease at age 18, unless the child is disabled or a full-time student, as noted above.

How much will  your child receive?

Generally speaking, your child will get one-half (1/2) of your benefit split equally between your eligible children up to the family maximum.  For example, if your monthly benefit is $2,000 a month and your family maximum is $3,000, you would receive your monthly benefit ($2,000) and your eligible children would receive the $1,000 balance split equally.