Applying for Social Security and Medicaid
From Autism Transition Handbook
On this page (click on a word to highlight the instances in the page):
DPW financial payee Social Security SSA SSDI SSI Supplemental Security Income supplementary
Federal funding, including Supplemental Security Income and Medical Assistance (Medicaid), may be available to help pay for health care and support services for your daughter or son.
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Social Security Benefits
Supplemental Security Income
Eligibility:
Supplemental Security Income (SSI) is a federally funded program that provides financial support to adults with disabilities and to families of children with disabilities to help them cover the extra costs associated with their disability. The SSI program is for individuals and families with limited incomes and resources. Before your daughter or son can receive Medical Assistance you must first apply for Supplemental Security Income. When a person is eligible for SSI, they are immediately approved for Medical Assistance. If your application for SSI is not approved, you must have an SSI rejection letter to apply for Medical Assistance.
The eligibility rules are different depending upon the age of your daughter or son. For children under the age of 18, your child can qualify if he or she meets Social Security’s definition of disability for children, and if his/her income in combination with the income of others living in the household falls within the eligibility limits. For a summary of eligibility see the Children under Age 18 Fact Sheet
Turning 18
Once your child turns 18, he or she is considered an adult for disability purposes in the SSI program, and different rules apply. In particular, the income and resources of family members do not count. Also, the SSA disability rules for adults apply rather than those for a child. Even if your 18 year old child was receiving SSI benefits, there will be a review during the one-year period that begins on his or her birthday, and you will need to prepare a re-application to continue receiving benefits. For a summary of elibility, see the Adult Fact Sheet.
Applying for Supplemental Security Income (SSI) Benefits
Monthly Rates for 2010:
Not all SSI recipients receive the maximum payment amount. Payments vary depending upon your living arrangements and income. The maximum monthly payment for an individual living alone is $674, and for an eligible couple $1,011, and for an eligible person living in another person's household $449. See the Social Security Electronic Fact Sheet for Pennsylvania for further information at http://www.ssa.gov/pubs/11150.html.
State Supplementary Payment in Pennsylvania:
The state of Pennsylvania adds money to the federal SSI payment (called State Supplementary Payment). If your son or daughter lives independently, in someone else’s household or in a Medicaid facility, he or she receives a separate payment from Pennsylvania in addition to the federal SSI payment. A single payment which includes both the federal SSI payment and the supplement from Pennsylvania is issued to residents of domiciliary care homes and personal care boarding homes. For further information on these supplemental payments, refer to the DPW's site at http://www.dpw.state.pa.us/About/OLTL/003671786.htm. Please note that if your son or daughter's income is slightly over the eligibility requirements for SSI, he or she may still be eligible for SSP.
What is a Representative Payee?:
According to the Social Security Administration, a representative payee is an individual or organization appointed by SSA to receive Social Security and/or SSI benefits for someone who cannot manage or direct someone else to manage his or her money. The main responsibilities of a payee are to use the benefits to pay for the current and foreseeable needs of the beneficiary and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When SSA requests a report, a payee must provide an accounting to SSA of how benefits were used or saved. As a representative payee, there are certain expenses for which you may be reimbursed. See the SSA site for more information: ttp://www.ssa.gov/payee/faqrep.htm
In addition to SSI, your son or daughter may be eligible for other SSA benefits, notable, SSDI (Social Security Disability Insurance). Click here Social Security benefits for a summary description of Social Security programs for which your son or daughter may be eligible.
See Also:
SSA Best site will determine your child's eligibility for SSA programs. The SSA BEST customized Connection screens citizens for 17 different Social Security programs and provides them with a list of benefits they may be eligible to receive.
Going to Work: A Guide to Social Security Benefits and Employment for Young People with Disabilities 2010 edition. This very easy to understand guide from The Institute for Community Inclusion covers SSI, SSDI, the Ticket to Work Program, PASS, and while it is geared for Massachusetts residents, it is quite useful for all audiences.
Medicaid (Medical Assistance)
Medicaid or Medical Assistance is a health care program for people with low incomes and limited resources. According to the Pennsylvania Health Law Project, Medical Assistance has the broadest coverage of medical and mental health services for persons under 21 of any insurance. (In the state of Pennsylvania, individuals under the age of 21 are considered "children" for the purposes of Medicaid.) Medicaid for children with disabilities provides families access to speech, occupational and physical therapy and behavioral health services, and has no premiums, co-pays or deductibles. Even if your child does not qualify for Supplemental Security Income (SSI) because your family income is too high, children that meet the Social Security Administration (SSA) level of disability will qualify for Medical Assistance. See Medical Assistance PH-95 Loophole Coverage. Medical Assistance adds to any existing coverage the child already has. Consequently, if your child has private insurance, that must be used first. For children with autism, there is both a physical and behavioral health component called HealthChoices. HealthChoices can be contacted at 1-800-440-3989, or through the County Assistance Office.
Once your child turns 21, he or she is no longer eligible for Medicaid's EPSDT program, but may be eligible for Medicaid or if working, MAWD, Medical Assistance for Workers with Disabilities. For detailed information on eligibility see the DPW website on Medical Assistance Eligibility Requirements.
See Also:
Medicaid Waivers
Medical Assistance Acronymns
Resources
Social Security and Medicaid Resources
