How Do You Qualify for SSI?

Another article on this website is pretty similar to this one titled, “Rules and Requirements to Qualify for Social Security Disability or SSI,” so you may be wondering why we’ve written this separate article on Supplemental Security Income (SSI).

While Social Security Disability Insurance (SSDI) and SSI benefits are both disability programs administered by the Social Security Administration, the requirements to qualify for benefits under each program are very different. The previous article provides only a brief overview of the rules and requirements. In this article, we will dive further into how to get SSI benefits. First, let’s look at the difference between SSDI and SSI.

Social Security Disability Insurance vs. Supplemental Security Income

Social Security Disability is a disability insurance benefits program administered by the Social Security Administration (SSA) under Title II of the Social Security Act. SSDI is available to any individual who has enough coverage credits. To have “insured status” – that is, to have sufficient coverage to be eligible to receive Social Security disability insurance benefits – a claimant must have paid enough Social Security taxes and earned enough “work credits.” Credits are earned by working and paying FICA taxes, which go into the Social Security trust fund from which claims are paid. You must have worked long enough and earned enough credits to be eligible for disability benefits.

Interesting side-note: Individual states formerly ran their own low-income disability programs as part of their general welfare programs until President Nixon worked to federalize these programs into the U.S. SSI program in 1972.

Supplemental Security Income is another disability benefits program that the SSA also administers. SSI falls under Title 16 of the Social Security Act and is funded by the general treasury, not the Social Security trust fund. There is no work requirement for SSI benefits. SSI is available to disabled claimants who have never worked and those who have not earned enough work credits to qualify for Social Security disability insurance. However, eligibility for SSI is still subject to income and asset limits.

SSI is also available to individuals who previously worked and were once eligible for Social Security disability. However, they are no longer eligible because they have not worked in a long time (thus, their coverage has lapsed). It is also available to children who are disabled and whose families have low incomes and assets.

The monthly maximum for SSI is $943 per month in 2024, but it could be reduced if someone is helping the claimant financially. As stated above, SSI also has income and asset requirements. For more information on SSI, click here.

Qualification For SSI

Supplemental Security Income (SSI) benefits are available to anyone who is disabled and:

• Has limited income;
• Has limited resources;
• Is a U.S. citizen or national, or in one of the specific categories of aliens;
• Is a resident of one of the 50 States, the District of Columbia, or the Northern Mariana Islands;
• Is not absent from the country for an entire calendar month or 30 consecutive days or more;
• Applies for any other cash benefits or payments for which they may be eligible (for example, pensions, Social Security benefits);
• Gives the SSA permission to contact any financial institution and request any financial records about the claimant;
• Files an application and
• Meets certain other requirements.

If you are 18 or older, Social Security may consider you “disabled” if you have a medically determinable physical or mental impairment (including an emotional or learning problem) which:

• Results in the inability to do any substantial gainful activity and
• Can be expected to result in death or
• Has lasted or can be expected to last for a continuous period of no less than 12 months.

How Do You Get SSI?

To apply for SSI disability benefits, you should visit your local Social Security field office. The application will be taken by a Social Security claims representative. Claims representatives work at local Social Security field offices. In addition to performing other duties, such as processing retirement claims, claims reps take SSI disability applications.

After an SSI disability application is completed, it is sent off to another agency that specializes in doing nothing but processing medical determinations on SSI, SSDI, and Medicaid claims. In most states, including Florida, this agency is known as Disability Determination Services, or DDS for short.

When an SSI disability application arrives at DDS, the file is immediately assigned to an individual who will process the medical portion of the claim. This individual is known as a disability determination specialist or disability examiner. After being assigned an SSI claim, the examiner will request records from each of the claimant’s treatment sources (hospitals, clinics, doctors, counselors, etc.)

Because many medical providers (especially large hospitals and practice groups) are slow in copying and mailing records, sometimes processing medical records requests can take several months. Once the records finally arrive, they will be evaluated by the DDS disability examiner. The examiner may then consult a physician and/or psychologist who acts as a medical consultant.

Can You Collect SSD and SSI at the Same Time?

When a claimant files for disability, the Social Security office will review the claim to determine whether the claim will be for Social Security disability insurance benefits, SSI disability benefits, or both. Filing for both SSD and SSI at the same time is known as a concurrent disability claim. A concurrent claim may be appropriate for individuals with sufficient quarters of coverage for SSD benefits but whose monthly benefit amount might be particularly low.

What Determines Whether You Will Receive SSI?

I often tell my clients that the most important part of a Social Security Disability case is medical records. That’s why it is important to continue treating with a medical doctor consistently and regularly. I like to see no more than a 90-day (3-month) gap between doctor visits. Then you will have the medical evidence to support a favorable determination in your claim. Less frequent treatment may indicate that the claimant’s conditions are not severe.

The examiner also needs access to more recent records to determine whether you are currently disabled. For example, it would not be enough to have a 5-year-old MRI evidencing a herniated disc. You would also need to show more recent records, such as recent treatment notes from a pain management doctor, to evidence the fact that your disability is current.

In some of my denials in the past, Judges have said something to the effect of:

“The claimant’s testimony is not credible [or believable] as to the severity of the claimant’s impairments. An individual experiencing the intensity of pain described by the claimant would have sought more regular medical treatment, or at least presented to the emergency room for treatment.”

In short, claimants should present to a doctor at least every 90 days. Otherwise, the claim is at risk for denial based on insufficient evidence to prove the disability.

Your Residual Functional Capacity

What you are capable of doing (or limited in doing) is referred to as your residual functional capacity (RFC) and can be documented in a residual functional capacity form. So, how does your residual functional capacity (RFC) determine whether you will receive SSI disability?

Your residual functional capacity will be first evaluated to determine whether you can return to any of the jobs you did in the past. If it is determined that you cannot return to your past work, your claim will be evaluated to determine whether you can perform “other work” of some kind, given your age, education, and skill set.

Most SSI claimants who are denied SSI benefits are turned down based on being able to do some other work; in other words, the DDS decides that although the claimant is not able to do his or her prior job, he or she is capable of doing some form of work other than that performed in the past.

Compassionate Allowances

The SSA must quickly provide benefits to applicants whose medical conditions are so serious that they meet disability standards. The Compassionate Allowances (CAL) initiative allows Social Security to target the most obviously disabled individuals for claims approval based on objective medical information that SSA can obtain quickly.

Fifty medical conditions were initially selected for this initiative. Since then, Social Security has added 150 additional conditions, bringing the total number of conditions to 200, and the list may continue to expand over time. To learn more about compassionate allowances, please read our article regarding compassionate allowances in Social Security Disability and SSI claims.

Do You Need a Lawyer for an SSI Case?

The SSI disability process is indeed a fairly difficult one to navigate, except in the most clear-cut cases. Most SSI applications are denied at the initial stage. So, to win most SSI claims, you must be willing to appeal the initial decision and go to a hearing. Studies have shown that claimants represented by attorneys win more often than claimants who represent themselves.

If the SSA has denied your SSI case, you should consider hiring a Social Security Disability lawyer to represent you at the hearing. The lawyer will help organize your medical records and get the opinion evidence you need to prove that your medical impairments are disabling. Contact our office online or call us today at (888) 321-8131.