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Presumptive SSI (and Other Fantasies)

By Jacques Chambers

(click here to download pdf)

It can take from six weeks to six months or longer to receive benefits once you apply for disability benefits from Social Security under either Social Security Disability Insurance (SSDI) or from Supplemental Security Income (SSI). Yet, due to the severity of their medical condition, some people have an urgent need for immediate cash, and can’t afford to wait the time it takes to process an application and start payments.

Only five states offer any type of temporary disability benefit that would pay while the Social Security applications are being processed. What do you do if you need money quickly?

Social Security added two programs to their Supplemental Security Income (SSI) program just to help people in such a financial bind. These were very helpful programs, but unfortunately, by the time that Social Security finished making the rules and requirements for the programs, they became programs that very few claimants can access. This is especially true for persons dealing with HCV.

However, while the programs are not easily accessible, they are the source of a lot of rumor and misinformation, so it important for people with HCV to be aware of them, even if they are rarely able to utilize them.

The two programs are:

  • Presumptive SSI , which allows Social Security to “presume” that, due to the severe nature of your medical condition, they will start benefits immediately and allow you up to six months of benefits while you complete the paperwork and they review your claim; and,
  • Emergency Advance Payment which will advance all or a part of the next month’s SSI payment due to an immediate, urgent need .

To repeat, however, these programs are not easy to access, especially for people dealing with HCV.

Presumptive Disability Program

Goal: The purpose of Presumptive SSI is to start monthly payments for seriously ill claimants while the initial paperwork and determination for disability are made. To accomplish this, with a minimum of initial paperwork Social Security will start paying monthly SSI benefits and will continue for up to six months, so the claimant can have income while completing the paperwork and waiting for Social Security to review it.

Eligibility: Social Security regulations limit “Presumptive Disability” payments to specific impairment categories. To receive these payments, you must meet all the regular income and resource requirements for SSI eligibility (See http://www.hcvadvocate.org/hepatitis
/living_w_hepatitis_ C .asp
for articles on SSDI and SSI) and also provide initial documentation, usually a physician’s statement and recent bank statements, which show that you fit within one of the categories of people who are eligible for this benefit.

The categories of specific impairments that will qualify for Presumptive SSI are:

1. Amputation of two limbs;
2. Amputation of a leg at the hip;
3. Allegation of total deafness;
4. Allegation of total blindness;
5. Allegation of bed confinement or immobility without a wheelchair, walker, or crutches, due to a long stan ding condition, excluding a recent accident or surgery;
6. Allegation of a stroke (cerebral vascular accident) more than 3 months in the past and continued marked difficulty in walking or using a hand or arm;
7. Allegation of cerebral palsy, muscular dystrophy or muscle atrophy and marked difficulty in walking (e.g., use of braces), speaking, or coordination of the hands or arms;
8. Allegation of diabetes with amputation of a foot;
9. Allegation of Down's syndrome (Mongolism);
10. Allegation of severe mental deficiency made by another individual filing on behalf of a claimant who is at least 7 years of age. For example: A mother filing for benefits for her child states that the child attends (or attended) a special school, or special classes in school, because of mental deficiency or is unable to attend any type of school (or if beyond school age, was unable to attend), and requires care and supervision of routine daily activities;
11.
A child is age 6 months or younger and the birth certificate or other evidence (e.g. hospital admission summary) shows a weight below 1200 grams (2 pounds, 10 ounces) at birth;
12. Human immunodeficiency virus (HIV) infection (and submission of form, SSA-4814-F5, completed by a physician showing a history of certain opportunistic infections);
13. A child is age 6 months or younger and available evidence (e.g. the hospital admission summary) shows a gestational age at birth on the table below with the corresponding birth weight indicated:

  • 37 – 40 weeks Less than 2,000 grams (4 pounds, 6 ounces)
  • 36 weeks 1,875 grams or less (4 pounds, 2 ounces)
  • 35 weeks 1,700 grams or less (3 pounds, 12 ounces)
  • 34 weeks 1,500 grams or less (3 pounds, 5 ounces)
  • 33 weeks 1,325 grams or less (2 pounds, 15 ounces)

14. A physician or knowledgeable hospice official confirms an individual is receiving hospice services because of terminal cancer and,
15. Allegation of spinal cord injury producing inability to ambulate without the use of a walker or bilateral hand-held assistive device more than two weeks following a spinal cord injury with verification of such status from an appropriate medical professional.

As you can see from the above listings, it would be unusual for a person with HCV to qualify for Presumptive Disability under SSI even if they meet the resource and income requirements.

Payments: Presumptive Disability payments:

  • Are for the same amount for which you would be eligible for under regular SSI rules;
  • May be made for up to 6 months pending the formal determination of disability or blindness;
  • Begin with the month in which the presumptive disability/blindness finding is made by the local Social Security office or State disability determination agency based on specific criteria; and,
  • End after 6 months if a formal determination has not been made.

Final determination: If the formal determination is eventually made that you are not disabled or blind:

  • You will not receive any further SSI benefits;
  • You can keep the money you’ve received – unless the formal rejection is due to a nonmedical factor of eligibility, such as if you were not truthful about the amount of your income or resources.

Emergency Advance Payments

If you have been approved for SSI eligibility whether through the normal process or through Presumptive Disability, you may request an Emergency Advance Payment. An Emergency Advance Payment is to assist you when financial emergencies strike such as when you are moving and need extra money for the move or are about to be evicted from your apartment.

The Social Security office will issue you a check for the emergency. However, the amount of the check will be deducted from the next month’s payment. At Social Security’s option, if taking the amount of the check out of your next month’s check will create a sub stan tial burden, SSA may elect to withhold 1/6 of the Emergency Advance Payment from the next six SSI checks.

NO TE : Not all Social Security field offices have check-writing capabilities. You need to find a District office. If you apply for an Emergency Advance Payment at a District office, you should be able to walk out with a check. Branch offices usually can get a check issued but it may take two to three days for you to get it.

You should also be aware that issuing such checks is considered burdensome by some offices. There are offices that will deny the ability to issue immediate checks, hopefully not many, but there are some.

These programs have sufficient restrictions that they are relatively difficult to access, but you should know of these programs and their availability if you should ever have need of and qualify for them.


Confused about applying for disability? Click
here

[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past twelve years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at jacques@helpwithbenefits.com or through his website at: http://www.helpwithbenefits.com.]



Copyright, (March, 2005) Hepatitis C Support Project / HCV Advocate www.hcvadvocate.org. All Rights Reserved. Reprint is granted and encouraged with credit to the Hepatitis C Support Project


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