Information on Eligibility for SSI and Medicaid
Supplemental Security Income (SSI) Eligibility Requirements
WHO IS ELIGIBLE FOR SSI?
Anyone who is:
- aged (age 65 or older); blind; or disabled.
- has limited income; and has limited resources; and is a U.S. citizen or national, or in one of certain categories of aliens (in general, an alien who is subject to an active warrant for deportation or removal does not meet the citizenship/alien requirement), is a resident of one of the 50 States, the District of Columbia, or the Northern Mariana Islands; and is not absent from the country for a full calendar month or for 30 consecutive days or more; and is not confined to an institution (such as a hospital or prison) at the government's expense; and applies for any other cash benefits or payments for which he or she may be eligible, (for example, pensions, Social Security benefits); and gives SSA permission to contact any financial institution and request any financial records about you; and files an application; and meets certain other requirements.
WHAT DOES “DISABLED” MEAN FOR A CHILD?
If you are under age 18 we may consider you “disabled” if you have a medically determinable physical or mental impairment, (including an emotional or learning problem) that:
- results in marked and severe functional limitations; and can be expected to result in death; or has lasted or can be expected to last for a continuous period of not less than 12 months.
If you are age 18 or older, the adult definition of disability explained below applies.
WHAT DOES "DISABLED" MEAN FOR AN ADULT?
If you are age 18 or older we 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 not less than 12 months.
SSA has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously 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 we can obtain quickly. Fifty medical conditions were initially selected for this initiative. Since that time we have added 150 conditions bringing the total number of conditions to 200. The list may expand over time. A complete list of CAL conditions may be viewed online at: http://www.socialsecurity.gov/compassionateallowances/conditions.htm.
Social Security Disability Insurance (SSDI) Eligibility Requirements
To qualify for Social Security disability benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security's definition of disability. In general, we pay monthly cash benefits to people who are unable to work for a year or more because of a disability. Benefits usually continue until you are able to work again on a regular basis. There are also a number of special rules, called "work incentives," that provide continued benefits and health care coverage to help you make the transition back to work.
If you are receiving Social Security disability benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same.
The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
"Disability" under Social Security is based on your inability to work. We consider you disabled under Social Security rules if: • You cannot do work that you did before; • We decide that you cannot adjust to other work because of your medical condition(s); and • Your disability has lasted or is expected to last for at least one year or to result in death.
This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments.
What Information Do I Need to Apply for SSI
The more information you have available, the faster your application process will be. These are some of the things you can expect to be asked to provide (from McClatchy-Tribune News Service)
- Your social security number
- Your birth certificate or other proof of your age
- Information about home where you live; mortgage or lease info; landlord's name
- Payroll slips, bank statements, insurance policies, burial fund records, and any other information about your income & what you own
- Names, addresses, telephone numbers of doctors, hospitals, and clinics where you have been seen if showing your are disabled or blind
- Proof of US citizenship or eligible noncitizen status
- Account number of bank account for automatic deposits
The link above will take you to the Red Book, a general reference source about the employment-related provisions of Social Security Disability Insurance and the Supplemental Security Income Programs for educators, advocates, rehabilitation professionals, and counselors who serve people with disabilities.
There are three sets of requirements - general, financial and medical that are evaluated to make an eligibility determination for Medicaid. While there are requirements that are generally the same for each set of services, there are some differences - for example, an application for services under the Aid to the Needy Blind program requires an individual to have a medical necessity determination of legally blind. Specific details regarding all eligibility requirements are explained for each service. General Requirements
All or most of the general requirements below must be met to be eligible for Medicaid services. When an item below is not required for a program, a DHHS District Office worker will inform you at the time of application.
Citizenship Status/Immigration: You must be either a US citizen or an eligible qualified alien. There are limited emergency medical services available for some non-qualified aliens. Contact a DHHS District Office for more information; Residency: You must be a current resident of NH but do not need to live here for a specified length of time; Age: You must meet any program age requirements; and Social Security Number: For most Medicaid programs the law requires that each individual requesting assistance furnish a social security number or verify that an application for a social security number was filed (if one has never been issued or you cannot provide the number).
Financial requirements are broken into two components: income and resources. Although every program examines income to determine eligibility, not every program counts resources. If a program counts resources, you must meet the program's resource requirements as well as the income requirements to be eligible for the program.
Household Income: Available income for all household members is counted when eligibility is determined. However, certain expenses are subtracted. Please refer to the Net Monthly Income Limits for the specific income requirements for the various programs; If Household Resources Are Counted: Resources owned by all household members are considered to determine eligibility. Examples of resources are cash, bank accounts, stocks, bonds, some vehicles, permanently unoccupied real estate, and some trusts. We do not count certain resources such as the home you live in, your furniture and some vehicles. Please refer to the Program Fact Sheet for the specific resource requirements for the various programs. Potential Income: Individuals who apply for some Medicaid programs must be prepared to explore and develop all potential sources of income. For example, if you are potentially eligible for any of the following (or additional benefits not listed), a DHHS District Office worker will tell you if you must apply for them: Social Security Benefits Retirement Benefits or Pensions Unemployment or Worker's Compensation Third-Party Medical Coverage VA Benefits (including Aid and Attendance) Contributions from any Liable Third Party Medical Requirements
Certain Medicaid service categories require a determination of medical eligibility in addition to general and financial requirements.
Determining that an applicant is medically eligible for Medicaid services involves an assessment of an applicant's medical condition, made by a DHHS medical review team. This review is based on an applicant's medical records and other medical documentation specifically related to an applicant's medical condition, keeping in mind access, quality, choice, and cost effectiveness. The DHHS medical review team consists of professional individuals including nurses, medical physicians, psychiatrists and clinical psychologists, as well as para-professionals and administrative staff.
The length of time required to complete the medical determination process depends on the clarity of information received from an applicant, the responsiveness of an applicant's healthcare provider to return information requested by the medical review team, the volume and comprehensiveness of information received, and the need for an applicant to have additional examinations or testing.
Next Steps: When a determination of medical eligibility is completed, an applicant is notified in writing. If an applicant also meets all general requirements and is found eligible financially, then the applicant will begin receiving the appropriate Medicaid services. If an applicant is found not to meet all the relevant eligibility requirements, the applicant is notified of his or her right to a Fair Hearing.