Prepared by:
Melinda Bird and
Marilyn Holle
This section covers three programs. All of them use the
same definition of disability (except there is a special definition for SSI
children):
Supplemental Security Income (SSI): These benefits
are for children and adults with limited income and resources. Persons aged 65
or older are also eligible (with certain limitations for non-citizens). The
2006 SSI benefit level in
Social Security Disability
Insurance (SSDI) Benefits: These are benefits for people who have worked
and paid into Social Security long enough to qualify for benefits when they
become disabled. The spouse and children of the worker with a disability may be
eligible for benefits in addition to worker’s benefits. These benefits are
sometimes called ATitle II@ benefits. Title II is the section
covering disability, retirement and dependent benefits in the Social Security
Act. After 24 months of SSDI benefits, the worker starts getting Medicare.
Social Security Disabled Adult Child Benefits (DAC or
CDB): This is a special Title II program for persons who are at least 18
years of age, who became severely disabled prior to age 22 and who are
unmarried when they apply. These special dependent benefits draw upon the
earnings record of a retired, disabled or deceased parent (or other caregiver)
that paid into Social Security. The Disabled Adult Child is not eligible for
these benefits until the parent begins receiving Title II benefits when retired
or disabled or when the parent dies. After 24 months of benefits, the DAC/CDB
recipient is eligible for Medicare.
Start the application process by calling
There are local agencies which can help with initial
Social Security application, such as Independent Living Centers. If you receive
General Assistance, the county may also help you with the SSI application.
If your initial application is denied, it is very
important to appeal. (See later section on appeals). You are more likely to win
if you get an attorney to handle your appeal. Private attorneys will represent
initial applicants at the administrative law judge hearing stage without
advance payment. If you win, the attorney's usual fee is 25% of the award of
retroactive benefits back to your initial application date. If you lose, there
is no charge. To find a local attorney who will help, contact the county bar
association or the National Organization of Social Security Claimants'
Representatives (NOSSCR) at
The local Social Security Office sends the forms completed
by the applicant, including medical releases and information about the person’s
disability problems, to the Department of Social Services Disability &
Adult Programs Division or DAPD. The DAPD is responsible for collecting medical
evidence before making a decision. Each applicant will be assigned an analyst
to develop the case. Usually the analyst will send Daily Activities
Questionnaires to the applicant and to someone who knows the applicant.
Help from an advocate in the disability determination process can make a real difference. The advocate can assist or get somebody to assist the applicant in completing the questionnaire so that the answers accurately reflect the impact of the disability problem on daily life. The advocate can touch base with the DAPD analyst and help get missing medical evidence. In most cases erroneous denials are because the DAPD did not have all the medical evidence it needed. If the advocate thinks that there may be an underlying organic element to the disability – as may be the case with some people with a history of drug or alcohol use – the advocate can suggest referral for special neuropsychological testing. Sometimes the analyst will send the applicant for a consultative psychiatric examination, but the exams arranged by DAPD are often superficial and fail to address the applicant’s disability problems. The advocate can assist the applicant by arranging for an examination through county providers.
An adult is disabled if unable to engage in substantial
gainful activity (
The definition of disability does not include persons who are disabled as a result of current alcohol or other substance abuse. However, such persons may be covered if they meet the disability standard because of other impairments even if those impairments were the result of past abuse.
The DAPD will look first to whether or not the applicant’s
impairment or combination of impairments meets or equals the criteria one of
the individual Listings of Medical Impairments. These are found in the Social
Security regulations (20
If the applicant does not meet or equal a listing, then the DAPD looks to see whether or not the applicant can go back to past types of work, if any. If you cannot do past work, then the DAPD looks to see whether or not there is other work reasonably available which you could do in light of your age, education, work experience, and disability limitations. For people with psychiatric disabilities and other mental or neurological impairments, there are usually "nonexertional limitations" which are considered. Social Security Rulings 85-15 and 85-16 discuss how Social Security looks at disability limitations relating to mental or neurological impairments.
In 1996 Congress narrowed the definition of disability for
children. The primary impact of the narrowed definition was on children with
mental impairments. Children under the age of 18 years are disabled if they
have “a medically determinable physical or mental impairment which results in
marked and severe functional limitations, and which can be expected to result
in death or which has lasted or can be expected to last for a continuous period
of not less than 12 months.” In practice, it means that children must show that
they meet the listings or that they medically or functionally equal the
listings.
The amount of resources and income other than from work does not matter for purposes of the SSDI and DAC programs. However, SSI is a need based program and the amount of resources and income matter.
For SSI, an individual can have $2,000 in resources. A
couple can have $3,000 in resources. Certain resources are exempt: a home,
household furnishings, wedding and engagement ring, a car used to get back and
forth to the doctor or work, a burial trust or account, resources used for
self-support. Social Security also does not count the retirement accounts owned
by the spouse of a person with a disability or the parent of a child with a
disability.
Income is money or something you can convert to money
which you receive in a month. What is left over as of the beginning of the next
month counts as a resource. The income received less allowable deductions can
affect the amount of SSI benefits received:
Example: Dora receives $460 a month in
SSDI/Title II benefits. That is considered unearned income and is reduced by
the Social Security deduction of $20 which applies to any income so that the
countable income for SSI purposes is $440. Dora’s SSI payment will be for the difference
between the SSI amount she would receive if she had no income ($836 in 2006 for
a single person) and $440, for an SSI grant of $396.
For SSI, Social Security takes into consideration or “deems”
the income and resources of other people in certain cases: The income and
resources of a parent or stepparent living with a child with a disability is
considered; the income of a spouse in the same household is considered; the
income of an immigrant’s sponsor is considered in certain circumstances.
There are special rules when you receive Ain-kind@
income. In-kind income only counts if it is for food, clothing or shelter. If
someone gives the SSI beneficiary a bus pass or cat food or pays someone else
directly for medical treatment or other services that is not income which
counts. However if the SSI beneficiary is living with other people and is not
paying his or her fair share of the food and housing expenses, the SSI payment
will be reduced under the “living-in-the-household-of-another” rule by one
third of the federal part of the SSI grant (in 2006, about $201) even if that
is more than the discrepancy between what is contributed and the SSI
beneficiary’s “fair share.”
This rule only applies when the SSI recipients are receiving all their food and shelter from the household. If the rule does not apply, then Social Security applies the “presumed value” rule which treats as countable income the lesser of (1) the difference between the value of what is received and what you pay for it, and (2) the “presumed value” which is one third the federal part of the SSI grant plus $20:
Example: Eduardo lives rent free in an
apartment over the garage behind his sister’s house. Eduardo agrees that the
rental value is $300 a month. Eduardo’s 2006 SSI monthly payment of $836 is
reduced by $201 plus $20 so that his reduced SSI is $615.00.
For purposes of receiving Title II Social Security
Disability and DAC benefits, the recipient only need be lawfully present in the
For purposes of SSI, the universe is divided between those
noncitizens who were either receiving SSI benefits before
The rules are complicated for persons who were lawfully
admitted after
Because resources and nonwork income are not considered for
purposes of the Title II programs (SSDI and DAC benefits), receiving a
retroactive payment does not affect benefits.
Under SSI, an adult has nine months in which to spend a check covering back benefits before that money will be counted as a resource. Receipts should be kept to show Social Security how resources were brought down to the allowable $2000 for an individual or $3000 for a couple.
Under the SSI program recipients will be reviewed once a year to see if they still meet the income and resource requirements of the SSI program.
Under SSI, SSDI/title II and DAC benefits, current
recipients will be reviewed to see whether they continue to be disabled. Congress
has given Social Security more money so that people will be reviewed at least
every three years. People being reviewed are not treated as new applicants. The
review is supposed to look at whether there has been improvement which results
in the ability to work. The first step of the review is an appointment at the
local office. That is to get information about treatment and support services
and to get releases so that health care providers may be contacted. That
information is sent to the DAPD, the state agency that also makes disability
determinations for applicants.
The role of advocates is important in this process. Sometimes
people become fearful and do not respond to the Social Security appointments or
contacts from DAPD. In those cases the current recipient will be terminated
from benefits not because he or she is no longer disabled but because of a “failure
to cooperate.” The advocate can provide important assistance by identifying
someone to assist the recipient through the process and by advising DAPD of the
need to make reasonable accommodation to the person’s disability limitations.
The advocate can provide help in insuring that the DAPD
gets medical evidence from treating sources so that the recipient is not sent
to one of Social Security’s consultative examiners. If the recipient is being seen
by a clinic, we recommend that the clinic person most familiar with the person
draft a report including a comparison between the status before and now to be
signed by the treatment team. Social Security only recognizes reports signed by
a physician or a clinical psychologist.
If the client receives a notice that Social Security
benefits will be terminated, appeal immediately. In many cases, benefits
will continue if an appeal is requested within 10 days of the notice. See
“Appeals” later in this section.
If Social Security determines that the recipient needs
help in managing his/her money, Social Security may appoint a relative, agency,
or friend to be the representative payee. People whose disability includes
problems with drugs or alcohol are required to have a payee. Only in rare
occasions will Social Security approve a board & care operator as the
representative payee. While the payments are made directly to the
representative payee, the money belongs to the recipient. Under certain
circumstances, Social Security authorizes the representative payee to deduct
$25 a month ($50 a month for persons who require a representative payee because
of drug or alcohol abuse) as fee.
The recipient may challenge the determination that a representative
payee is needed and the naming of a particular person as the payee. Social
Security is obligated to investigate complaints of financial abuse by a payee. Reports
should be made in writing to Social Security. Where there is a serious
question, Social is obligated to investigate and suspend payments to the
representative payee.
Social Security treats work differently depending on
whether you are receiving SSI or Title II disability benefits. If you are
receiving both, both sets of rules apply to you at the same time.
You can work and still get SSI unless your income gets so
high that you are no longer financially eligible. SSI has generous income
counting rules. One half of your earned income is not counted in figuring the
amount of your SSI. You can also reduce your countable and thus increase the
amount of your SSI through Impairment Related Work Expense (IRWE) deductions.
These are the charges the recipient pays out of pocket for assistance and
treatment related to the disability and for the extra expenses someone has
because of working and having a disability.
Practice
Tip: If you live in a board and care which provides care and supervision in
addition room and board, the value of these services can be deducted from any
earned income as an Impairment Related Work Expense.
With a “Plan for Achieving Self Support” or PASS, income or an excess resource can be sheltered and not counted in determining eligibility for SSI. The income or resources sheltered can be used to pay for tuition, equipment needed to work, etc. Persons interested in seeing whether a PASS would assist them, and particularly persons not now eligible for SSI, should be referred to someone with expertise in writing and implementing Plans for Achieving Self Support.
For SSDI/Title II benefits, work can result in a
termination of benefits even for persons who are still disabled. You will have
a "trial work period" month if (1) you earn more than $620 or (2) if
self-employed, you work more than more than 40 hours per month. The amount
earned in any trial work period month does not affect the amount of benefits
until the ninth month of trial work. When a recipient’s gross earnings are more
than $860 in the ninth month of trial work or thereafter, Social Security
presumes the recipient is performing “substantial gainful activity” or
If earnings fall to $860 or less per month, there may be a
period when the recipient would be entitled to reinstatement. Even if gross
earnings are more than $500 a month, sometimes other factors indicate the work
is not
When the recipient gets the overpayment notice the first
question is whether there really was an overpayment. If the amount of
overpayment is not correct, request an appeal within 10 days. (In some cases,
benefits will continue during the appeal. See, “Appeals.” If the
recipient cannot tell from the notice, then a reconsideration by "informal
conference" should be requested so that the recipient can find out the
reason for the overpayment.
Even if the recipient agrees the overpayment is correct but does not believe he or she was at fault, then the recipient should request an overpayment waiver. If the overpayment is because of income or changed living situation, Social Security looks primarily at whether or not the recipient told Social Security about the income or changed living situation. Social Security is required to take into consideration disability limitations when determining whether or not someone was at fault for purposes of a waiver.
To get a waiver, the recipient must also show that
reducing the SSI check to pay back the overpayment will cause hardship. Even if
Social Security finds that the recipient was not at fault, the request for a
waiver will be denied if there is not convincing evidence of hardship from
repayment.
PRACTICE
TIP: When there is an overpayment and the person is receiving
SSI or both SSI and a Title II disability benefit, the amount of recovery is
limited to 10% unless there is fraud. Although this protection does not apply
to persons who receive only Title II disability benefits, as a practical
matter, Social Security will often arrange a monthly payment schedule.
The recipient often needs assistance in filling out the
waiver form and/or in explaining how the disability limitations interfered with
the recipient’s ability to understand or act with respect to reporting
requirements. When the recipient did not report, or did not keep records of
reporting, the advocate can provide or secure help for the recipient to put
reporting and record keeping systems in place. Every SSI recipient should have a
notebook and three-hole punch so that everything received and a copy of
everything sent is put in the notebook and so that every contact and
communication is written down.
When there is an overpayment and a representative payee,
in most cases the recipient should be found not at fault for the overpayment. The
recipient has a right to waiver separate from any right that the representative
payee may have.
SSI applicants who appear eligible for SSI and who are
having a financial emergency can get an emergency advance payment of up to a
month's benefits. SSA POMS
For clients whose Social Security benefits have already
been approved and who face a financial emergency, Social Security can request
expedited check issuance, where the Treasury Department mails the check to the
client. If the emergency is such that the client cannot wait for a check in the
mail, the Social Security office can issue an SSI Immediate Payment of up to
$200 on the spot. POMS E02004.100 and POMS E02801.030B.
If a Social Security check is late or lost, the client may
immediately report the check missing. Social Security then has up to 10 days to
issue a replacement check to be issued. POMS SI 02004.100B.4.a.
The steps in the Social Security appeal process are: (1) reconsideration, (2) appeal to an administrative law judge (ALJ) hearing, and (3) appeal to the Appeals Council. The time period for filing an appeal (request for reconsideration or request for hearing) is 60 days from receipt date of the initial or reconsideration decision. Social Security presumes the notice was received by the fifth day after the date on the notice.
Applicants and recipients can ask for reconsideration by
case review (someone else in the office will review the papers in the file and
anything you submit) or informal conference (usually the best approach
-- you meet in person or over the phone with the decision maker). Recipients
who are getting SSI can also request formal conference (like an informal
conference but with the ability to have a subpoena issued to compel the
presence of a person or papers that may be needed for a fair decision). If you
leave the form blank as to which kind of reconsideration you want, Social
Security will only give you case review.
When appealing a notice saying you no longer disabled so that the termination is on medical grounds, full benefits will continue through the ALJ hearing if you appeal within 10 days of receiving the initial or reconsideration notice and you ask that benefits continue. Ask to fill out the Benefit Continuation Election Statement. If you later lose but you were appealing in good faith, any overpayment can be waived. If you request reconsideration through a paper review of your file (case review) and lose, you can still have a face-to-face reconsideration meeting (informal or formal conference) with a hearing officer.
For other issues continuation of benefits are only
available to persons who receive SSI or SSI and Title II benefits and only to
the first reconsideration step in the appeal process. The request for
reconsideration with the request that benefits continue needs to be made within
ten days of receiving the notice.
People who receive only Social Security Title II benefits
are not entitled to continuation of benefits when they ask for a
reconsideration involving a nonmedical issue. They only have a right to
reconsideration by “case review” although most offices will schedule a
conference on request. New applicants similarly only have the right to a
reconsideration by case review.
Sometimes there are problems with how the local Social
Security field office handles a client’s case, apart from questions which can
be handled on appeal such as whether the client is disabled or whether there is
an overpayment. Some examples are if the client is treated rudely; the client
files an appeal but never gets an answer or a hearing and benefits are cut
anyway; the Social Security worker refuses to accept an application or an
appeal request; the client is refused an accommodation for her disability; a
check is missing or lost and Social Security refuses to help; or Social
Security refuses to respond when the client reports problems with a
representative payee.
When a client has problems with how Social Security
administers benefits, write a letter of complaint to the “Field Office Manager”
of the local Social Security office, explaining the problem and asking for an
investigation. You should also send a copy of your complaint to the Public
Affairs Unit, Social Security Administration, San Francisco Regional Office,
This same office also houses the "Critical Congressional Unit," which handles inquiries from Congressional staff regarding constituent complaints. In an urgent situation, such as a client being cut off benefits with no notice, they will respond to requests from an advocate (but not from a client).
The Medicaid program, known in
PRACTICE
TIP: It is easier and faster to get
Medi-Cal based on disability than to get SSI. Apply first for Medi-Cal and
then, once the Medi-Cal is in place, apply for SSI at the Social Security
office. If the applicant is denied SSI, Medi-Cal will continue as long as she
keeps appealing. If she is denied SSI first, this denial will also control her
Medi-Cal application, which will be denied.
People who do not get SSI can still get Medi-Cal. To get Medi-Cal alone, apply at the county welfare office. Medi-Cal must approve or deny the application within 90 days. Even if an individual’s income is too high to get SSI, she can still get Medi-Cal if:
§ She meets the Medi-Cal resource limits ($2000 for an individual, $3000 for a two person family, higher amounts for larger family sizes);
§ She is over
age 65, blind or has a disability that meets the SSA standards; and
§ She is a
resident of
There are no income limits for Medi-Cal. If a person’s
income is above the Medi-Cal standard ($600 for one person, $750 for two, $934
for three people or a couple, higher levels for larger families), he can get
Medi-Cal with a monthly “share of cost.” The share of cost is the difference
between the person’s income and the Medi-Cal standard. Once the Medi-Cal
recipient gets medical bills equal to the amount of his monthly share of cost,
Medi-Cal will pay the rest of his medical bills for the month. (He does not
have to pay the bills.) A Medi-Cal recipient can also meet his share of cost
for several months into the future with old, unpaid medical bills.
People who get Medicare benefits because they get Social
Security benefits but not SSI can also apply for Medi-Cal. Medi-Cal covers some
services which Medicare does not cover, such as home health services,
rehabilitative mental health services, some prescription drugs, etc.
Medi-Cal pays for a wide range of medically necessary
services. Mental health services are covered through the county Medi-Cal Mental
Health managed care plan. Other covered services include doctor’s visits,
hospitalization, prescription drugs, x-ray and laboratory services, durable
medical equipment, eyeglasses, dental care, hearing aides and home health care
including nursing care. After a provider submits a ATreatment
Authorization Request@
to cover needed services, Medi-Cal has 30 days to approve, deny or send the
request back for more information. If Medi-Cal does not act within 30 days, the
request is deemed to be approved automatically.
If Medi-Cal denies an eligibility application or a request
for services, the county or the Med-Cal agency must provide a written notice of
action to the recipient explaining the reason for the denial. The notice must
also explain how to appeal by requesting a Medi-Cal fair hearing. Even if there
was no notice of action, for example when there is a delay in getting needed
services, a client can appeal by calling or writing the Medi-Cal fair hearing
office.
PRACTICE
TIP: Medi-Cal appeals are heard by Administrative Law Judges from the
Administrative Adjudications Division, California Department of Social
Services,
|
Toll-free Appeal Line: Fax: Office of Chief ALJ: |
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(213) 897-398 Fax: |
Fax: (415)557-1166 |
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Fax: |
Fax: (916)229-4185 |
People who used to receive SSI based on drug and alcohol
use and whose benefits were terminated in January of 1997 are entitled to continue
Medi-Cal while appealing. The Medi-Cal continues not just to the Social
Security ALJ hearing but also through the request for review by the Appeals
Council. If such individuals lose the ALJ hearing, it is important that they
appeal to the Appeals Council if they believe they are still disabled and need
Medi-Cal.
Children with disabilities who do not qualify for SSI
because of their parent’s income may still qualify for Medi-Cal with a share of
cost. Even if the share of cost is several thousand dollars per month, Medi-Cal
can help by covering the rest of any hospital charges, etc. for the month.
Some other special Medi-Cal eligibility rules:
(a) In calculating share of cost, the income of a step-parent is not counted; only the child’s income and the income of a parent with whom the child is living is counted.
(b) Children placed out of home through the Dependency court are automatically Medi-Cal eligible.
(c) Children
with Adoption Assistance funding are Medi-Cal eligible.
In addition, children can qualify for Medi-Cal with no
share of cost and without regard to their parents’ assets and resources through
the “Percent of Poverty” programs. This is important because family savings
sometimes appear to make the child ineligible for Medi-Cal. These special
programs are: 100% of Poverty: Children age 6 but less 19 years of age
are eligible if family income is less than 100% of the federal poverty
guidelines ($1667 per month for a family of four in 2006); 133% of Poverty:
Children from age 1 to 6 are eligible if family income is 133% of poverty
($3334 for a family of four in 2006); 200% of Poverty: Pregnant women and
infants up to age one are eligible with family income up to $200 of poverty
($2742 per month for four in 2006). Income is counted after the $90 deduction
for earned income and child care costs. Children may also qualify for the
Healthy Families program (see next section).
Healthy Families is a new insurance program for children
who are ineligible for Medi-Cal or eligible only for Medi-Cal with a share of
cost. The child must have no health insurance and may not be covered by any
other employer based insurance plan. Family income (after allowable deductions
when there is earned income) may not be more than 200% of the federal poverty
level. Call
Mental health services under a Healthy Families plan are
identical to those in the CalPERS program. This includes up to 30 days
inpatient services or, as a substitute for each day of hospitalization two days
of residential treatment, three days of day care treatment, or four outpatient
visits. In addition, short-term mental health intervention is covered up to 20
visits a year.
There is also a SED benefit under Healthy Families.
Children who were terminated from SSI under the new
stricter disability standards are entitled to Medi-Cal if they would be
eligible for SSI but for the change in definition; they also are entitled to continue
Medi-Cal while appealing. This is true even if their SSI benefits are not
continuing through the appeal. The Medi-Cal continues not just to the Social
Security ALJ hearing but also through the request for review by the Appeals
Council. If children lose the ALJ hearing, it is important that they appeal to
the Appeals Council if they believe they are still disabled and need Medi-Cal.
Children under the age of 21 who are eligible for Medi-Cal
are entitled to extra services, including intensive home and community-based
mental health services, through a special program known as EPSDT, which stands
for “Early and Periodic Screening, Diagnosis, and Treatment.” 42 U.S.C. § 1396a
(a)(10)((A); 42 U.S.C. § 1396d(a)(4)(B). Under the EPSDT program, the
state must provide diagnostic and treatment services "to correct or
ameliorate defects and physical and mental illnesses and conditions covered by
the screening service, whether or not such services are covered under the State
plan.” 42 U.S.C. § 1396d(r)(5). This is an easier standard of medical
necessity than regular Medi-Cal: children can get services to maintain
functioning, even if their condition will not necessarily improve.
Children are entitled to receive the EPSDT services they
need even if the services would not be available to them if they were adults. These
are known as Asupplemental@ EPSDT services. The EPSDT program can
cover individual or family therapy more frequently that Medi-Cal would
otherwise authorize. EPSDT can also cover extensive behavior management and
crisis intervention services in the home, in group homes or in residential
placements for children with mental disabilities. These services may include
one-on-one or even two-on-one behavior aides and other in-home behavior
management programs, family counseling, in-home therapy, therapeutic staff
support and behavioral intervention or life skill training. The cost of EPSDT
services in the home or community must be no more than the cost of
institutional placement.
The provider should request authorization to provide EPSDT
Supplemental mental health services from the county managed care Mental Health
Plan. Authorization for other non-mental health supplemental EPSDT services
should be requested from the state Department of Health Services, or if the
child is enrolled in Medi-Cal managed care plan for physical health services,
from the managed care plan. If the request for authorization is denied, the
family can appeal through the regular Medi-cal appeal process. (See Section B.5
above.)
Under EPSDT, children can qualify for intensive case
management similar to Targeted Case Management for adults. Children and their
families can request case management to assist with a request for supplemental
EPSDT mental health services identify a provider, develop a treatment plan,
etc. A provider or family can also request EPSDT mental health services
directly from the county.
In May, 1998, PAI and other advocacy groups filed a
lawsuit in federal court in
Therapeutic behavior intervention services are important
as part of “wrap-around” plans for children who would otherwise be placed in
high level facilities (
Through EPSDT, the state and the county must cover these
and other mental health services for children when they are medically
necessary, must provide case management to help families and to find providers
and submit requests, and must provide services to all children who need them
promptly and without waiting lists.
In response to the Emily Q. litigation, DHS and
The IHSS/
In most counties services are delivered through AIndividual Providers@ which means the recipient decides who
to hire. The
The application process is started by calling the county
welfare department. The welfare department will send someone out to evaluate
the applicant to determine the services and number of hours to be authorized. You
have a right to be assessed before you move into your own home so that
there will be no gap in services.
Most of the
In determining the number of IHSS hours it will authorize, the county adds together the time it takes to do each task for which help is needed. Remember that the IHSS program covers assistance needed in the form of prompt reminders. For instance, an applicant with a psychiatric disability and medication side effects may need someone to come into the home in the morning to get the applicant up and to prompt the person through the sequence of tasks related to bathing, grooming, and dressing. IHSS can cover that assistance.
In addition to covering specific tasks, the IHSS program
also covers “protective supervision” for persons who need that service to
monitor behavior related to a mental impairment including mental illness and to
intervene to prevent injury to the IHSS recipient. While other services are
approved on a task basis, protective supervision approved for a block of time
to cover the time in between specific tasks. In most cases the maximum hours
that can be authorized for specific tasks and protective supervision together
is 195 hours a month. In some cases where the time for meal preparation,
personal care and paramedical services equal 20 or more hours per week, the
maximum time can be 283 hours a month. Counties do not like approving
protective supervision so that when this service is needed, extra time should
be spent documenting why protective supervision is needed — i.e., how the
person injured himself in the absence of someone monitoring behaviors, how the
person would have injured himself in the absence of someone intervening.
You meet the financial eligibility requirements for IHSS
if you receive SSI. If your income is too high to be eligible for any SSI, you
are still eligible for IHSS with a share of cost representing the difference
between your other income less $20 and the applicable SSI grant level. Medi-Cal
comes automatically with IHSS. You have a lower share of cost with IHSS than
you would with Medi-Cal. You can also get IHSS with no share of cost if you are
a “Pickle” — that is someone who used to receive SSI but is no longer eligible
because of Social Security Cost of Living increases and therefore is eligible
for Medi-Cal with no share of cost.
The applicant or recipient has appeal rights like those
under Medi-Cal. See Section B.5, pages 15-16. If there is a notice reducing or
terminating benefits, there are timelines for appealing in order for benefit to
continue until the fair hearing decision: The fair hearing request must be
postmarked within ten days of the date on the notice or before the
reduction or termination goes into effect — whichever is later.
Some clients with psychiatric disabilities do not get
Social Security benefits, even though they have little or no income, because
(a) they are waiting as much as a year or more for their application to be
approved, or (b) SSA does not consider them to be disabled. These clients
should apply for General Assistance (also known as general relief) and Food
Stamps, since these do not require a finding of disability. Clients must apply
at their county welfare office; applications are generally processed within 45
days. General Assistance benefits vary from county to county but are
consistently low, averaging from $200 to $250 per month for a single person. State
law permits counties to limit general assistance to three months per year. Food
Stamp benefits may average from $150 to $250 per year, depending on other
income and family size.
Adults and children who do not get Social Security
benefits may qualify for CalWORKS benefits if there is a child in the family
who is “deprived of parental support” because one parent is absent, disabled or
unemployed. Again, benefit levels are far lower than SSI, with a maximum grant
of only $611 for a family of three. Parents are also subject to rigorous work
requirements, although there are exemptions for people with disabilities and
caregivers of children with disabilities. A parent can satisfy the work requirements
by becoming an IHSS provider for his or her child with a disability.
Families can combine SSI and CalWORKS. For example, a
parent who receives SSI for herself can get a CalWORKS benefits for the support
of her child; her SSI income will not be counted in calculating the CalWORKS
grant. Similarly, the single parent of a child on SSI can get CalWORKS benefits
for herself as a needy caretaker without regard to the SSI income.