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[Background Material and Data on Programs within the Jurisdiction of the Committee on Ways and Means (Green Book)]
[Program Descriptions]
[Section 3. Supplemental Security Income (SSI)]
[From the U.S. Government Printing Office, www.gpo.gov]

 
SECTION 3 - SUPPLEMENTAL SECURITY INCOME (SSI)

CONTENTS

Background
Trends
Basic Eligibility
      Categorical Requirements
      Citizenship and Residency Requirements
      Prohibition of Payment to Felons and Fugitives
      Income and Resource Requirements
      Presumptive Eligibility for Persons with AIDS and HIV
      Public Institution Requirement
Application to Other Programs Requirement
      Eligibility for Social Security
      Eligibility for Medicaid
      Eligibility for Food Stamps
Self-Sufficiency and SSI
SSI Benefits
      Federal SSI Benefit Standard
      Benefits for Persons Living in the Household of Another
      Benefits for Persons Living in a Medicaid Institution
      Benefits of Former Recipients of State Assistance
      Overpayments
      Faster Initial SSI (and Social Security) Payments
      State Supplementation
      Maximum SSI and Food Stamp Benefits for Individuals Living 
            Independently
      Comparison of SSI Payment Levels to Poverty Thresholds
Trends in the SSI Caseload
      Number of Recipients
      Characteristics of Adult Disabled and Blind Recipients
      Characteristics of Recipients Receiving Benefits on the Basis of 
             Age
      Characteristics of Children Receiving Benefits
      Overview of Caseload Developments
Eligibility of Drug Addicts and Alcoholics
Eligibility of Noncitizens
Eligibility of the Homeless
Special SSI Provisions for the Working Disabled
      Earned Income Disregards
      Eliminating Work Disincentives
      Special Benefits for Certain World War II Veterans
Measures of SSI Participation and Growth
      SSI Participation Rates
      Changes in Number of Recipients, 1970-2002
      SSI Program Costs
Legislative History
      104th Congress
      105th Congress
      106th Congress
      107th Congress
References

BACKGROUND

The Supplemental Security Income (SSI) Program is a means-tested, 
federally administered, income assistance program authorized by title 
XVI of the Social Security Act. Established in 1972 (Public Law 
92-603) with benefits first paid in 1974, SSI provides monthly cash 
payments in accordance with uniform, nationwide eligibility 
requirements to needy aged, blind, and disabled persons.
The SSI Program replaced the Federal-State Programs of Old-Age 
Assistance and Aid to the Blind established by the original Social 
Security Act of 1935 as well as the Program of Aid to the Permanently 
and Totally Disabled established by the Social Security Amendments of 
1950. Under the former programs, Federal matching funds were offered 
to the States to enable them to give cash relief, "as far as 
practicable" in each State, to eligible persons whom the 
States deemed needy. The States set benefit levels and administered 
these programs. The Federal-State adult assistance programs continue 
to operate in Guam, Puerto Rico, and the Virgin Islands. Under the 
Covenant to Establish a Commonwealth of the Northern Mariana Islands, 
enacted as Public Law 94-241 on March 24, 1976, the Northern Mariana 
Islands became the only U.S. jurisdiction outside the 50 States and 
the District of Columbia authorized to operate an SSI Program.

The Congress intended the new SSI Program to be more than just a Federal 
version of the former State adult assistance programs which it replaced. 
In describing the new program, the report of the Committee on Finance 
stated: "The Committee bill would make a major departure from the 
traditional concept of public assistance as it now applies to the aged, 
the blind, and the disabled. Building on the present Social Security 
Program, it would create a new Federal program administered by the 
Social Security Administration (SSA), designed to provide a positive 
assurance that the Nation's aged, blind, and disabled people would no 
longer have to subsist on below poverty-level incomes" (U.S. Senate, 
1972, p. 384). 
The SSI Program was envisioned as a basic national income maintenance 
system for the aged, blind, and disabled which would differ from the 
State programs it replaced in a number of ways. It would be 
administered by SSA in a manner as comparable as possible to the way 
in which benefits were administered under the Social Security Program. 
While it was understood that modifications would be necessary to make 
SSA's systems work for the new program, SSI was seen as an add-on 
rather than a new system. SSA had a longstanding reputation for 
dealing with the public on a fair and humane basis, but with scrupulous 
regard for the requirements of law. Thus, it was expected that both 
recipients and taxpayers would be pleased with the outcome.
Under the former adult assistance programs the amount of assistance 
could vary from person to person according to an evaluation of the 
individual's needs. The SSI Program, by contrast, represented a "flat 
grant" approach in which there would be a uniform Federal income 
support level.
In contrast to the former State programs with their provisions for liens 
against property and relative support requirements, the SSI Program was 
intended to have minimal barriers to eligibility other than a lack of 
income. Even here, the new SSI Program incorporated more generous 
provisions for disregarding income C particularly earned income C than 
was provided under the Old-Age Assistance Program. The report of the 
House Committee on Ways and Means stated that the SSI Program was 
designed to provide incentives and opportunities for those able to work 
or to be rehabilitated that would enable them to escape dependency 
(U.S. House, 1971, p. 147).
For the most part, the nature of the SSI Program is expressed by its 
title. It was conceived as a guaranteed minimum income for the aged, 
blind, and disabled which would supplement the Social Security Program 
and act as an income-related program to provide for those who were not 
covered or minimally covered under Social Security or who had earned 
only a minimal entitlement under the program.

It should be noted that even though SSA administers the SSI Program, SSI 
is not the same as Social Security.  The SSI Program is funded by 
general revenues of the U.S. Treasury - personal income taxes, corporate 
taxes, and other taxes. Social Security benefits are funded by the 
Social Security taxes paid by workers, employers, and self-employed 
persons.  The programs also differ in other ways such as the conditions 
of eligibility and the method of determining payments. In addition, 
States have the option of supplementing the basic Federal SSI payment. 
In some cases, State supplementary payments are administered by the 
State instead of SSA.

TRENDS

Table 3-1 summarizes the trends in the SSI Program:
1.	The number of recipients on SSI has risen from nearly 4 million 
in 1974 to 6.8 million in December 2002. The number of SSI recipients 
declined early in the program as the number of aged individuals on SSI 
declined, but that trend reversed in the mid-eighties as rapid growth in 
disabled recipients outstripped the minimal change in the elderly and 
blind SSI populations.
2.	Total annual benefits paid under the SSI Program rose from about  
$5.2 billion in 1974 to $34.6 billion in 2002.
3.	The monthly Federal benefit rates for individuals and couples 
rose from $140 and $210 in 1974 to $552 and $829 in 2003 (2003 figures 
are not in table), respectively. Nearly all of these changes resulted 
from the statutory indexation of the Federal benefit rates to the 
Consumer Price Index (CPI).
4.	The proportion of SSI recipients receiving Social Security 
benefits declined from nearly 53 percent in 1974 to 36 percent in 2002. 
The fraction of SSI recipients receiving some other type of unearned 
income rose slightly from about 11 percent in 1974 to 12 percent in 
2002, and the fraction with earnings increased slightly from less than 
3 percent in 1974 to more than 4 percent in December 2002.
5.	The Federal benefit rate as a percent of the appropriate poverty 
level for individuals has ranged from 72 to 77 percent and was 76 
percent in 2002; for couples it has ranged from 86 to 91 percent and was  
90 percent in 2002. Most States supplement the Federal benefit for at 
least some participants.
6.	The SSI Program pays benefits to children who are blind or have 
other disabilities. Some of the increases in participation since 1991 
reflect the revised definition of disability for children as a result 
of the Supreme Court's decision in the Sullivan v. Zebley case. Public 
Law 104-193 (enacted August 22, 1996) established a more restrictive 
disability definition for children which is expected to result in a 
slower rate of growth in the number of children receiving SSI benefits.

BASIC ELIGIBILITY

CATEGORICAL REQUIREMENTS

To qualify for SSI payments, a person must satisfy the program criteria 
for age, blindness, or disability. The aged are defined as persons 65 
years and older. The blind are individuals with 20/200 vision or less 
with the use of a correcting lens in the person's better eye, or those 
with tunnel vision of 20 degrees or less. Disabled individuals are 
those unable to engage in any substantial gainful activity by reason of 
a medically determined physical or mental impairment expected to result 
in death or that has lasted, or can be expected to last, for a 
continuous period of at least 12 months. The test of "substantial 
gainful activity" in calendar year 2003 is to earn $800 monthly in 
counted income, with impairment-related expenses subtracted from 
earnings. Generally, the individual must be unable to do any kind of 
work that exists in the national economy, taking into account age, 
education, and work experience. Children may qualify for SSI if they 
are under age 18 (or under age 22 if a full-time student), unmarried, 
and meet the applicable SSI disability or blindness, income, and 
resource requirements. Public Law 104-193, the Personal Responsibility 
and Work Opportunity Reconciliation Act (PRWORA) of 1996, established 
a new disability definition for children under age 18 which requires a 
child to 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."

TABLE 3-1--SUPPLEMENTAL SECURITY INCOME SUMMARY, SELECTED YEARS 
1974-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Under pre-1996 law, low-income children could qualify for SSI benefits 
in two ways: their disability could match one of the impairments in the 
medical "listing of impairments" or they could be evaluated under an 
individualized functional assessment disability determination procedure 
(generally considered a less stringent process) that determined whether 
an unlisted impairment seriously limited a child's ability to perform 
activities normal for his age. Both methods were stipulated in Federal 
regulations. Until the Supreme Court's 1990 ruling in Sullivan v. 
Zebley, the medical listings were the only way to determine a child's 
eligibility for SSI benefits. Adults, in contrast, could receive an 
assessment of their functional and vocational capacities even if they 
did not meet one of the listings. The Court ruled that sole reliance on 
the listings did not satisfy the law's requirement to gauge whether 
children's disorders were of comparable severity to impairments that 
would disable adults. The 1996 welfare reform law discontinued the 
individualized functional assessment and the "comparable severity" 
standard upon which it was based. Many children on the rolls as a 
result of an individualized functional assessment had their benefits 
terminated, and future awards based on individualized functional 
assessments were barred. Thus, the SSI Program for Children is 
restricted to those who have impairments that meet or equal at least 
one of the listings. Pursuant to the 1996 law, the listing of 
impairments has been changed to reflect the new disability 
definition for children.

CITIZENSHIP AND RESIDENCY REQUIREMENTS

To qualify for SSI a person must be a citizen of the United States or, 
if not a citizen, be a refugee or asylee who has been in the country for 
less than 7 years, or be a "qualified alien" who was receiving SSI as of 
August 22, 1996 or who was living in the United States on August 22, 
1996 and subsequently became disabled. Subsequent to 1996, changes were 
made to the alien eligibility requirements that extended to certain 
groups of aliens, added new categories to the list of qualified aliens, 
exempted certain Native Americans from the eligibility limitations and 
granted SSI eligibility to aliens who are determined to be victims of  
"severe forms of trafficking in persons." (For more detailed information 
on eligibility requirements for noncitizens, see Appendix J.)
In addition to the citizenship requirement, a person must be a resident 
of the United States or the Northern Mariana Islands, or a child of a 
person in the military stationed outside the United States, or a student 
temporarily abroad; must apply for all other benefits to which she is 
entitled; and must, if she is disabled, accept vocational rehabilitation 
services if they are offered.

PROHIBITION OF PAYMENT TO FELONS AND FUGITIVES

The 1996 welfare reform law provides that, as of August 22, 1996, SSI 
benefits may not be paid to individuals who are fleeing to avoid 
prosecution for a felony crime, or fleeing to avoid custody or 
confinement after conviction for a felony crime, or violating a 
condition of probation or parole imposed under Federal or State law.

INCOME AND RESOURCE REQUIREMENTS

Income
Individuals and couples are eligible for SSI if their incomes fall below 
the Federal maximum monthly SSI benefit, currently $552 for an 
individual and $829 for a couple (calendar year 2003 standards). If only 
one member of a couple qualifies for SSI, part of the ineligible 
spouse's income is considered to be that of the eligible spouse (this 
procedure is called "deeming"). If a couple separates, each person is 
treated as an individual in the month following the month of separation. 
If an unmarried child living at home is under age 18, some of the 
parent's income is deemed to that child. If an immigrant is sponsored 
into the United States, some of the sponsor's and the sponsor's spouse's 
income may be deemed to that immigrant.

Income includes cash, checks, and items received "in kind" such as food 
and shelter. Wages, net earnings from self-employment, and income from 
sheltered workshops are considered earned income. Social Security 
benefits, workers or veterans compensation, annuities, rent, and 
interest are counted as unearned income.

An individual does not have to be totally without income to be eligible 
for SSI benefits. Maximum SSI benefits are paid, assuming the other 
conditions of eligibility are met, if the individual or couple has no 
"countable" income in that particular month. If the individual or couple 
has "countable" income, a reduction is made against the maximum payment. 
Not all income is counted for SSI purposes. Since 1972, the major 
exclusions have included the first $20 of monthly income from virtually 
any source (such as Social Security benefits), and the first $65 of 
monthly earned income plus one-half of remaining earnings.

Income received in sheltered workshops and work activity centers is 
considered earned income and qualifies for the earned income exclusion. 
Table 3-2 shows the maximum income that an individual and couple can 
have, taking into account these income exclusions, and still remain 
eligible for Federal SSI benefits.

TABLE 3-2--MAXIMUM INCOME FOR ELIGIBILITY FOR FEDERAL SSI BENEFITS, 2003

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Work-related expenses are disregarded (i.e., subtracted from income) in 
the case of blind applicants or recipients and impairment-related work 
expenses are disregarded in the case of disabled applicants or 
recipients. The SSI Program also does not count income and resources 
that are set aside as part of an approved plan for achieving 
self-support (PASS). A PASS is an income and resource exclusion that 
allows an SSI recipient who is blind or disabled to set aside income 
and resources for a work goal. The money set aside can be used to pay 
for such items or services as education, vocational training, or 
starting a business.
The value of any in-kind assistance is counted as income unless such 
in-kind assistance is specifically excluded by statute. Generally, 
in-kind assistance provided by or under the auspices of a federally 
assisted program, or by a State or local government (for example, 
nutrition, food stamps, housing, or social services), will not be 
counted as income. As described later, if an SSI applicant or recipient 
is living in the household of another and receiving in-kind support and 
maintenance from him, the SSI benefit standard for such an individual is 
reduced by one-third. By regulation, SSA also has ruled that the value 
of any in-kind support and maintenance received (other than in-kind 
assistance received by reason of living in another's household) is 
presumed to equal one-third of the Federal SSI benefit standard plus 
$20. The individual can rebut this presumption. If it is determined that 
the actual value is less than the one-third amount, the lower actual 
value will be counted as unearned income.

In-kind support and maintenance provided by a private nonprofit 
organization to aged, blind, or disabled individuals is excluded under 
the SSI Program if the State determines that the assistance is provided 
on the basis of need. Certain types of assistance provided to help meet 
home energy needs also are excluded from income.  For example, certain
assistance provided to an aged, blind, or disabled individual for the 
purpose of meeting home energy costs by a home heating oil or gas 
supplier, a utility company, or a private nonprofit organization also is 
excluded. As countable income increases, a recipient's SSI benefit amount 
decreases. Generally, ineligibility for SSI occurs when countable 
income equals the Federal benefit standard plus the amount of State 
supplementation, if any.

Resources
Since 1974 SSI eligibility has been restricted to qualified persons who 
have resources of not more than $2,000, or $3,000 in the case of a 
couple. The resource limit for a couple applies even if only one member 
of a couple is eligible. If the couple separates, the person is treated 
as an individual in the following month. If an unmarried child living at 
home is under age 18, the parent's assets are considered to be the 
child's (i.e., deemed to the child). In determining countable resources, 
a number of items are not included, such as the individual's home, and, 
within reasonable limits set by SSA, household goods, personal effects, 
an automobile, and a burial space for the individual, spouse, and members 
of the immediate family. Regulations place a limit of $2,000 in equity 
value on excluded household goods and personal effects and exclude the 
first $4,500 in current market value of an auto (100 percent of the 
auto's value is excluded if it is used to obtain medical treatment or for 
employment or has been modified for use by or transportation of a 
handicapped person or is necessary to perform essential daily activities 
because of distance, climate, or terrain). The value of property which 
is used in a person's trade, or business, or by the person as an 
employee also is excluded. The value of certain other property that 
produces income, goods, or services essential to a person's self-support 
may be excluded within limits set by SSA in regulations. SSI and Social 
Security retroactive benefit payments may not be considered as a 
resource for a period of 6 months after the month in which the 
retroactive benefit is received. Resources set aside under a PASS also 
are excluded.

The cash surrender value of life insurance policies if the total face 
value of all policies is $1,500 or less is not counted toward the $2,000 
or $3,000 countable resources limit. The entire cash surrender value of 
life insurance policies, if the total face value of all policies on an 
individual's life is greater than $1,500, counts toward the resources 
limit, but may be excludable under one of the other resource provisions.	
An individual and spouse may have excluded up to $1,500 each of burial 
funds. However, the $1,500 maximum amount is reduced by the face value 
of any excluded life insurance policies and the value of any irrevocable 
burial contracts, trusts, or arrangements. If left to accumulate, 
interest earned on excluded burial funds and burial spaces is not 
countable as either income or resources for SSI purposes.
Individuals who give away or sell any nonexcludable resource for less 
than fair market value may be subject to penalty. Also, such a transfer 
may make the individual ineligible for certain Medicaid covered nursing 
services. SSA must notify individuals of the penalty and provide 
information upon request to the States regarding transfers of resources.
The Deficit Reduction Act of 1984 (Public Law 98-369) requires the 
Internal Revenue Service (IRS) to furnish SSA with certain nonwage 
information about SSI recipients. The IRS information consists primarily 
of reports of interest payments submitted to IRS by financial 
institutions but also includes income from dividends, unemployment 
compensation, and other sources. In fiscal year 1987, computer 
matches between IRS tax files and SSI records resulted in 239,000 
matches. Only cases involving IRS reports of interest income of $51 or 
more were examined. The resulting savings to the SSI Program were $64 
million. As a result of SSA's evaluation of these cases, the tolerance 
level was lowered to $41 beginning with fiscal year 1988 and 398,000 
matches were identified. In fiscal year 1989, there were 508,000 matches. 
SSA has evaluated and adjusted the tolerance levels several times over 
the years. Effective October 1993, the tolerance level for income from 
resources ''e.g., interest and dividends'' is $60. The tolerance level 
for other nonwage income not from resources ''e.g., unemployment 
compensation and pensions'' is $1,000. Also, a special tolerance was 
developed for cases that had been matched before; if the current year's 
resources are less than $10 more than the prior year's resource 
indicators, the IRS report is not examined. All match information is 
sent to Social Security offices for verification of the information. 
For fiscal year 2002 there were 92,000 matches.

Based on a study of the 1993 matches, SSA decided to apply a statistical 
profiling technique to the IRS matches. Statistical profiling increases 
the cost effectiveness of the IRS process by targeting the more 
error-prone matches and eliminating the less productive matches. The 
resulting savings to the SSI Program were $45 million.
Prior to the 1984 Deficit Reduction Act, if in any month a recipient's 
assets exceeded the asset limit, the individual was ineligible for 
benefits in that month and the entire amount of the benefit paid for 
that month was considered an overpayment subject to recovery. 
Effective October 1, 1984, SSI law provides that in cases where 
there is an overpayment based solely on an excess of assets of $50 or 
less, the recipient is deemed to be without fault for purposes of 
waiving the overpayment and the overpayment is not recovered unless the 
Secretary finds that the failure to accurately and timely report the 
excess was knowing and willful on the part of the recipient.
An individual may receive SSI benefits for a limited time even though he 
has certain nonliquid property that, if counted, would make him 
ineligible. These benefits are conditioned upon the disposal of the 
property, and are subject to recovery as overpayments when the property 
is sold. The 1987 Budget Reconciliation Act provides, in addition, for 
the exclusion of real property if it cannot be sold because it is 
jointly owned and sale would cause undue hardship to the joint owner due 
to loss of housing, because there are legal impediments to its sale, or 
because reasonable efforts to sell it have been unsuccessful.

Deeming of Income and Resources
The income of an ineligible spouse who lives with an adult SSI applicant 
or recipient is considered in determining the eligibility and amount of 
payment to the individual. The income of the parents of a child under 
the age of 18 who is blind or disabled also is considered in determining 
the eligibility and payment for the child. However, since 1990, children 
with disabilities who are eligible for Medicaid at home under State home 
care plans, who previously received SSI personal needs allowances (PNAs) 
while in medical institutions, and who otherwise would be ineligible for 
SSI because of their parents' income or resources, have been eligible 
for the $30 monthly PNA that would be payable if they were 
institutionalized, without regard to their parents' income and resources. 
Effective October 1, 1993, an ineligible parent or spouse who is absent 
from a household due solely to a duty assignment as a member of the 
Armed Forces is considered, absent evidence to the contrary, to be 
living in the same household as the SSI applicant or recipient for 
deeming purposes.

By regulation, the Commissioner of Social Security has provided that in 
determining the amount of the income of an ineligible spouse or parent 
to be deemed to the SSI applicant or recipient, the needs of the spouse 
or parent and other children in the household are taken into account. In 
addition, the SSI earned and unearned income exclusions are applied in 
determining the amount of income to be deemed to the SSI applicant or 
recipient. If the combined countable income of an SSI applicant and an 
ineligible spouse does not exceed the SSI benefit standard for an 
eligible couple in that State (including any federally administered State 
supplementary payment), the SSI applicant would be eligible to receive an 
SSI and/or State supplementary benefit.
For example, in 2003 in a State with no supplementation, here is how the 
deeming procedure would work in the case of an ineligible spouse earning 
$600 per month living with an eligible individual with $200 of Social 
Security benefits:

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Thus, the benefit for the eligible individual will be $381.50 (SSI law 
requires that benefits be rounded down to the next lower dollar). 
Without deeming and as an individual, the recipient would have received 
$372 [$552 - ($200 less $20 exclusion)]. The $20 exclusion can be used 
only once and is applied first to unearned income, which in this example 
is the $200 of Social Security income. An individual's resources are 
deemed to include those of the ineligible spouse (or in the case of a 
child under the age of 18, those of the parents) with whom the 
individual is living. Under SSI regulations, in determining the amount 
of the spouse's or parents' resources that can be deemed, all applicable 
exclusions are applied. In the case of a child, only the value of the 
parents' resources that exceeds the applicable limits ($2,000 for a 
single parent, and $3,000 for two parents) is deemed to the child. 
Also, under regulations, pension funds of an ineligible spouse or 
parent are excluded from deeming. In December 2002, there were about 
167,970 children's cases in which deeming reduced benefits. This figure 
does not take into account, however, the number of children who were not 
eligible because of the deeming provision. (For a discussion of deeming 
rules for noncitizens, see Appendix J.)

PRESUMPTIVE ELIGIBILITY FOR PERSONS WITH AIDS AND HIV

	Section 1631(a)(4)(B) of the Social Security Act provides 
that the Commissioner of Social Security may pay up to 6 months of SSI 
benefits to a person applying for benefits based on disability or 
blindness prior to the determination of the individual's impairment if 
the individual is presumptively disabled or blind, and otherwise 
eligible. A finding of presumptive disability or blindness may be made 
at the Social Security field offices only for specified impairment 
categories because the field office employees generally are not trained 
disability adjudicators; however, at the State agencies where there are 
disability adjudicators a finding of presumptive eligibility may be made 
for any impairment category.
On February 11, 1985, acquired immune deficiency syndrome (AIDS), as 
defined by the Centers for Disease Control, was added (pursuant to 
interim Federal regulations) to the impairment categories, thus allowing 
field offices to find presumptive disability for persons claiming they 
had AIDS. These regulations were scheduled to expire February 11, 1988, 
but were extended until  December 31, 1989; and in 1989 they were 
extended until December 31, 1991. In December 1991, a new more liberal 
regulation was implemented. Under the new procedures, the Social 
Security field offices may make a finding of presumptive disability for 
any individual with the human immunodeficiency virus (HIV) whose disease 
manifestations are of listing-level severity, rather than only for those 
who have been diagnosed with AIDS.
SSA standards governing presumptive SSI eligibility for persons with 
HIV disease have been challenged in court in at least one State on the 
grounds that they discriminate against women. The contention is that the 
listing of impairments reflects the course of HIV disease in men, while 
women tend to have different symptoms and therefore are excluded. Others 
have argued that the Centers for Disease Control definition and the 
somewhat broader SSA listing have failed to keep pace with changing 
manifestations of HIV disease.

PUBLIC INSTITUTION REQUIREMENTS

	Public institutions are prisons, hospitals, nursing homes, or 
any institution that is operated or administered by a governmental unit. 
The governmental unit could be the Federal, State, city, or county 
government, or another political subdivision of the State. Residents of 
public institutions for a full calendar month are ineligible for SSI 
unless one of the following exceptions applies:
1.	The public institution is a medical treatment facility and 
Medicaid pays more than 50 percent of the cost of care.
2.	The individual is residing in a publicly operated community 
residence which serves no more than 16 residents. Such a facility must 
provide an alternative living arrangement to a large institution and be 
residential  (i.e., not a correctional, educational, or medical 
facility).
3.	The public institution is a public emergency shelter for the 
homeless. Such a facility provides food, a place to sleep, and some 
services to homeless individuals on a temporary basis. Payments to a 
resident of a public emergency shelter for the homeless are limited to 
no more than 6 months in any 9-month period.
4.	The individual is in a public institution primarily to receive 
educational or vocational training. To qualify, the training must be an 
approved program and must be designed to prepare an individual for 
gainful employment.
5.	The individual was eligible for SSI under one of the special 
provisions of section 1619 of the Social Security Act (see section on 
"Special SSI Provisions for the Working Disabled") in the month 
preceding the first full month of residency in a medical or psychiatric 
institution which agrees to permit the individual to retain benefit 
payments. Payment may be made for the first full month of 
institutionalization and the subsequent month.
6.	A physician certifies that the recipient's stay in a medical 
facility is likely not to exceed 3 months and the recipient needs to 
continue to maintain and provide for the expenses of the home to 
which she may return. Payments may be made for up to the first 3 full 
months of institutionalization.
	
		To help institutionalized individuals return to 
community living, the SSI Program includes a prerelease procedure for 
institutionalized individuals. Some individuals are medically ready to 
be released from an institution but are financially unable to support 
themselves. The prerelease procedure allows such individuals to 
apply for SSI payments and food stamps several months in advance of 
their anticipated release so benefits can commence quickly after 
release. A formal prerelease agreement can be developed between an 
institution and the local Social Security office. However, an 
individual can file an application for SSI under prerelease without 
the existence of such an agreement. Under Federal law, residents of 
public institutions for a full calendar month generally are 
ineligible for SSI benefits. Prisons are considered public 
institutions. The bar against SSI benefits to prisoners has been 
enforced through an exchange of computerized data between SSA and 
the Federal Bureau of Prisons, State prisons, and some 
county prisons. According to the SSA's Office of the Inspector General, 
these computerized arrangements generally covered about three-quarters 
of inmatesCall Federal and State prisoners but only about 15 percent of 
county prisoners. The agreements were voluntary and until recently 
involved no payments to the institutions. However, the 1996 welfare 
reform law (Public Law 104-193), required the Commissioner of Social 
Security to enter into a contract with any interested State or local 
institution (such as a prison, jail, or mental hospital) under which 
the institution regularly would provide to the Commissioner the names, 
Social Security numbers, dates of birth, and such other identifying 
information concerning the inmates or residents of the institution to 
help the Commissioner enforce the "prohibition of payments to residents 
of public institutions" rule. To encourage such reporting so benefits 
can be ended as Federal law intends, the Commissioner must pay the 
institution up to $400 for each resident found to be wrongly receiving 
SSI payments if the information is provided to the Commissioner within 
30 days after such individual becomes a resident, or up to $200 for 
each SSI - receiving inmate if the information is provided after 30 days 
but within 90 days of the person's becoming a resident. Between March 1, 
1997 and March 6, 2003, SSA paid $87.4 million for 240,105 incentive 
payments.

In 1999, Congress acted to further tighten restrictions on the payment 
of Federal benefits to prisoners. Public Law 106-170, signed into law on  
December 14, 1999, expands the SSI Program's benefit suspension rules 
and incentive payments regarding State and local prisoners to include 
individuals receiving Old-Age, Survivors, and Disability Insurance 
(OASDI) benefits. (Payments to prisons will be reduced by 50 percent 
for multiple reports on individuals who receive both SSI and OASDI 
benefits.) Public Law 106-170 also requires State prisons to provide 
inmate information to Federal and federally assisted benefit programs, 
including SSA. To help reduce fraudulent benefit payments of food 
stamps, veterans benefits, unemployment benefits, and educational aid, 
Public Law 106-170 directs SSA to share its prisoner database with 
other Federal agencies and departments.

APPLICATION TO OTHER PROGRAMS REQUIREMENT

Since SSI payments are reduced by other income, applicants and 
recipients must apply for any other cash benefits due them. SSA works 
with recipients and helps them get any other benefits for which they 
are eligible.

ELIGIBILITY FOR SOCIAL SECURITY

Since its inception SSI has been viewed as the "program of last resort."  
That is, after evaluating all other income, SSI pays what is necessary 
to bring an individual to the statutorily prescribed income "floor." 
As of December 2002, 35.5 percent of all SSI recipients also received 
Social Security benefits (57.8 percent of the aged, 34.3 percent of the 
disabled, and 30.3 percent of the blind). Social Security benefits are 
the single highest source of income for SSI recipients. The  SSI Program 
considers Social Security benefits unearned income and thus counts all 
but $20 monthly in determining the SSI benefit amount.

ELIGIBILITY FOR MEDICAID

States have three options as to how they treat SSI recipients in 
relation to Medicaid eligibility. Section 1634 of SSI law allows SSA 
to enter into agreements with States to cover all SSI recipients with 
Medicaid eligibility. SSI recipients are not required to make a 
separate application for Medicaid under this arrangement. As of 
January 1, 2003, 32 States and the District of Columbia chose this 
option, and SSI recipients in these States account for approximately 
79 percent of all SSI recipients nationwide.

Under the second option, States elect to provide Medicaid eligibility 
for all SSI recipients, but only if the recipient completes a separate 
application with the State agency which administers the Medicaid 
Program. Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah and 
the Commonwealth of the Northern Mariana Islands, affecting about 
5 percent of SSI recipients nationwide, have elected this option.
The third and most restrictive option is known as the "209(b)" option, 
under which States may impose Medicaid eligibility criteria which are 
more restrictive than SSI criteria, so long as the criteria chosen are 
not more restrictive than the State's approved Medicaid State plan in 
January 1972. The 209(b) States may be more restrictive in defining 
blindness or disability, and/or more restrictive in their financial 
requirements for eligibility, and require a Medicaid application with 
the State. However, aged, blind, and disabled SSI recipients who are 
Medicaid applicants must be allowed to spend down in 209(b) States, if 
the State uses more restrictive income criteria, regardless of whether 
the State has a medically needy program. Currently 11 States use the 
209(b) option for Medicaid coverage of aged, blind, and disabled SSI 
recipients. About 16 percent of the SSI recipient population nationwide 
lives in these 209(b) States. The 11 States that use this option are 
Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New 
Hampshire, North Dakota, Ohio, Oklahoma, and Virginia. An amendment 
included in the 1986 SSI Disability Amendments (Public Law 99-643) 
required, effective July 1, 1987, that 209(b) States continue Medicaid 
coverage for individuals in section 1619 status if they had been 
eligible for Medicaid for the month preceding their becoming eligible 
under section 1619 (see section below on "Special SSI Provisions for 
the Working Disabled"). The same legislation required States to provide 
continued Medicaid coverage for those individuals who lose eligibility 
for SSI on or after July 1, 1987 when their income increases because 
they become newly eligible for Social Security benefits as an adult who 
was disabled as a child (disabled adult child) or because of an 
increase in their benefits as an adult who was disabled as a child. 
"Disabled adult children" who otherwise would be eligible for SSI 
continue to be considered SSI recipients for Medicaid purposes. 
Protection against loss of Medicaid also is provided for certain blind 
or disabled individuals who lose their SSI benefits when they qualify 
for Social Security disabled widow or widower's benefits beginning as 
early as age 50. The Omnibus Budget Reconciliation Act of 1990 provides 
that such individuals, who otherwise would continue to qualify for SSI 
on the basis of blindness or disability, will be deemed to be SSI 
recipients for purposes of Medicaid eligibility until they become 
eligible for Medicare.

ELIGIBILITY FOR FOOD STAMPS

Except in California, which has converted food stamp benefits to cash 
that is included in the State supplementary payments, SSI recipients 
may be eligible to receive food stamps. SSI beneficiaries living alone 
or in a household where all other members of the household receive or 
are applying for SSI benefits can file for food stamps at an SSA office. 
If all household members receive SSI, they do not need to meet the Food 
Stamp Program financial eligibility standards to participate in the 
program because they are categorically eligible. However, SSI 
beneficiaries living in households where other household members do not 
receive or are not applying for SSI benefits are referred to the local 
food stamp office to file for food stamps. These households must meet 
the net income eligibility standard of the Food Stamp Program to be 
eligible for food stamp benefits.The interaction with the Food Stamp 
Program has important financial implications for a State which desires 
to increase the income of its SSI recipients by $1. Because food stamps 
are reduced by $0.30 for each additional $1 of SSI income including 
State supplements, the State must expend $1.43 to obtain an effective 
$1 increase in SSI recipients' total income.

SELF-SUFFICIENCY AND SSI

Section 1615(d) of the Social Security Act requires SSA to reimburse 
State vocational rehabilitation agencies for reasonable and necessary 
costs of services which resulted in disabled SSI recipients' being 
successfully rehabilitated. The objective of vocational rehabilitation 
for SSI recipients is to help disabled individuals achieve and sustain 
productive, self-supporting work activity. SSA provides funds to 
reimburse vocational rehabilitation agencies for costs incurred in 
successfully rehabilitating SSI recipients. A successful rehabilitation 
is defined by law as one in which vocational rehabilitation services 
result in performance of substantial gainful activity for a continuous 
period of 9 months. In 1999, Congress expanded the Vocational 
Rehabilitation Program. Public Law 106-170, signed into law on December 
17, 1999, creates a Ticket to Work and Self-Sufficiency Program. The 
purpose of the program is to help recipients leave the SSI rolls through 
greater accessibility to a broader pool of vocational 
rehabilitation providers than was previously available to them.

Under the new law, the Commissioner of Social Security will provide 
tickets to work to disabled SSI beneficiaries that they can use as 
vouchers to obtain employment services, case management, vocational 
rehabilitation, and support services from providers of their choice, 
including State vocational rehabilitation agencies. The program is 
implemented on a graduated basis, beginning within  1 year of enactment 
at sites selected by the Commissioner and within 4 years of 
enactment in every State. The program is permanently authorized.
The elements of the ticket system include program managers, employment 
networks, individual work plans, program evaluations, and a Ticket to 
Work and Work Incentives Advisory Panel composed of 12 members. The 
Commissioner is required to contract with program managers (one or more 
public or private organizations with expertise and experience in the 
field of vocational rehabilitation or employment services) through a 
competitive bidding process to help SSA administer the program. Program 
managers are to recruit and recommend employment networks to the 
Commissioner, ensure that adequate choices of services are available to 
beneficiaries, ensure beneficiary access to services, and provide 
assurances to SSA that employment networks are complying with 
agreement terms.

The ticket to work law requires employment networks to consist of a 
single public or private provider or an association of providers 
combined into a single entity which assumes responsibility for the 
coordination and delivery of services. Employment networks are required 
to have experience providing relevant employment services and support 
for individuals with disabilities and will have to provide an array of 
such services under the program. Employment networks and beneficiaries 
must develop an individual employment plan so that the beneficiary 
can exercise informed choice in selecting an employment goal and 
specific services needed to achieve that goal. Employment networks 
prepare and provide periodic performance reports to beneficiaries
holding a ticket and provide periodic quality assurance reviews of 
employment networks. The Commissioner is required to establish a method 
for resolving disputes between beneficiaries and employment networks. 
The ticket to work law also requires that State vocational 
rehabilitation agencies and employment networks enter into agreements 
regarding the conditions under which services will be provided when an 
individual is referred by an employment network to State vocational 
rehabilitation agencies. The Commissioner must establish a timeframe 
for these agreements and a dispute resolution method. Payment to 
employment networks is based on outcomes and long-term results by 
providing one of two payment systems: an outcome payment system or an 
outcome-milestone payment system. Under the outcome payment system, 
employment networks are provided with up to 40 percent of the average 
monthly disability benefit for each month benefits are not payable to 
the beneficiary due to work (but not for more than 60 months). Under 
the outcome-milestone payment system, the employment networks receive 
early payments based on the achievement of one or more milestones toward 
permanent employment. The total amount payable under the outcome-
milestone payment system must be less than the total amount that 
otherwise would have been payable for an individual under the outcome 
payment system. Regardless of which payment system is used,  SSI 
beneficiaries forgo SSI payments to participate in the ticket to work 
system, and instead receive earnings from work. Providers use the 
ticket, or voucher, to claim payment from SSA for services they provide 
to beneficiaries. Providers are paid for each month in which an SSI 
beneficiary is not receiving benefits because the individual is working 
or has earnings. The Commissioner is required to design and conduct a 
series of evaluations of the payment system to assess the cost 
effectiveness and effects of the program, in consultation with the 
Advisory Panel, and report the findings to Congress.

SSI BENEFITS

FEDERAL SSI BENEFIT STANDARD

The Federal SSI benefit standard for 2003 is $552 a month for an 
individual and $829 for a couple. As is discussed later, most States 
supplement the Federal SSI benefit. The result is a combined Federal 
SSI/State supplemental benefit standard against which countable income 
is 
compared in determining eligibility and benefit amount. However, many 
States limit their supplementation to certain categories of individuals 
based on specific indicators of needCespecially special housing needs.
	Like Social Security benefits, Federal SSI benefits are 
indexed to the Consumer Price Index (CPI). Indexing occurs through a 
reference in the SSI law to the Social Security cost-of-living 
adjustment (COLA) provision. Prior to the Social Security Amendments of 
1983 (Public Law 98-21), the SSI and Social Security cost-of-living 
increases occurred in benefits paid in July. Public law 98-21 delayed 
the Social Security and SSI COLAs from July 1983 to January 1984. 
However, in lieu of a COLA increase in the SSI benefit standard, the 
Federal SSI benefit was increased in July 1983 by $20 a month for an 
individual and $30 a month for a couple. Table 3-3 shows the Federal 
SSI benefit from the beginning of the  SSI Program until the present
time. In calendar year 2002, about 818,050 applicants were awarded SSI 
benefits. Under previous law, new recipients received a prorated SSI 
benefit for the month in which they applied. For example, a person who 
applied on the 15th of the month could receive 2 weeks of benefits for 
that month. (The typical applicant did not get that money immediately 
because SSA might take several months to process the application.) The 
1996 welfare reform law changes the effective date of an  SSI 
application to the later of the first day of the month following the 
date the application is filed or the date the individual first becomes 
eligible for SSI benefits.

BENEFITS FOR PERSONS LIVING IN THE HOUSEHOLD OF ANOTHER

SSI law provides that if an applicant or recipient is "living in another 
person's household and receiving support and maintenance in kind from 
such person," the Federal SSI benefit applicable to such individual or 
couple is two-thirds of the regular Federal SSI benefit. As shown in 
Table 3-3, the Federal SSI benefit in 2003 for those determined to be 
living in the household of another is $368 for an individual and $552.67 
for a couple.
	
	Regulations specify the criteria for determining when this 
reduced benefit applies. It does not apply to an individual who owns or 
rents, buys food separately, eats meals out rather than eating with the 
household, or pays a pro rata share of the household's food and shelter 
expenses.
	In December 2002 4.2 percent, or about 285,000 SSI recipients, 
had their benefits determined on the basis of this "one-third reduction" 
benefit standard. Sixty-five percent of those recipients were receiving 
benefits on the basis of disability (See Table 3-4).

BENEFITS FOR PERSONS LIVING IN A MEDICAID INSTITUTION

When individuals enter a hospital or other medical institution in which 
more than half of the bill is paid by the Medicaid Program, their 
monthly SSI benefit standard is reduced to $30, beginning with the first 
full calendar month of residence. This benefit, called a personal needs 
allowance (PNA), is intended to take care of small personal expenses, 
with the cost of maintenance and medical care being provided through 
Medicaid. The 1996 welfare reform law requires that children (under 
age 18) residing in medical institutions who have private medical 
insurance be eligible only for the $30 SSI PNA, just like those with 
Medicaid coverage. The Federal PNA benefit of $25 was increased to $30 
a month on  July 1, 1988Cthe first increase since the SSI Program began 
in 1974. The annual cost-of-living increase for SSI does not apply to 
the PNA. However, the  1987 Budget Reconciliation Act provides that if 
a physician certifies that the recipient's stay in such a medical 
institution is not likely to exceed 3 months and they need to continue 
to maintain a home to which they may return, SSI benefits 
will not be reduced and recipients will continue to receive full SSI 
benefits for up to the first 3 months of institutionalization.
	Approximately 143,636 or 2.2 percent of SSI recipients received 
benefits  as of December 2000 on the basis of this personal needs 
allowance. The average benefit was $21.80. For those individuals whose 
income from non-SSI sources exceeds the $30 benefit standard (including 
those who were receiving both Social Security and SSI before entering 
an institution), Medicaid regulations require States to allow SSI 
recipients (and other non-SSI Medicaid eligibles) to retain no less than 
$30 a month of their income as a "personal needs allowance" when their 
income is applied, along with Medicaid reimbursement, to pay for their 
institutional medical care. These regulations are applicable to 
individuals whose income from non-SSI sources exceeds the $30 benefit 
standard (including those who were receiving both Social Security and 
SSI before entering an institution).

Nineteen State programs have exercised their option to supplement 
the PNA. Prior to the 1985 Budget Reconciliation Act, SSI regulations 
would not allow for Federal administration of State PNA supplements. 
An amendment included in that legislation now requires SSA, at the 
request of a State, to administer such State supplementary payments. 
As of December 2002, California, the District of Columbia, 
Massachusetts, Michigan, New Jersey, New York, Rhode Island, and 
Vermont had opted for Federal administration. Approximately 30 States 
allow some or all of those individuals affected by the Medicaid PNA 
regulations to retain more than $30 a month.

		BENEFITS OF FORMER RECIPIENTS OF STATE ASSISTANCE

The essential person payment is a Federal benefit for an individual who 
was transferred to SSI from a former State Program of Aid to the Aged, 
Blind, or Disabled. As shown in Table 3-3, the Federal benefits of 
these persons are increased by up to $277 monthly in 2003 to take into 
account an "essential person" living in the household.
Essential persons are those (generally an ineligible spouse or relative) 
who live with the eligible individual and who are considered necessary 
to provide essential care and services for the eligible individual and 
whose needs were taken into account in December 1973 in determining the 
need of the individual. Essential persons do not themselves receive SSI 
payments; rather, the standard of payment to which an eligible 
individual or couple is entitled is increased, and any income and 
resources of the essential persons are combined with those of the 
eligible individual 
or couple in calculating the amount for which the individual or couple 
is eligible.Eligibility for such increased payments apply only to a 
person included as  an essential person in December 1973 and ends when 
the person no longer lives with the eligible individual, becomes 
eligible for SSI in his own right, or becomes the eligible spouse of 
an eligible individual.
Some States have categories of State supplementation similar to the 
"essential persons" category for individuals transferred from the 
pre-SSI Program.

OVERPAYMENTS

A provision in the 1984 Deficit Reduction Act established limits on 
recovery by the Social Security Administration (SSA) of overpayments 
made to SSI recipients. The amount of recovery in any month is now 
limited to the lesser of:  (1) the amount of the benefit for that month; 
or (2) an amount equal to 10 percent of the countable income (plus the 
SSI payment) of the individual (or couple) for that month. This 
limitation does not apply if there is fraud, willful misrepresentation, 
or concealment of information in connection with the overpayment. The 
recipient may request a higher or lower rate at which benefits 
may be withheld to recover the overpayment.

FASTER INITIAL SSI (AND SOCIAL SECURITY) PAYMENTS

Making initial payments faster for those who are presumptively or proven 
eligible is a goal of the SSI Program. The provisions for a one-time 
emergency advance payment continues to permit a faster response to 
presumptive or proven eligibility in new claims with critical needs. 
Pursuant to the 1996 welfare reform legislation, these emergency advance 
payments must be repaid through proportionate reductions in SSI benefits
over a period of not more than 6 months. In fiscal year 2002, Social 
Security offices made 7,459 emergency advance payments using their 
third-party drafts in these new claims situations totaling $4,234,503 
with an average payment amount of $569.
Beginning in October 1985, local Social Security offices were given the 
authority to make "immediate payments" for Social Security and SSI cases 
at management's discretion when the local offices found that benefits 
were due but unpaid and an expedited Treasury payment would be too slow. 
"Immediate" usually means while the beneficiary waits or the next day 
at the latest. Payments are made using third-party drafts issued by the 
local field office. Payments are limited to the maximum per beneficiary
of $999 or the amount due, whichever is less, once in a 30-day period. 
The payment must be approved by office management. During fiscal
year 2002, 85,726 Social Security and 82,598 SSI immediate payments 
were issued under this procedure. The total amount of these payments 
equaled $93,326,975 for an average of $554 per payment.

STATE SUPPLEMENTATION

Mandatory State Supplementation
	State supplementary payments are required by law to maintain 
income levels of former State adult assistance recipients transferred to 
the Federal SSI Program.  The purpose of these mandatory State 
supplements is to assure that no person suffers a reduction in income 
as result of the transfer to the SSI Program. 

TABLE 3-3--MONTHLY FEDERAL SSI BENEFIT RATES, 1974-2003  

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-4--PERCENTAGE AND NUMBER OF PERSONS RECEIVING FEDERALLY 
ADMINISTERED PAYMENTS, BY LIVING ARRANGEMENT AND CATEGORY, 
DECEMBER 2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Under mandatory supplementation rules, States are to 
maintain recipients of the Programs of Old-Age Assistance, Aid to the 
Blind, and Aid to the Permanently and Totally Disabled at their December 
1973 income level.  That level is the amount an individual received in 
December 1973 under the terms and conditions of the State plan in effect 
for the month of June 1973, plus her other income.  Thus, State must 
provide a supplementary payment to any individual who, because of 
special needs or other reasons, had a December 1973 payment higher that 
the amount she received under the basic Federal SSI Program.  
	To remain eligible for Medicaid Federal matching funds, States 
were required to adopt a mandatory State supplementation program. In 
February 2003, approximately 1,200 recipients or less than 0.02 percent 
of all recipients were receiving federally administered payments based 
in part or solely on the mandatory supplementation rule.  

Optional State Supplementation
In addition to any mandatory supplementation States must provide, a 
State (or political subdivision) may choose to provide an optional 
supplement to Federal SSI payments. This optional supplement also is 
intended to help individuals meet needs which are not fully met by the 
Federal payment. The State determines whether it will make such a 
payment, to whom, and in what amount. States have  the option of 
covering recipients of mandatory supplementation under their program 
of optional supplementation.
At the present time, all but seven States and jurisdictions provide 
some form of optional State supplementation. States that provide no 
supplement are: Arkansas, Georgia, Kansas, Mississippi, Commonwealth 
of the Northern Mariana Islands, Tennessee, and West Virginia. States 
(or local jurisdictions) may elect to administer their supplementary 
payments themselves or may contract with SSA for Federal administration. 
Fourteen States and the District of Columbia have contracted with 
SSA to administer the State optional supplementation program. Since the 
SSI Program began in 1974, eight States have shifted from Federal to 
State administration of their optional State supplementation program.

Section 1618 of the Social Security Act requires States that have chosen 
to supplement the Federal SSI benefit to continue to provide 
supplementation and to maintain the supplementary payments (or spending 
for supplements) at specified levels. The purpose of section 1618 is to 
require States to pass along to SSI recipients the amount of any Federal 
benefit increase. Some States had not done this before the enactment of 
section 1618 on October 21, 1976 (Public Law 94-585). Instead, when 
Congress enacted cost-of-living increases in the Federal SSI benefit 
amount, some States would reduce the levels of the State supplementary 
payments by the amount of the Federal benefit increase. Congress 
responded by enacting the section 1618 pass-along/maintenance-of-effort 
provision for State supplementary payments.
Section 1618 allows States to comply with the pass along requirement by 
either (1) maintaining their State supplementary payment levels for 
specified types of living arrangements at or above March 1983 levels 
(sometimes referred to as the payment level method) or (2) maintaining 
their supplementary payment spending  so that total annual Federal and 
State expenditures will be at least equal to what they were in the prior 
12-month period plus any Federal cost-of-living increase, provided the 
State was in compliance for that period (sometimes referred to as the 
total expenditures method). In effect, section 1618 requires that once 
a State elects to provide supplementary payments, it must continue to 
do so. Under section 1618, a State that is found to be out of 
compliance under the maintenance-of-effort rules is subject to loss of 
its Federal Medicaid reimbursement. In California's case, a further 
"penalty" would be levied for failure to meet the pass along/
maintenance-of-effort mandate. It would lose permission to "cash out" 
food stamp benefits for SSI recipients, and regular food stamp 
allotments would have to be offered to them.

Variation in Payment Amount
In addition to categorical variations which may apply (i.e., aged, 
blind, disabled), a State may elect a number of variations in optional 
supplementary payments to account for specific differences in living 
costs to a recipient. The type and amount of the variations selected 
must be specified in the Federal-State agreement. A State may make 
variations in its payments to account for both geographic and living 
arrangement cost differences.

A significant number of the aged, disabled, and blind receiving SSI 
cannot live alone because of mental or physical limitations and have a 
need for housing which includes services beyond room and board. These 
services often include supervision for daily living and protective 
services for the mentally retarded, chronically mentally ill, or the 
frail or confused elderly. Such nonmedical supervised and/or group 
living arrangements generally cost more than the Federal SSI benefit 
needs standard of $552 a month in 2003, and often more than the 
combined Federal and SSI State supplementation for those classified as 
living independently. Thus, all but 10 of the 50 States and the District 
of Columbia have Federal- or State-administered State supplementation 
which is specifically directed at covering the additional cost of 
providing housing in a protective, supervised, or group living 
arrangement.
These living arrangements are identified by a variety of terms 
including: adult foster care homes; domiciliary care homes; congregate 
care; group homes for the mentally retarded, and other terms. The 
amount of supplementation by the  State also varies a great deal. For 
example, in 2001 in the State of Maryland under a State-administered 
supplementation program, a "specialized and intensive supervision" group 
living facility had a State supplementation of $666 a month in addition 
to the Federal benefit of $552. Thus, the maximum total Federal and 
State SSI payment in a month in Maryland is $1,218. In Oregon, for 
example, the State supplementation is less than $2 a month for those who 
need little supervision and care. However, in some States the cost of 
supervised group living care also is partially met by direct State 
funding of the staff. Some States make payments for nonmedical group care 
directly to private residential facilities based on a rate negotiated by 
the State with each facility. In such cases, there is often a PNA 
payment made directly to or on behalf of the residents of the facility.

Administrative Fees
The Omnibus Budget Reconciliation Act of 1993 amended the State 
supplementation provision to provide for State payment for Federal 
administration of State supplementary payments. For fiscal year 1994, 
the administration fee was $1.67 per payment. The rate per payment 
rose to $3.33 for fiscal year 1995, and $5.00 for fiscal year 1996 
and each succeeding year, or a different rate deemed appropriate for 
the State by the Commissioner.

The Balanced Budget Act of 1997 (Public Law 105-33) increased the fee 
charged by the SSA to administer a State's supplementary SSI payments. 
For fiscal year 1998, the fee was $6.20. The rate per payment rose to 
$7.60 for 1999,  $7.80 for 2000, $8.10 for 2001, and $8.50 for 2002.  
The fee for 2003 is $8.59 per payment. Each succeeding year, fees are 
indexed to increases in the Consumer Price Index or set at a different 
rate as determined by the Commissioner of Social Security. Amounts of 
fees collected in excess of $5 per check are credited to a special 
Treasury fund available for Social Security Administration 
administrative purposes. Such amounts are credited as a discretionary 
offset to discretionary spending to the extent that they are made 
available for expenditures in appropriation acts.
Public Law 106-170 authorizes SSA to penalize States that are late in   
paying their administrative fees. Specifically, SSA may charge a State 
for whom it administers supplementary payments a penalty equal to 5 
percent of the supplementary payment and administrative fees due if that 
State has not paid SSA the administrative fees it owes. States must pay 
SSA on the business day preceding the date that SSA pays monthly 
benefits, or for the last month in a State's fiscal year, the fifth 
business day following the date that SSA pays monthly benefits.

State SSI Supplement Levels Over Time
Throughout the period from July 1975 to January 2003, 22 States have 
continuously provided supplemental SSI payments to aged individuals 
living independently.
During the period from July 1975 to January 2000, no State increased 
supplements faster than inflation for aged individuals living 
independently or aged couples living independently (see Tables 3-5 
and 3-6).
As of December 2002, there were 2,462,652 beneficiaries (36.3 percent) 
receiving a State supplement. For those SSI recipients, other than those
receiving a State supplement because they are living in some type of 
group living arrangement, the amount of State supplement ranges from 
$1.70 a month to $362 a month for an individual. At present, 26 States 
and the District of Columbia supplement the Federal standard for 
individuals living independently.

MAXIMUM SSI AND FOOD STAMP BENEFITS FOR INDIVIDUALS LIVING INDEPENDENTLY

Table 3-7 for individuals and Table 3-8 for couples illustrate by State 
the maximum potential payment from Federal SSI, State supplements, and 
food stamps for persons with no income. Approximately 65 percent of SSI 
households in the Food Stamp Program claim a shelter deduction for 
shelter expenses exceeding roughly one-third of their monthly income. 
About 3 percent of SSI households claim a medical cost deduction for 
out-of-pocket expenses over $35 per month.

COMPARISON OF SSI PAYMENT LEVELS TO POVERTY THRESHOLDS
	
Table 3-9 compares the Federal SSI benefit for a single individual to 
the Bureau of the Census poverty threshold. Both the poverty threshold 
and the benefit level are indexed to the Consumer Price Index. (The 
percentage increase for the poverty threshold and the SSI benefit 
increase varies slightly because of a difference in the method of 
calculation.) As a result of Public Law 98-21, SSI benefit levels were 
increased by $20 per month for individuals and $30 per month for couples 
in July 1983. They were further increased by 3.5 percent in  January 
1984. This explains why SSI benefits, in relation to the poverty level, 
increased to approximately 76 percent in 1984 compared to 72 percent in 
the  1975 to 1980 period. In 2000, benefit levels were 76 percent of the 
poverty level. Table 3-10 presents the same information for a couple. 
The SSI benefit for a couple is 90 percent of the poverty threshold in 
2002.

	

TABLE 3-5--STATE SSI SUPPLEMENTS FOR AGED INDIVIDUALS WITHOUT COUNTABLE 
INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-6--STATE SSI SUPPLEMENTS FOR AGED COUPLES WITHOUT COUNTABLE 
INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-7--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED 
INDIVIDUALS LIVING INDEPENDENTLY, JANUARY 2000 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-8--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED 
COUPLES LIVING INDEPENDENTLY, JANUARY 2000 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TRENDS IN THE SSI CASELOAD

NUMBER OF RECIPIENTS

	As shown in Table 3-11, in December 2002, nearly 6.8 million 
persons received federally administered SSI payments. Of these, about 
1.3 million received federally administered payments on the basis of 
being aged, about 5.5 million on the basis of being disabled, and 
78,000 on the basis of blindness. However, 743,800 of those receiving 
benefits on the basis of disability or blindness were over the age of 
65. 
	Table 3-11 also indicates that approximately 4.3 million of 
those receiving federally administered SSI payments received only 
Federal SSI payments, 2.2 million received a combination of Federal 
and State payments, and  283,000 received State supplements only.

TABLE 3-9--COMPARISON OF COMBINED BENEFITS TO POVERTY THRESHOLDS FOR 
ELIGIBLE INDIVIDUALS RECEIVING SSI; SSI AND SOCIAL SECURITY; AND SSI, 
SOCIAL SECURITY, AND FOOD STAMPS, SELECTED YEARS 1975-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-10--COMPARISON OF COMBINED BENEFITS TO POVERTY THRESHOLDS FOR 
ELIGIBLE COUPLES RECEIVING SSI; SSI AND SOCIAL SECURITY; AND SSI, 
SOCIAL SECURITY, AND FOOD STAMPS; SELECTED YEARS 1975-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-11--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS,  
TOTAL AMOUNT, AND AVERAGE MONTHLY AMOUNT, BY SOURCE OF PAYMENT AND 
CATEGORY, DECEMBER 2002
	
	
	

 [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Table 3-12 shows the trends in the numbers of persons receiving 
federally administered SSI payments from December 1975 through December 
2002, both by reason for eligibility and by age categories. There was a 
steady decline in the number of SSI recipients from 1975 until 1983. 
However, in the last 19 years the number of SSI recipients has increased 
from about 3.9 million to about 6.8 million, an increase of 74 percent.
	
CHARACTERISTICS OF ADULT DISABLED AND BLIND RECIPIENTS

	Major Disabling Diagnosis C As shown in Table 3-13, of the SSI
disabled ages 18-64, 23.5 percent were eligible on the basis of mental 
retardation and 36.6 percent on the basis of other mental disorders. 
Therefore, over 60 percent of all SSI disabled recipients are eligible 
on the basis of a mental disability. The next three largest categories 
are: diseases of the musculoskeletal system and connective tissues 
''10.1 percent; diseases of the nervous system and sense organs'' 
8.4 percent; and diseases of the circulatory system'' 5.2 percent.
	In December 2002, 1.4 million or 23.6 percent of the adult 
disabled or blind receiving SSI benefits had a representative payee. 
Representative payees are individuals, agencies, or institutions 
selected by SSA to receive and use SSI payments on behalf of the SSI 
recipient when it has been found necessary by reason of the mental or 
physical limitations of the recipient.
	Age C When a person who is receiving SSI on the basis of 
blindness or disability becomes age 65, SSA does not convert the 
individual to eligibility on the basis of age. As shown in Table 3-14, 
16 percent of the SSI adult population receiving benefits on the basis 
of disability are age 65 or older (25.3 percent of the blind were age 
65 or older).
	Sex C In December 2002, 59.1 percent of those receiving SSI 
benefits on the basis of disability were women.
	Race C In December 1999, the most recent available data showed 
that 64 percent of those receiving SSI benefits on the basis of 
disability were white;  30 percent were black; 6 percent other races. 
(Note: This is the same information that was in the 2000 edition of 
Green Book, and is still the most recent data available.)  The 1999 race 
data came from the Survey of Income and Program Participation, matched 
to SSA program data on receipt of SSI benefits.  They replace the 
previous series of numbers, which were based on SSA program data. The 
principle difference in the two sets of numbers is that Hispanics were 
coded as "other" in the older series, and may be of any race in the 
newer series.
	Other Income C In December 2002, 30.3 percent of the disabled 
and 34.3 percent of the blind on SSI also received Social Security 
benefits. Table 3-15 shows the number of SSI recipients with other 
sources of income, both unearned and earned.

TABLE 3-12--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI 
PAYMENTS BY CATEGORY AND AGE, SELECTED YEARS 1975-2002 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-13--DISABILITY DIAGNOSIS OF SSI AND SECTION 1619 DISABILITY 
RECIPIENTS, DECEMBER 2002 1 [Percentage Distribution by Diagnostic 
Group]

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

CHARACTERISTICS OF RECIPIENTS RECEIVING BENEFITS ON THE BASIS OF AGE

	Age C In December 2002, of SSI recipients receiving benefits on 
the basis of  age (65 or older), 35.7 percent were 80 years of age or 
older (Table 3-14).
	Sex C In December 2002, 70.1 percent of those receiving benefits 
on the basis of age were women.
	Race C In December 1999, 58 percent of those receiving SSI on 
the basis of age were white; 26 percent were black; 16 percent were 
other races. (Note: this is the same information that was in the 2000 
edition of the Green Book and is still the most recent information 
available).  The 1999 race data came from the Survey of Income and 
Program Participation, matched to SSA program data on receipt of SSI 
benefits.  They replace the previous series of numbers, which were 
based on SSA program data.  The principle difference in the two sets 
of numbers is that Hispanics were coded as "other" in the older series, 
and may be of any race in the newer series.
	Other Income C In December 2002, 57.8 percent of SSI 
recipients receiving benefits on the basis of age also received Social 
Security benefits. Only 1.5 percent had earned income.

TABLE 3-14--NUMBER AND PERCENTAGE DISTRIBUTION OF SSI RECIPIENTS 
RECEIVING FEDERALLY ADMINISTERED PAYMENTS BY CATEGORY AND AGE GROUP, 
DECEMBER 2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

CHARACTERISTICS OF CHILDREN RECEIVING BENEFITS

To be eligible for SSI payments as a child, an individual must be under 
age 18 (or under age 22 if a full-time student), be unmarried, and meet 
the SSI criteria for: disability or blindness; citizenship/residency; 
and income and resources.
	At the end of SSI's first year (December 1974), 71,000 disabled 
and blind children received SSI benefits, less than 2 percent of the 
total SSI caseload. By December 1980, payments were made to almost 
229,000 blind and disabled children, 5.5 percent of the SSI caseload. 
By December 1996, 1,018,000 blind and disabled children were eligible 
for SSI payments, nearly a fourteen fold increase over December 1974. 
These children made up 15.4 percent of SSI recipients, and represented a 
fast growing segment of the SSI population.
	Many analysts attribute the growth in the early and mid 1990s 
to outreach activities, the Supreme Court decision in the Zebley case 
(which mandated an individualized functional assessment process for 
children under age 18), expansion of the mental impairment category, 
and reduction in reviews of continuing disability.
The rapid growth in the number of children receiving SSI, as well as 
the debate over the procedures by which children's eligibility should 
be judged, led Congress to enact provisions as part of the 1996 welfare 
reform law that changed the SSI Program with respect to disabled 
children (Public Law 104-193). This law discontinued the individualized 
functional assessment disability determination procedure. Under this 
procedure, persons whose impairments were not equivalent to those in the 
Federal "Listing of Impairments" were reviewed under a less stringent 
process. The 1996 law established a new (separate) disability definition 
for children (under age 18) which requires a child to have "a medically 
determinable physical or mental impairment which results in marked or 
severe functional limitations, and which can be expected to result in 
death o which has lasted or can be expected to last for a continuous 
period of not less than  12 months." Changes in the eligibility rules 
applied to new applications and pending requests for administrative and 
judicial review effective beginning August 22, 1996.
The 1996 law also required SSA to conduct one-time redeterminations of  
the eligibility of children already on the rolls who might not meet the 
new eligibility criteria. SSA also is required, on an ongoing basis, to 
conduct continuing disability reviews (CDRs) of low birth weight babies, 
all other children whose impairments are likely to improve, and 18 year 
olds.
The Congressional Budget Office (CBO) estimated that the 1996 SSI 
reforms affecting children would result in direct (mandatory) Federal 
SSI savings of $7.4 billion over 6 years (fiscal years 1997-2002). 
However, after writing the regulations implementing the 1996 children's 
reforms, SSA estimated that about 135,000 children (13 percent of SSI 
child recipients) would no longer qualify for SSI as a result of the 
new regulations. SSA expected the average number of SSI children to 
fall to 950,000 in fiscal year 1998, when the law became fully 
implemented, before rising again in subsequent years. SSA estimated 
that Federal program savings would amount to $4.8 billion over the 
6-year period - not  $7.4 billion as estimated by CBO.
SSA estimated that 288,000 children receiving SSI needed to be 
redetermined under the new law. As of April 1, 2002, 101,000 (38 
percent) of children who received notices of redetermination were 
found to be ineligible for SSI benefits. Virtually all administrative 
appeals on the redeterminations have been completed.
The number of children receiving SSI payments, and the percentage of 
the caseload they represent, has declined from 955,174 (14.4 percent) 
in December 1996 to 846,784 (12.8 percent) in December 2000, before 
rising again to  914,821 (13.5 percent) in December 2002.
	In December 2002, 64.7 percent of SSI children were 12 years 
old or younger, and about 16 percent were under 5 years old. About 
35.3 percent, an estimated 322,100 children, were between the ages 
of 13 and 17. Child recipients were more likely to be boys than 
girls by a ratio of about 3 to 2.
	
TABLE 3-15--PERSONS RECEIVING FEDERALLY ADMINISTERED SSI PAYMENTS AND 
ALSO RECEIVING OTHER INCOME, AND AVERAGE MONTHLY AMOUNT OF INCOME, 
BY SOURCE OF INCOME AND DISABILITY CATEGORY, DECEMBER 2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	An estimated 81.9 percent of children lived in their parent's 
household. Less than 2 percent of the children were patients in a 
medical facility where more than half of the cost of their care was 
covered by the Medicaid Program. Another 16.7 percent lived in other 
hospitals, nursing homes, residential schools, foster care, or 
independently.
	The number of persons receiving federally administered SSI 
payments and unearned income, by type of income, is included in Table 
3-16.About 26.7 percent of the children had some type of unearned 
income. The three major types of unearned income were: support from 
absent parents  (11.8 percent), Social Security benefits (7.1 percent), 
and in-kind support and maintenance (7 percent). In addition, about 21 
percent of children had income "deemed" from their parents.

TABLE 3-16--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI 
PAYMENTS AND UNEARNED INCOME (OTHER THAN SOCIAL SECURITY) AND 
AVERAGE MONTHLY UNEARNED INCOME, BY TYPE OF INCOME, DECEMBER 2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

OVERVIEW OF CASELOAD DEVELOPMENTS

	In summary, the trends in the nature of the SSI population show 
the  following:
-	A steady decline in the number of persons receiving SSI benefits 
on the basis of old age.
-	A recent decrease in the number of blind and disabled children 
under 18 receiving SSI; from a high of 14.4 percent of total SSI 
recipients in December 1996 to 13.5 percent in December 2002.
-	A continuing increase in the number of persons ages 18-64 
receiving benefits on the basis of disability or blindness. Between
December 1989 and December 2002, this group of beneficiaries grew 
by more than 1,595,000 persons (from 50 percent to 57 percent of the 
recipient population).

ELIGIBILITY OF DRUG ADDICTS AND ALCOHOLICS

Under both the SSI and the Social Security Disability Insurance (DI) 
Programs, disability is defined as a mental or physical impairment that 
is so severe that it prevents an individual from doing any kind of work 
that exists in the national economy, taking into account age, education, 
and work experience. Prior to January 1997, drug addiction and 
alcoholism were qualifying medical impairments under both SSI and DI. 
Thus, a person whose drug addiction or alcoholism was a contributing 
factor material to his disability was eligible for SSI. The SSI Program 
required that payments for drug addicts and alcoholics be made to a 
representative payee (i.e., a person or agency responsible for 
managing the recipient's finances), that recipients participate in 
treatment if available, and that the treatment be monitored.

SSI provisions relating to drug addicts and alcoholics were contained 
in the original SSI law (Public Law 92-603). Initially, the Senate 
sought to exclude these individuals from SSI by putting them in a 
separate services program. During  debate on the 1972 legislation, 
Members of the Senate argued that these drug addicts and alcoholics 
would need treatment, case management, and close monitoring so that 
they would not use the SSI benefits to "support their alcoholism 
or addiction." The Senate provision that excluded drug addicts and 
alcoholics from the SSI Program was deleted in favor of the House 
provision that required recipients to undergo treatment. The Senate's 
concern about providing direct payments to substance abusers was 
accommodated by the provision requiring that benefits be provided 
through representative payees. Although virtually all SSI recipients 
diagnosed as drug addicts or alcoholics received their payments via a 
representative payee, most representative payees were family members 
or friends of recipients, and it is suspected that some of them were 
likely to give in to threats, coercion, or persuasion of the recipient, 
thereby in some cases enabling recipients to obtain direct control of
their SSI payments.In 1994, Congress responded to concerns that 
significant numbers of  SSI and DI recipients were using their Federal 
cash payments to support their addictions by passing legislation (Public
Law 103-296) that placed a 3-year time limit on program benefits to 
persons disabled solely because of their addiction to drugs or alcohol, 
extended requirements on treatment and monitoring to  DI recipients,
required DI recipients classified as substance abusers to receive their 
benefits through representative payees, encouraged organizations and 
agencies to act as representative payees for recipients classified as 
substance abusers, and temporarily or permanently ended benefits of 
recipients who failed to comply with treatment requirements.

In 1996, Congress passed legislation that went even further by 
terminating drug and alcohol addiction as conditions that qualify 
individuals for SSI benefits. Under Public Law 104-121, individuals are
not considered disabled for either  SSI or DI if drug addiction or 
alcoholism is the contributing factor material to their disability. The 
law mandated the Commissioner of Social Security to require that persons 
who qualified for SSI or DI based on some other disabling condition, but 
who are nonetheless determined to have a drug or alcohol condition and 
are incapable of managing their own benefits, have a representative 
payee and be referred for treatment. The preferred representative payee 
for persons with a drug or alcohol condition who are not capable of 
managing their own benefits is an organization. Public Law 104-121 also 
authorized $50 million for fiscal year 1997 and $50 million for fiscal 
year 1998 for drug treatment services. Recipients classified solely as 
drug addicts or alcoholics became ineligible for SSI beginning 
January 1, 1997.  Applicants were no longer eligible for benefits 
beginning March 29, 1996 if they were disabled solely on the basis of 
drug or alcohol addiction. 
	Following the passage of Public Law 104-121, SSA notified  
209,372 individuals who were receiving SSI or DI benefits based on drug 
addiction and/or alcoholism. (According to SSA, approximately 90,000 
recipients of DI ''about 47,000 of whom were also SSI beneficiaries'' 
were identified as drug addict and alcoholic beneficiaries in 1996. 
However, historical data on  DI beneficiaries does not exist as the 
drug addict and alcoholic provisions of the Social Security Act were 
not applicable until 1995.) As of April 2, 1999, approximately 140,978 
beneficiaries responded to the notices. About 10,000 of these responses 
did not require medical determination because of erroneous  coding of 
disability diagnosis or cessation of benefits before January 1, 1997.
Of all beneficiaries identified as having a drug or alcohol addiction, 
SSA terminated benefits for 124,746 (59.6 percent) and continued 
benefits based on another disability for 83,746 (39.9 percent). Another 
859 individuals qualified for benefits based on age. [These figures 
will change as the agency processes more appeals and hearing decisions.]

ELIGIBILITY OF NONCITIZENS 

Although the 1996 welfare reform law (Public Law 104-193) barred most 
noncitizens from receiving SSI, this prohibition was modified by  
Public Law 105-33, the Balanced Budget Act of 1997, for legal immigrants 
who were receiving SSI on August 22, 1996 and disabled legal immigrants 
who were living in the United States on August 22, 1996. The Noncitizen
Benefit Clarification and Other Technical Amendments Act of 1998 (Public
Law 105-306) provided continuing eligibility for SSI for nonqualified 
aliens who were receiving benefits on August 22, 1996. For more 
information on provisions and issues related to noncitizens, see
Appendix J.

ELIGIBILITY OF THE HOMELESS

SSA field offices have established a variety of activities and special 
procedures to reduce the problems faced by homeless individuals in 
obtaining Social Security or SSI benefits for which they are eligible. 

Field offices and DDSs throughout the nation also have established  
liaisons with various organizations to assist homeless populations in 
applying for and maintaining entitlement to DI and SSI benefits.  In 
support of the President's initiative to end chronic homelessness within
10 years, SSA participates in the Interagency Council on Homelessness.  
SSA received $8 million dollars in the fiscal year 2003 SSI 
appropriation to administer a competitive demonstration grants program 
to provide outreach and application assistance to the homeless and other 
underserved populations.

SPECIAL SSI PROVISIONS FOR THE WORKING DISABLED

EARNED INCOME DISREGARDS

Since SSI began in 1974, the first $65 of monthly earned income (or, up 
to the first $85 if the recipient has no unearned income) plus one-half 
of the remaining earnings have been disregarded in determining 
eligibility for and the amount of SSI benefits. In addition, all 
work-related expenses are disregarded in the case of blind persons and 
impairment-related work expenses are disregarded in the case of disabled 
persons. Finally, income and resources set aside under a plan for 
achieving self-support (PASS) are excluded.

ELIMINATING WORK DISINCENTIVES

Prior to enactment of the section 1619 program in 1980 on a temporary 
3-year basis (see below), a disabled SSI recipient who worked faced a 
substantial risk of losing both SSI cash benefits and Medicaid. Work was 
treated the same way it was under the Social Security Disability 
Insurance Program: after a trial work period, work at the level of 
substantial gainful activity ($800 or more of earnings per month; $300 
per month before January 1990) led to the loss of disability status even 
if the individual's total income and resources were within SSI Program 
limits. Loss of SSI disability status caused loss of categorical 
Medicaid eligibility as well. Thus, disabled individuals had a 
disincentive to work because of their fear of losing SSI and Medicaid.

In response to this work disincentive, in 1986 Congress enacted  
Public Law 99-643 which added section 1619 to the Social Security Act. 
Under this provision, SSI recipients who work can continue to receive 
benefits even if their earnings are at or above the level of substantial 
gainful activity and as long as there is not a medical improvement in 
the disabling condition. Under the income disregard formula, the amount 
of their cash benefits is gradually reduced as earnings increase until 
their countable earnings reach the SSI benefit standard or what is known 
as the "break-even point." In a State with no supplementation, as shown 
in Table 3-2, this earned income eligibility limit is $1,189 per month 
in  2003 for a person who has no unearned income. People who receive 
section 1619 benefits continue to be eligible for Medicaid on the same 
basis as regular  SSI recipients. If States supplement the Federal 
benefits standard, the "break-even point" increases $2 for every $1 
of State supplementation above the Federal benefit standard.
Under section 1619(b), blind and disabled individuals can continue to be 
eligible for Medicaid even if their earnings take them past the SSI 
income disregard "break-even point." In some 209(b) States, workers may 
lose Medicaid eligibility before attaining 1619 (a) or (b) status if 
they did not have Medicaid coverage the month before section 1619 status 
began, thus making this provision inoperable for those workers. Special 
eligibility status granted by section 1619(b), under which the 
individual is considered a blind or disabled individual receiving SSI 
benefits for purposes of Medicaid eligibility, applies as long as the 
individual: (1) continues to be blind or have a disabling impairment; 
(2) except for earnings, continues to meet all the other requirements 
for SSI eligibility; (3) would be seriously inhibited from continuing 
to work by the termination of eligibility for Medicaid services; and  
(4) has earnings that are not sufficient to provide a reasonable 
equivalent of the benefits (SSI, State supplementary payments, Medicaid, 
and publicly funded attendant care) that would have been available if 
he did not have those earnings.

In making an initial determination under the fourth criterion, SSA 
decided to compare the individual's gross earnings to a "threshold" 
amount. The threshold amount is the amount of gross earnings, after the 
monthly $20 general income, $65 earned income, and one-half of the 
remainder exclusions are applied, that it would take to reduce to zero 
the Federal SSI benefit and State supplementary payment plus the average 
Medicaid expenditures for disabled SSI cash recipients for the State of 
residence. If the individual's earnings exceed this threshold, an 
individualized threshold is calculated which considers the person's 
actual Medicaid use, the State supplement rate for the person's actual 
living arrangement, and the value of publicly funded attendant care 
available to the person in the absence of earnings. In determining a 
person's income to compare to the individualized threshold, any 
applicable exclusions are deducted from earnings, including work 
expenses if the person is blind, impairment-related work expenses, 
and income set aside under a plan for achieving self-support.
In other words, Medicaid eligibility continues until the individual's  
earnings reach a higher plateau which takes into account the person's 
ability to afford both medical care and normal living expenses.
A disabled individual also has the ongoing protection of being able to 
be reinstated to eligibility for cash assistance benefits under regular 
SSI or 1619(a), or Medicaid only eligibility under 1619(b) if her work 
attempt fails or the physical or mental disability causes a pattern of 
erratic work. This protection is not indefinite, but SSA cannot 
terminate the disability status of an individual for 12 months after 
her most recent determination of eligibility for regular SSI or under 
section 1619 (a) or (b). However, if the individual recovers medically, 
a new application and new disability determination would be required to 
establish a new period of eligibility once the individual has been off 
the rolls for 12 months or more. The ticket to work law enacted in 1999 
(Public Law 106-170) contains a number of provisions designed to 
eliminate work disincentives that existed in the SSI Program. Under this 
law an individual whose eligibility for SSI benefits, including 
eligibility under section 1619(b), has been terminated due to 12 
consecutive months of suspension for excess income from work activity, 
may request reinstatement of SSI benefits without filing a new 
application. To be eligible for this expedited reinstatement of benefits, 
an individual must have become unable to continue working due to a 
medical condition and must file the application for reinstatement 
within 60 months of the termination of benefits.The ticket to work 
law also requires SSA to establish a community-based Work Incentive 
Planning and Assistance Program to provide individuals with information 
on SSI work incentives. Specifically, SSA must establish a corps of 
work incentive specialists within the agency and a program of grants, 
cooperative agreements, and contracts to provide benefit planning and 
assistance to individuals with disabilities and outreach to individuals 
who may be eligible for the Work Incentive Program.
	SSA is authorized by the ticket to work law to make grants 
directly to qualified protection and advocacy programs to provide 
services and advice to SSI beneficiaries about vocational 
rehabilitation, employment services, and obtaining employment. 
States have the option of covering additional groups of working 
individuals under Medicaid. The ticket to work law allows States to 
provide Medicaid coverage to working individuals with disabilities 
who, except for their earnings, would be eligible for SSI and to working 
individuals with disabilities whose medical conditions have improved. 
Individuals covered under this new option could buy into Medicaid 
coverage by paying premiums or other cost-sharing charges on a sliding 
fee scale based on income established by the State. States are permitted 
to allow working individuals with incomes above 250 percent of the 
Federal poverty level to buy into the Medicaid Program.

SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS

Section 251 of Public Law 106-169, enacted on December 14, 1999, 
provides special benefits to certain World War II veterans who served 
in the U.S. military during the period beginning September 16, 1940 
and through  July 24, 1947, or who served in the organized military of 
the Philippines during the period beginning July 26, 1941 and through 
December 30, 1946. The special benefits are payable each month after 
April 2000 that these veterans reside outside the United States.
In order to be eligible for the special benefits, an individual must: 
(1) be age 65 or older on December 14, 1999 (the date Public Law 
106-169 was enacted);  (2) be a World War II veteran as described above; 
(3) file an application for the special veterans benefits and be 
eligible for SSI for that month; (4) be eligible for SSI in December 
1999; and (5) not have other benefit income above 75 percent of 
the current SSI Federal benefit rate.
Qualified veterans receive a monthly benefit equal to 75 percent of the 
current SSI Federal benefit rate less the amount of their benefit income 
for the month. The maximum benefit under this formula for 2003 is $414. 
There is no provision for the payment of benefits to dependents or 
survivors. "Benefit income" means any recurring payments such as 
annuities, pensions, retirement, or disability benefits that the 
veteran received during the 12-month period immediately before applying 
for special benefits, or payments received later that are similar to 
benefits received during the 12-month period.

MEASURES OF SSI PARTICIPATION AND GROWTH

SSI PARTICIPATION RATES

Table 3-17 shows several measures of Federal SSI participation among the 
elderly and the total population. The numerator in the first three 
columns is the sum of columns 2 and 4 in Table 3-19. Thus, the number of 
SSI aged participants includes the disabled and blind population over 
age 65. Column 1 simply divides the SSI aged participants by the total 
number of elderly. That rate declined from 11.1 percent in 1975 to 6.5 
percent in 1989, primarily as a result of increasing incomes among the 
aged and decreasing participation among low-income elderly. The rate was 
5.6 percent in 2001. Column 2 presents the number of elderly SSI 
recipients divided by the number of poor elderly. This rate declined 
from 76 percent in 1975 to 54 percent in 1982. Between 1982 and 1984, 
this percentage increased, perhaps as a result of outreach efforts 
mandated by the 1983 Social Security Amendments (Public Law 98-21). 
Since 1985 the rate fluctuated between  53 percent and 64 percent and 
was 58 percent in 200. This rate is a gross measure of participation, 
in that it does not control for other SSI eligibility factors such as 
assets or the under counting of income. The denominator for column 3 is 
the number of individuals age 65 and older who live in aged-only 
households and who would be in poverty without SSI benefits. This rate 
has fluctuated between 73 percent and 60 percent since 1979, and was 
68 percent in 2001.

TABLE 3-17--PERCENTAGE OF GENERAL POPULATION ENROLLED IN SSI, SELECTED 
YEARS 1975-2001

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

The final column of Table 3-17 shows the number of SSI participants as a 
percentage of the total population. The numerator for this calculation 
is the first column of Table 3-19. The percentage of the entire 
population receiving  SSI benefits declined from 2.0 percent in 1975 
to 1.7 percent for the 1982-85 time period, but increased to 2.5 percent
''its highest level ever'' in 1995 and 1996. In 2001, 2.4 percent of the 
population received SSI benefits. Table 3-18 shows the percentage of a 
given State's population receiving SSI benefits for selected years.

TABLE 3-18--PERCENTAGE OF GENERAL POPULATION ENROLLED IN SSI BY STATE, 
SELECTED YEARS 1975-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

CHANGES IN NUMBER OF RECIPIENTS, 1970-2002

SSI is one of the largest cash assistance programs for the poor and, 
until recently, was one of the fastest growing entitlement programs 
(see Table 3-12 above); program costs grew 20 percent annually from 
1991 through 1994. According to GAO, three groups accounted for 
nearly 90 percent of the SSI Program's growth between 1986 and 1993: 
adults with mental impairments, children, and noncitizens. These 
groups grew at an annual average rate of 11.0, 16.4, and 15.5 percent, 
respectively, from 1986 through 1993, compared with 4.9 percent for all
SSI recipients. The SSI recipient population also changed dramatically: 
disabled recipients now account for nearly 80 percent of recipients. 
The GAO report found that SSI recipients now tend to be younger, stay 
on SSI longer, receive larger benefits, and depend more on SSI as a 
primary source of income. Factors contributing to caseload growth 
include the following: expansion in disability eligibility, notably 
for mentally impaired adults and for children; increased outreach by 
SSA; lack of effort to help recipients return to work; infrequent 
reviews of cases to confirm that the disability is continuing; 
immigration growth; and transfers from State programs, among others 
(U.S. General Accounting Office, 1995).
Table 3-19 illustrates the changes in the number of individuals 
receiving assistance under the federally administered SSI Program
and prior programs. The total number of individuals receiving 
assistance was 3.1 million in 1970; this number increased to 4.3 
million in 1975 and declined to 3.9 million in 1982. Since then, 
the number of SSI recipients has grown each year. In 2002, there 
were nearly 6.8 million SSI recipients. Despite this overall growth, 
the number of aged receiving SSI has declined sharply since 1975 from 
2.3 million (or 2.5 million if disabled and blind persons over age 65
are counted as aged) to 1.25 million individuals in 2002 (approximately
2.0 million if disabled and blind persons over 65 are counted). 
Meanwhile, the number of blind or disabled receiving assistance 
increased sharply.

TABLE 3-19--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI 
PAYMENTS AND ADULT ASSISTANCE  UNDER PRIOR PROGRAMS, SELECTED 
YEARS 1970-2008 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

The number of persons receiving SSI payments, by State, in December 2002 
is provided in Table 3-20.

TABLE 3-20--NUMBER OF PERSONS RECEIVING SSI PAYMENTS, BY STATE, 
DECEMBER 2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

SSI PROGRAM COSTS 

Table 3-21 shows total expenditures for the SSI Program in each State 
in 2002, including not only the federally administered Federal and 
State supplementation payments but also the State-administered State 
supplementation payments. Table 3-22 shows the total (Federal- and 
State-administered) State supplementation payments by State for SSI 
for selected fiscal years, 1986-2002.

TABLE 3-21--SUPPLEMENTAL SECURITY INCOME: TOTAL PAYMENTS, FEDERAL 
SSI PAYMENTS, AND FEDERAL- AID STATE-ADMINISTERED STATE 
SUPPLEMENTATION PAYMENTS, CALENDAR YEAR 2002 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-22--STATE SSI SUPPLEMENTATION PAYMENTS, SELECTED YEARS 1986-2002

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

TABLE 3-23--FEDERAL AND STATE BENEFIT PAYMENTS UNDER SSI AND PRIOR ADULT 
ASSISTANCE PROGRAMS, SELECTED YEARS 1970-2005 

[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Table 3-23 presents the total amount of Federal and State 
benefit payments from calendar years 1970-87 and fiscal years 1988-2005. 
From 1970-73, these were the benefits under the Old-Age Assistance, Aid 
to the Blind, and Aid to the Permanently and Totally Disabled Programs. 
In fiscal year 1999, Federal benefit payments totaled $28.1 billion and 
State payments totaled $3.2 billion, amounting to an overall total of 
$31.3 billion. In fiscal year 2000, total (Federal and State) SSI 
benefits are estimated to total $29.5 billion and are projected to 
increase to $32.7 billion in fiscal year 2002.

		LEGISLATIVE HISTORY

104th CONGRESS

Public Law 104-121, the Contract with America Advancement Act of 1996, 
among other changes, prohibits disability insurance (DI) and 
Supplemental Security Income (SSI) eligibility to individuals whose 
drug addiction and/or alcoholism (DAA) is a contributing factor material 
to the finding of disability. This provision would apply to individuals 
who file for benefits on or after the date of enactment and to 
individuals whose claims are finally adjudicated on or after the date of 
enactment. This provision also applies to current beneficiaries on  
January 1, 1997. It stipulates that SSI must: (1) notify current DAA 
beneficiaries of the new provisions within 90 days of enactment; and 
(2) complete new medical determinations by January 1, 1997 for affected 
current beneficiaries who request such a determination within 120 days 
after the date of enactment. 
	Public Law 104-121 applies representative payee requirements to 
DI or SSI beneficiaries who have a DAA condition, as determined by the 
Commissioner, and who are incapable of managing benefits. The Social 
Security Administration (SSA) would refer these individuals to the 
appropriate State agency for treatment. The representative payee and 
referral for treatment provisions would apply to applications filed 
after the third month following the month of enactment. In addition, 
the new law retains the $50 fee that representatives can collect for 
beneficiaries who have a DAA condition. The legislation also authorizes
an appropriation of $50 million for each of fiscal years 1997 and 1998 
to carry out activities relating to the treatment of drug and alcohol 
abuse under the Public Health Service Act.
	Further, Public Law 104-121 authorizes additional funds to SSA 
for fiscal years 1996-2002 for the purpose of conducting Social Security 
disability insurance continuing disability reviews (CDRs) and 
Supplemental Security Income CDRs and disability eligibility 
redeterminations. This new funding level is achieved by increasing the 
amount of funds available for appropriations under the discretionary 
spending cap. The Commissioner of Social Security must ensure that the 
funds made available pursuant to this provision are used, to the 
greatest extent practicable, to maximize the combined savings to the 
Old-Age, Survivors, and Disability Insurance (OASDI), SSI, Medicare, and 
Medicaid Programs. Moreover, the Commissioner is required to report 
annually, for fiscal years 1996-2002, to Congress on the amount of money 
spent on CDRs, the number of reviews conducted (by category), the 
disposition of such reviews (by program), and the estimated savings over 
the short-, medium-, and long-term for OASDI, SSI, Medicare, and 
Medicaid Programs from CDRs which result in cessations, and the 
estimated present value of such savings.
Public Law 104-193, the Personal Responsibility and Work Opportunity 
Reconciliation Act (PRWORA) of 1996, signed on August 22, 1996, makes 
several major changes in SSI law. These include:
	Limited Eligibility of Noncitizens for SSI Benefits CPRWORA 
prohibits SSI eligibility for all noncitizens except: refugees, 
asylees, and noncitizens whose deportation has been withheld (limited to 
their first 5 years of residence); certain active duty Armed Forces 
personnel, honorably discharged veterans, and their spouses and 
dependent children; and lawful permanent residents who have worked 
for 10 years or more. For purposes of the exception based on work, 
children are credited with all quarters worked by their parents, and 
married individuals (including widows) are credited with work 
performed by spouses during their marriage. However, after December 31, 
1996, quarters of work during which an individual received Federal 
public assistance are not countable toward this exception.
	Deeming of Sponsors' Incomes and Resources-For purposes of 
eligibility for sponsored noncitizens admitted under new, legally 
enforceable affidavits of support, PRWORA deems all of the sponsors' 
(and sponsors' spouses') incomes and resources to the noncitizen until 
citizenship. However, deeming is not required for lawful permanent 
residents who have worked for 10 or more years (not counting quarters 
of work after 1996 during which the individual received Federal public 
assistance), or for children and spouses of workers credited with work 
performed by them.
	Requirements for Affidavits of Support for Sponsorship 
''Affidavits of support are made legally enforceable against the sponsor 
until the noncitizen becomes a U.S. citizen. The agency that provides 
assistance to a noncitizen must request reimbursement from the sponsor 
for assistance provided.
	Reporting of Illegal Immigrants to the Immigration and 
Naturalization Service-The Commissioner of Social Security must 
furnish to the Immigration and Naturalization Service the name, address, 
and other identifying information of any individual that SSA knows is 
unlawfully present in the United States.
	SSI Eligibility Based on Childhood Disability ''The comparable 
severity standard is eliminated and replaced by the standard that a 
child is considered disabled if she has a medically determinable 
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. 
The Social Security Administration is directed to eliminate references 
to maladaptive behavior in the domain of personal/behavioral function 
in the listing of impairments for children and to discontinue the use 
of individualized functional assessments in evaluating a child's 
disability. SSA is also required to redetermine, using the new criteria 
and by no later than August 22, 1997, the eligibility of recipients who 
may be affected by the new criteria. Benefits for those recipients 
who do not meet the new criteria would end on or after the later of 
July 1, 1997, or the date of the redetermination.
	CDRs must be conducted once every 3 years for child recipients 
with nonpermanent impairments, and not later than 12 months after birth 
for low birth weight babies. Representative payees must present evidence 
to SSA that the recipient is receiving treatment that is medically 
necessary and available, unless SSA determines that such treatment 
would be inappropriate or unnecessary. An eligibility redetermination, 
using the adult initial eligibility criteria, must be performed within 
1 year after child recipients turn 18.
	Funding-PRWORA authorizes the appropriation of an additional  
$150 million in fiscal year 1997 and $100 million in fiscal year 1998 
for the costs of performing CDRs and redeterminations.
	Prisoner Reporting ''The law provides for incentive payments  
($400 for information received within 30 days of confinement or $200 
for information received from 31 to 90 days after confinement) to State 
and local penal institutions that furnish identifying information to 
SSA which results in suspension of SSI benefits to prisoners.
	Modifying the Effective Date of Applications ''An individual's 
application for SSI benefits would be effective on the first day of the 
month following the date on which the application is filed, or on which 
the individual first becomes eligible, whichever is later. (This change 
effectively eliminates prorated payments for the month of application, 
while continuing emergency advance payments and subsequent repayments 
over several months in certain cases.)
	Reduction in Cash Benefits Payable to Institutionalized 
Individuals whose Medical Costs are Covered by Private Insurance-PRWORA 
limits to not more than $30 a month, cash benefits payable to children 
who are in an institution receiving medical care covered by private 
insurance.
	Installment Payments of Large Past-Due SSI Payments-A schedule 
for paying large retroactive SSI benefit amounts at 6-month intervals 
is established.
	Dedicated Savings Accounts-PRWORA requires the establishment of 
a  bank account to maintain large retroactive SSI benefits, to be used 
for education or job skill training, special equipment, medical 
rehabilitation, or other appropriate items or services related to the 
impairment of the child.Public Law 104-208, the Department of Defense 
Appropriations Act for fiscal year 1997, includes the Illegal 
Immigration Reform and Immigrant Responsibility Act of 1996, which 
amends Public Law 104-193 with regard to noncitizens' eligibility for 
SSI benefits. 
Noncitizen individuals and their children who are battered or bused 
are added to the list of "qualified aliens." Sponsorship affidavits of 
support are made legally binding and sponsor-to-immigrant deeming of 
income and resources in the SSI Program continues until noncitizens 
become U.S. citizens or they, their spouses, or parents work 40 quarters 
in the United States. The law also provides additional exceptions to 
sponsor-to-immigrant deeming for indigent noncitizens whose sponsors do
not provide them with income sufficient to obtain food and shelter and f
or battered individuals and their children.In addition, Public Law 
104-208 requires several reports to Congress. The Commissioner of 
Social Security is required to report the aggregate number of Social 
Security numbers issued to noncitizens not authorized to work but under 
which earnings were reported and the extent to which Social Security 
numbers and Social Security cards are used by noncitizens for fraudulent 
purposes. These two reports are due no later than 3 months after the end 
of each fiscal year, and within  1 year after the date of enactment, 
respectively. The General Accounting Office also is required to report 
to Congress and the Department of Justice within 180 days after the date 
of enactment on the extent to which means-tested benefits are being 
paid to noncitizens acting as representative payees who are not 
"qualified aliens."

105th CONGRESS

Public Law 105-18, an emergency supplemental appropriations bill, 
provides a 1-month extension for noncitizens who were receiving 
benefits on the date of enactment of Public Law 104-193 (August 22, 
1996) and who would not continue to be eligible under the noncitizen 
restrictions in that law by changing the date by which SSI 
redeterminations of eligibility had to be completed from August 22, 
1997 to September 30, 1997. Public Law 105-33, the Balanced Budget Act 
of 1997, made several major changes in SSI. These include:

SSI Eligibility for Aliens Receiving SSI on August 22, 1996 and Certain 
Disabled Legal Aliens-Public Law 105-33 provides that, despite 
restrictions in the 1996 welfare reform law, noncitizens lawfully 
residing in the United States who were receiving SSI on August 22, 1996, 
remain eligible for SSI. In addition, noncitizens lawfully residing 
in the United States on August 22, 1996, are eligible for SSI if they 
become disabled in the future. The law also provides that members of 
Native American Indian tribes who are noncitizens are not affected by 
the  SSI restrictions in Public Law 104-193. In addition, individuals 
who received SSI prior to January 1, 1979, continue to be eligible for 
benefits if the Commissioner of Social Security lacks clear and 
convincing evidence that such individuals are noncitizens ineligible 
for benefits.Extension of Eligibility Period for Refugees and Certain 
Other Qualified Aliens from 5 to 7 Years for SSI and Medicaid; Status 
of Cuban/Haitian Entrants and Certain Amerasians-Public Law 105-33 
extends from 5 years to 7 years the initial eligibility period for 
SSI and Medicaid for refugees, asylees, and noncitizens who have had 
their deportations withheld. In addition, Cuban and Haitian entrants 
and Amerasian immigrants are added to the categories of noncitizens 
who are considered "qualified aliens." These groups are eligible for 
SSI for their initial  7 years, and are exempt from the 5-year 
eligibility ban on noncitizens entering the United States after 
August 22, 1996.
Exceptions for Certain Indians from Noncitizen Limitations on 
Eligibility  for Supplemental Security Income and Medicaid Benefits-
Public Law 105-33 exempts noncitizen members of federally recognized 
Indian tribes or noncitizen Native Americans from the SSI and Medicaid 
restrictions in the 1996 act.
Exemption from Noncitizen Restrictions on SSI Program Participation by 
Certain Recipients Eligible on the Basis of Very Old Applications-
Public Law 105-33 exempts certain individuals who have been on SSI 
rolls since before January 1, 1979, from the noncitizen restrictions 
in the 1996 act.
Derivative Eligibility for Noncitizens for Medicaid and Food Stamp 
Benefits-Public Law 105-33 provides that noncitizens who are otherwise 
ineligible for Medicaid under the 1996 act may be eligible for Medicaid 
if they receive  SSI benefits and if the State's Medicaid plan provides 
Medicaid eligibility for SSI recipients. The legislation also clarifies 
that noncitizens who are otherwise ineligible under the 1996 act for 
food stamps would not be made eligible for food stamps because they 
receive SSI benefits.
	Fees for Federal Administration of State Supplementary Payments-
Public Law 105-33 increases fees for SSA's administering State 
supplementary payments, with added collections available for SSA 
administrative purposes.
	Timing of Delivery of October 1, 2000, SSI Benefit Payments-
In order to meet budget targets, Public Law 105-33 provides that the 
October 2000 SSI check be paid on October 2, which is a Monday, rather 
than on the last Friday in 
September.
	Medicaid Coverage for Certain Workers and Children, Public Law 
105-33 gives the States the option of permitting individuals who had 
been receiving  SSI disability benefits, but are working, to buy into 
Medicaid if their family income is less than 250 percent of poverty. 
In addition, States are required to continue Medicaid coverage for 
children who were receiving SSI disability benefits as of August 22, 
1996, but whose eligibility would end because they do not meet the 
new, more strict SSI childhood disability eligibility criteria.
	Technical Amendments to the 1996 Welfare Reform Law -The 
legislation makes a number of technical clarifications with regard 
to the disabled children's redetermination and continuing disability
review requirements. Technical changes also clarify the meaning of 
the term "final adjudication" with regard to  SSI disability cases 
based on drug addiction or alcoholism and expands the applicability 
of provisions in Public Law 104-121 that require treatment referrals 
and authorization of fees for organizations serving as representative 
payees for  SSI beneficiaries who have a DAA condition.
	Technical corrections also are made that clarify when the 
reporting incentives involving prisoners apply and that allow SSA to 
charge a fee as a condition of processing requests for information by 
law enforcement authorities regarding SSI recipients who are fugitive 
felons and probation or parole violators. Clarifications are made 
concerning SSI dedicated savings account funds and terminology relating 
to medical treatment facilities and the applicability of the $30 SSI 
payment limit are updated. Noncitizens technical correction provisions 
include adding battered parents to the definition of "qualified alien" 
and the exemptions from sponsor-to-immigrant deeming, clarifying that 
veterans widow(er)s may be eligible for benefits, and authorizing SSA 
to disclose noncitizens' quarters of coverage information to other 
governmental agencies for the purpose of carrying out the noncitizen 
restriction provisions.
	Public Law 105-306, the Noncitizen Benefit Clarification and 
Other Technical Amendments Act of 1998 provided continuing eligibility 
for SSI for nonqualified aliens who were receiving benefits on 
August 22, 1996.

106th CONGRESS

	Public Law 106-169, the Foster Care Independence Act of 1999, 
contains numerous provisions related to SSI fraud reduction and 
overpayment recovery. 
These provisions are summarized below.
	Overpayments and Debt Collection-The law amends the Social
Security Act to make representative payees liable for the repayment 
of Social Security benefit checks distributed after the recipient's 
death. SSA will monitor these repayments using representative payees' 
Social Security numbers. Beginning on December 14, 2000, SSA is 
authorized to recover up to 50 percent of lump sum  SSI benefit 
payments made to individuals (or eligible spouses) who are themselves 
liable for the repayment of SSI benefits. The law also authorizes SSA 
to intercept Federal and State payments owed to individuals, use debt 
collection agencies, and other techniques to collect overpayments.
	Treatment of Assets-Public Law 106-169 changes the way assets 
held in trusts are treated when determining SSI Program eligibility 
and benefit amounts.  (A trust is defined by SSA as a legal arrangement
involving property and  ownership interests.) Assets and income in 
irrevocable trusts may not be revoked or used by an individual for 
personal support and maintenance. These trusts, previously exempt 
from SSI resource limit calculations, will be counted toward the 
resource limit for program eligibility and used to determine benefit 
amounts. All trusts established after January 1, 2000-regardless of 
the purpose of the trust, degree of trustee discretion, or restrictions 
on distribution-will be affected by the law. However, the new law 
allows the Commissioner of Social Security to waive the consideration 
of a trust if doing so would create an undue hardship for an individual. 
The criteria for undue hardship will be determined by the Commissioner.
	Disposal of Resources-The law also imposes new rules regarding 
resources disposed of at less than fair market value. Individuals or 
their spouses who dispose of resources at less than fair market value 
will be ineligible for SSI benefits from the "look-back" date (the 
date the individual applied for benefits or, if later, the  date the 
individual disposed of resources for less than fair market value) for a 
length of time calculated by SSA. The ineligibility period is 
determined by  dividing the total value of the disposed resources 
by the maximum monthly benefit and the maximum applicable State 
supplementary payment. This ineligibility  period may not exceed 36 
months. Similar restrictions on the treatment of assets and the 
disposal of resources were already in effect for the Medicaid Program 
before enactment of Public Law 106-169.
	Certain resources are exempt from this provision: resources 
transferred to a trust, if the trust is considered a resource available 
to the individual; the transfer of a home to family members under 
certain conditions; the transfer of resources to a spouse for the 
spouse's sole benefit; or the transfer of resources to an individual's 
blind or disabled child (under age 65). Furthermore, a resource may be 
exempt if an individual proves to the Commissioner that he intended 
to dispose of the resource  at fair market value; or that the resource 
was transferred for reasons other than to qualify for the SSI Program; 
or if the Commissioner determines that denial of eligibility would 
cause an undue hardship.
	Penalties for False or Misleading Statements-The law contains 
provisions authorizing SSA to establish a new administrative process 
to determine whether individuals have fraudulently claimed benefits 
in cases considered too small to prosecute in court. The law provides 
for increasing penalties of  6, 12, and 24 months of ineligibility 
depending on the nature of the case. However, the imposition of these 
penalties will not impact an individual's receipt of other assistance. 
The penalty procedure applies only to false and misleading statements 
made after the date of the law's enactment, December 14, 1999. The 
Commissioner is mandated to develop regulations detailing the 
administrative process for imposing the penalties within 6 months of 
enactment.

Health care providers and attorneys convicted of fraud or 
administratively fined for fraud involving SSI eligibility 
determinations are barred from participating in the SSI Program for at 
least 5 years. SSA will provide individuals with reasonable notice and 
opportunity for a hearing and judicial review. SSA will also notify the 
State agencies that employ such individuals and the State licensing 
agencies that license or certify them. Attorneys and health care 
providers are required to inform SSA of any past violations or 
convictions. The Commissioner or Inspector General of Social Security 
may waive the exclusion from involvement with the SSI Program for an 
individual who is the only provider of services to a community and may 
terminate exclusions on a case-by-case basis.
	Information Sharing Requirements-There are a number of 
provisions regarding information sharing between Federal and State 
agencies in the new law. SSA is authorized to obtain financial records 
for SSI recipients to ensure that they meet SSI's resource restrictions 
and remain eligible for benefits.
	States are required to provide the Commissioner with information 
for determining individuals' eligibility for Social Security and SSI 
benefit programs. State prisons are also required to provide inmate 
information to Federal and federally assisted benefit programs. To 
help reduce fraudulent benefit payments to prisoners of food stamps, 
veterans' benefits, unemployment benefits, and educational aid, SSA is
required to share its prisoner database with other Federal agencies and 
departments.
	The law directs SSA to conduct computer matches with Medicare 
and Medicaid data maintained by the Department of Health and Human 
Services on individuals who are residents of public institutions. 
Data obtained from these matches may be used as a substitute for a 
physician's certification that an individual's stay in an institution
will be less than 3 months. The Commissioner and the Secretary of the 
Department of Health and Human Services will mutually determine the 
terms of the data matching.
	Study and Reporting Requirements-The law requires the 
Commissioner, in consultation with the SSA Inspector General and the 
Attorney General, to study and report to Congress on legislative and 
administrative reforms that would reduce or prevent SSI and Social 
Security DI fraud and overpayments. Furthermore, the Commissioner must 
include an itemized account of the amount of funds required to support 
efforts to combat fraud by applicants and beneficiaries in the SSA 
annual budget. This requirement is effective for annual budgets 
prepared after fiscal year 1999.
	Public Law 106-170, the Ticket to Work and Work Incentives 
Improvement Act of 1999, expands Medicaid coverage and provides work 
incentives for disabled beneficiaries of SSI. The law also creates a 
"ticket to work" system whose purpose is to expand the numbers and 
types of providers that SSI beneficiaries may choose to assist them 
in receiving employment and vocational rehabilitation services. In 
addition, the law has several other provisions:
	Greater Accessibility to Vocational Rehabilitation Providers-
Individuals on the SSI rolls are given access to a broader pool of 
vocational rehabilitation providers. SSI recipients are provided with 
"tickets" that they can use as vouchers to obtain employment services, 
case management, vocational rehabilitation, and support services from 
the providers of their choice, including State vocational rehabilitation 
agencies. This program will be implemented on a gradual basis within 
1 year of enactment at test sites and within 4 years in every State.
The law also authorizes the Commissioner to make grants of up to $7 
million each year for fiscal years 2000-2004 to protection and 
advocacy organizations providing information and advice about obtaining 
vocational rehabilitation and employment services. The Secretary of 
Health and Human Services is authorized to award grants to States to 
design, establish, and operate infrastructures providing items and 
services to support working individuals with disabilities, and to conduct 
outreach campaigns to publicize the new benefits under the legislation 
($20 million, $25 million, $30 million, $35 million, and $40 million for
fiscal years 2001-2005, respectively; for fiscal years 2006-2011, the 
law authorizes the prior year's amount adjusted for inflation.)

	Creation of Employment Network-Employment networks are required 
to consist of a single public or private provider or an association of 
providers combined into a single entity which assumes responsibility for 
the coordination  and delivery of services. Employment networks, which 
must be experienced in providing relevant employment and support 
services to individuals with disabilities will work with beneficiaries 
to develop employment plans and employment goals. The employment 
networks are responsible for providing periodic performance reports to 
beneficiaries holding tickets and periodic quality assurance reviews. 
The Commissioner will establish mechanisms for resolving disputes 
between employment networks and beneficiaries. State vocational 
rehabilitation agencies and employment networks must enter into 
agreements with individuals referred by an employment network to a 
State vocational rehabilitation agency for services.Payment to 
employment networks is based on one of two payment systems. Under 
the outcome payment system, employment networks are provided with up  
to 40 percent of the average monthly disability benefit for each month 
(up to  60 months) benefits are not payable to the beneficiary due to 
work. Under the outcome-milestone payment system, employment networks 
receive early  payments based on the achievement of one or more 
milestones toward permanent employment. The total amount payable 
under this system may not exceed the total amount payable under the 
outcome payment system. Regardless of the system  used, beneficiaries 
forgo their SSI benefit and instead receive earnings from work. The 
cost effectiveness of the payment systems will be evaluated by the 
Commissioner.
	Limitations on Continuing Disability Reviews (CDRs) for Ticket 
to Work Participants - The law prohibits the Commissioner from 
initiating a CDR for a beneficiary participating in the Ticket to Work 
and Self-Sufficiency Program. Further, if beneficiaries do not succeed 
at their work effort, the law provides for  the reinstatement of SSI 
benefits without requiring re-application.
	Medicaid Expansion - Under Public Law 106-170, States can opt to 
cover persons with disabilities at higher income and resource levels 
than otherwise permitted (i.e., over 250 percent of the Federal poverty 
level and over $2,000, respectively), and whose medical condition would 
not otherwise permit them to be covered. States can require these 
individuals to "buy into" Medicaid coverage by paying premiums or other 
cost-sharing charges on a sliding fee scale based on income, as 
established by the State.
	Demonstration Projects and Studies - The law extends Social 
Security demonstration projects relating to disabled beneficiaries and 
establishes a new demonstration project to test phasing out disability 
benefits for earnings above a certain level of income. Further, the 
General Accounting Office is required to study the effects of the 
substantial gainful activity level on recipients who return to work, 
and report on whether disregarding certain income for calculating 
benefits is appropriate.
	Other - The law permits the Commissioner to withhold an 
assessment charge of  6.3 percent of the attorney's fees for the purpose 
of recovering costs to SSA of withholding and payment of attorneys fees. 
SSA is authorized to penalize States that are late in paying 
administrative fees to SSA.
		
107th  CONGRESS 

	Public Law 107-73, the Economic Growth and Tax Reconciliation 
Act of 2001, was signed into law on June 7, 2001. The law increases 
child tax credit amounts gradually from $500 for each child to $1,000 
in 2010 and expands the child tax credit by making it refundable for 
low-income workers.  Previously, the child tax credit was refundable 
in very limited situations.  The credit will be excluded from income or 
resources in determining eligibility for means-tested programs, 
including SSI and is also excluded as part of resources in the month 
of receipt and the following month.  Public Law 107-116, Making 
Appropriations for the Departments of Labor, HHS and Education, FY 2002, 
was signed into law on January 10, 2002 and contained one provision 
affecting the SSI program. The law provides that  $7 million of the 
funds appropriated for the Supplemental Security Income program are 
to be used for outreach efforts under section 1144 of the Social 
Security Act to identify individuals who may be eligible for Medicare 
cost sharing under the Medicaid program.
	Public Law 106-386, the Victims of Trafficking and Violence 
Protection Act of 2000, provides that noncitizens who are victims of 
"severe forms of trafficking in persons in the United States" shall be 
treated as refugees for purpose of SSI and be eligible for SSI benefits 
for the first 7 years they are in the United States. 
	Public Law 106-395, the Child Citizenship Act of 2000, provides 
that certain blind and disabled children may become citizens of the 
United States earlier than previously.  This citizenship status would 
provide them eligibility for SSI benefits.  
	Public Law 106-245, the Radiation Exposure Compensation Act 
Amendments of 2000, would, among other things, exclude as countable 
income for SSI purposes the compensation received under this statute.  

REFERENCES

National Academy of Social Insurance. (1995). Restructuring the SSI 
disability program for children and adolescents. Washington, DC: Author.

Quigley, E. (1992, August 7). The homeless. CQ Researcher, 2 (No. 29).

Social Security Administration. (1999 and various years). Annual 
statistical supplement to the Social Security Bulletin, 1999 (SSA Pub. 
No. 13-11700). Washington, DC: Author. [Earlier years of this annual 
publication were used in preparing various tables for this chapter.]

Social Security Administration. (1999, December). Supplemental 
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the National Commission on Childhood Disability). Washington, DC: Author.

Sullivan v. Zebley, et al., No. 88-1377 (U.S. filed February 20, 1990).
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Income: Growth and changes in recipient population call for reexamining 
program (GAO/HEHS 95-137). Washington, DC: Author.

U.S. House of Representatives, Committee on Ways and Means. (1971, 
May 26). Social Security Amendments of 1971 (House Report No. 92-231). 
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U.S. Senate, Committee on Finance. (1972, Sept. 26). Social Security
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