420-2 CONCURRENT PARTICIPATION IN THE SSI PROGRAM

420-2 CONCURRENT PARTICIPATION IN THE SSI PROGRAM

420-2 A. RELATIONSHIP BETWEEN THE SSI AND APA PROGRAMS

The Supplemental Security Income ( SSI ) program is a national, federally-funded and administered, public assistance program for the needy aged, blind, and disabled. Alaska's APA program is intended to supplement the benefits provided by the SSI program.

Because of the APA program's higher income eligibility limits and differing policy concerning citizenship requirements, many clients are eligible for APA but not for SSI ; there is no requirement that APA applicants or recipients whose countable income exceeds the applicable SSI standard pursue application for SSI benefits. Participation in the SSI program is, however, a condition of eligibility for any APA applicant who receives countable needs-based income from such sources as Temporary Assistance or BIA-GA that causes them to exceed the income limit for the SSI program. If SSI decides that these individuals are eligible, SSI payments can begin once the needs-based income ends.

With few exceptions, the SSI and APA programs use the same eligibility criteria. Because of this relationship between the two programs, the decision of the Social Security Administration on a claimant's eligibility for SSI benefits may be the basis of a case worker's decision on the individual's eligibility for APA benefits. The only essential difference between SSI and APA eligibility criteria are APA 's more liberal income policies, and APA requirements that recipients be residents of Alaska and at least 18 years old. Thus, the requirement to participate in the SSI program goes beyond simple pursuit of a source of income; an APA client whose income is within SSI limits must not only apply for SSI , but also must be found eligible for SSI benefits, or the client will be ineligible for APA benefits.

Exception: The APA and SSI programs may apply a disqualification period if an individual (or spouse) transfers a resource for less than its value. If the APA disqualification period ends before the SSI disqualification period, the individual may qualify for APA benefits after the end of the APA disqualification period. To qualify for assistance, the individual must still meet all other APA eligibility requirements except for receipt of SSI benefits. See manual section 433-1 for the policy on transfer of resources.

420-2 B. TIME LIMIT FOR PURSUIT OF SSI BENEFITS

1. APA applicants

Unless the individual has already established a current SSI claim and is receiving the maximum amount of SSI for their living situation, an otherwise eligible applicant whose countable income is within SSI limits must file a claim for SSI and be in pay status within 30 days of the date of interview. The applicant must be provided with written notice of the requirement to file for SSI and be given a reasonable amount of time to do so. Clients shall be informed that SSI claims may be filed in person or by telephone, and that SSI will allow a responsible individual to apply on behalf of another. If the applicant fails, without good cause, to comply with this requirement, APA assistance must be denied.

Example: Morris receives SSI and also had a part time job at a grocery store. The job at the grocery store ended. Morris must be given 30 days to report the job end to SSI and provide verifcation of the increase of SSI before APA can begin.

2. APA recipients

Whenever the countable income of an APA recipient who is not receiving SSI is expected to decrease to less than the applicable SSI standard, the case worker shall provide the client with a notice, in writing, that he or she must apply for and provide verification of an SSI application or reported change within 30 days. SSI application, or proof of reported change in circumstances, is required of any APA recipient whose income or living situation changes enough to indicate potential SSI eligibility or an increase in SSI benefits.

If the mandatory verification is received by the due date, APA benefits continue until the Social Security Administration makes a decision. If they do not provide this verification before the due date, the APA case should be closed with 10 days notice of adverse action. Medicaid may continue if Medicaid eligibility requirements are still met. See ADLTC 530 .

Refer clients to the SSI program even if it appears that they will be eligible for a period as short as one calendar month. Clients whose monthly income fluctuates above and below SSI limits must maintain an open SSI claim; SSI rules allow an individual's claim to remain open in nonpay status for up to 11 consecutive months without reapplication. Individuals in nonpay status with SSI Supplemental Security Income are considered to have an open SSI claim because they still meet the SSI disability requirements; such individuals continue to remain eligible for APA if they meet all other factors of eligibility. Individuals in SSI nonpay status must report to the SSA any change in their circumstances which might result in eligibility for SSI payments.

Example: Jim begins seasonal employment in May. His countable earnings make him ineligible for SSI payments and he goes into non-pay status with SSI . Jim’s APA case remains open because his income is still below the need standard. In September, the tourist season is winding down and his income goes below the SSI limit. Jim is referred to SSI and given 30 days to reopen his claim.

420-2 C. BENEFITS TO APA APPLICANTS PENDING AN SSI DECISION

APA applicants who are applying for both SSI a nd APA are not eligible for regular APA benefits while SSI is determining their eligibility. They may, however, be eligible for Interim Assistance payments until SSI makes a final decision on their eligibility. See manual section 426-2 .

420-2 D. BENEFITS TO APA RECIPIENTS PENDING AN SSI DECISION

APA recipients are required to pursue SSI benefits when they appear eligible. If an APA recipient is still deemed disabled and meets all other factors of eligibility, the recipient should be given 30 days to provide verification that they are pursuing SSI . If this mandatory verification is received by the due date, APA benefits continue until the Social Security Administration makes a decision . If they do not provide this verification by the due date, the APA case should be closed with 10-day notice of adverse action. Medicaid may continue if Medicaid eligibility requirements are still met. See ADLTC 530 .

If SSI finds the client eligible, adjust the APA case to reflect receipt of SSI benefits. If SSI finds the client ineligible for any reason except excess income, close the APA case and redetermine Medicaid eligibility.

If SSI denies the application solely because of excess income, the client may continue to be eligible for APA benefits if the client's income is within the APA limits and the client continues to meet all other factors of eligibility.

420-2 E. VERIFICATION OF PURSUIT OF SSI BENEFITS

An individual's application for and pursuit of SSI benefits may be verified in several different ways. Whenever possible, the case worker should use the client's own documents as the verification source. Examples of verification sources include:

Copies of any notice from SSA to the client which indicate the client is currently pursuing a claim;

Referral letter from SSA to DPA which indicates the client has filed an SSI claim;

SSI award letter;

Current SSI benefit check;

SDX interface match or paper printout which indicates a current SSI claim;

Response to a State Verification Exchange System ( SVES ) inquiry from SSA which indicates a current SSI claim.

If no acceptable documentary evidence is available to verify application for or pursuit of SSI benefits, a case worker may request information by fax machine or telephone the servicing SSA office and get verbal verification. Telephone contacts should be used only when no alternative verification source is reasonably available.

SSI will accept a written or oral request for benefits and establish the date of the request as a filing date for SSI benefits, but an SSI application is not considered to be received until a signed SSI application form is actually received by SSA . An individual who has not submitted a signed application to SSI has not complied with the APA requirement to apply for SSI benefits.