National Alliance on Mental Illness
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Switch From SSI To SSDI Does Not Mean Loss Of Medicaid
by Robert Bohlman, NAMI director of government relations

There is a little-known interaction between the Supplemental Security Income (SSI) program and the Social Security Disability Insurance (SSDI) program that is proving disruptive and disturbing to many NAMI consumers and families. It should not cause concern, however, because law requires the continuation of Medicaid when adult children who were disabled before age 22 are switched from SSI to SSDI under the conditions described below. (In some states a spend-down may be required.*)

Under Social Security Disability Insurance, there is a benefit to adult children with disabilities existing before age 22. When such a person's parent becomes disabled, retires, or dies, a payment based on this parent's earnings becomes payable to the adult child. This policy is intended to assure that each person covered by the Social Security Act receives the benefit(s) to which he/she is properly entitled.

Adult children are required to apply for this benefit within 30 days of the parent's disability, retirement, or death. SSDI then becomes the new primary income maintenance program for adult children who have previously participated in SSI. (If the SSDI payment is low enough, an adult child may continue receiving a reduced SSI payment as well.) Because SSI is intended to be a program of last resort, individuals must have first applied for all other public assistance to which they may be entitled, and must apply in the future for any to which they become entitled.

Many NAMI consumers and families believe-incorrectly-that switching from SSI to SSDI means losing Medicaid coverage. In fact, some people may actually have been given this misinformation by SSA or Medicaid staff. But a person no longer covered by SSI when their primary cash benefit source is switched to SSDI cannot lose Medicaid coverage. The Employment for Disabled Americans Act of 1986 (Public Law 99-643) requires states to continue Medicaid coverage when an individual who became disabled before age 22 and received SSI becomes eligible for SSDI or has an increase in SSDI benefits. Such disabled adult children continue to be considered SSI recipients for Medicaid purposes. Be aware that increased income from sources other than SSDI could make disabled adult children financially ineligible for Medicaid.

Persons with severe mental illnesses may at times be unable to respond to a notice from Social Security that they must apply for SSDI within 30 days. And, further, there may be inconsistency between Social Security Administration headquarters and area offices. NAMI is working with the SSA to solve these problems. Area Social Security office staff, the Health Care Financing Administration, and the states' Medicaid agencies should also be engaged so that the law is consistently and correctly implemented.

*In eleven states (Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia), continuing to be considered SSI recipients for purposes of Medicaid eligibility has different consequences. Even these states must, at minimum, permit a spend-down to "categorically needy" Medicaid status for such disabled adult children. Since the enactment of SSI in 1972, each of these states has had the right to administer a separate financial eligibility test for Medicaid, and each can decide whether to "disregard" the disabled adult child's SSDI income in whole or in part when calculating the financial threshold part of the eligibility criteria. They can also perform a separate disability determination. In all remaining thirty-nine states Medicaid participation is linked to SSI eligibility, though some (Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah) require a separate application.