SECTION 4. SUPPLEMENTAL SECURITY INCOME (SSI) -------------------------------------------------------------------------- The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 changed this program; see appendix L for details. --------------------------------------------------------------------------- CONTENTS Background Trends Basic Eligibility Categorical Requirements Citizenship and Residency Requirements Income and Resource Requirements Presumptive SSI Eligibility for Persons with AIDS and HIV Public Institution Requirement Application to Other Programs Requirement Eligibility for Social Security Eligibility for AFDC Eligibility for Medicaid Eligibility for Food Stamps Vocational Rehabilitation and Treatment and Monitoring Requirements 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 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 Legal Immigrants (Aliens) for SSI Eligibility of the Homeless Special SSI Provisions for the Working Disabled Earned Income Disregards Eliminating Work Disincentives Overview of Section 1619 Provisions Measures of SSI Participation Legislative History Legislative Changes Made in the 92d Congress Legislative Changes Made in the 93d Congress Legislative Changes Made in the 94th Congress Legislative Changes Made in the 96th Congress Legislative Changes Made in the 97th Congress Legislative Changes Made in the 98th Congress Legislative Changes Made in the 99th Congress Legislative Changes Made in the 100th Congress Legislative Changes Made in the 101st Congress Legislative Changes Made in the 103d Congress Legislative Changes Made in the 104th 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) and begun 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 persons in eligible categories 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 (Senate Report No. 92-1230, 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 SSI 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--particularly earned income--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 from their dependent situations (House Report No. 92-231, 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, corporation 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 areas 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 the Federal Government (i.e., the Social Security Administration). TRENDS Table 4-1 summarizes the trends in the SSI Program since its inception in 1974: 1. The number of recipients on SSI has risen from nearly 4 million in 1974 to 6.5 million in December 1995. 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-1980s as rapid growth in disabled recipients outstripped the minimal change in the elderly and blind SSI populations. TABLE 4-1.--SUPPLEMENTAL SECURITY INCOME SUMMARY, SELECTED YEARS 1974-95 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Year Item ------------------------------------------------------------------------------------------------------------------------------------- 1974 1978 1980 1984 1986 1988 1990 1991 1992 1993 1994 1995 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Recipients: \1\ Total............................................... 3,996,064 4,216,925 4,142,017 4,029,333 4,269,184 4,463,869 4,817,127 5,118,470 5,566,189 5,984,300 6,295,786 6,514,134 ------------------------------------------------------------------------------------------------------------------------------------- Aged.................................................. 2,285,909 1,967,900 1,807,776 1,530,289 1,473,428 1,433,420 1,454,041 1,464,684 1,471,022 1,474,852 1,465,905 1,446,122 Blind................................................. 74,616 77,135 78,401 80,524 83,115 82,864 83,686 84,549 85,400 85,456 84,911 83,545 Disabled.............................................. 1,635,539 2,171,890 2,255,840 2,418,522 2,712,641 2,947,585 3,279,400 3,569,237 4,009,767 4,424,022 4,744,470 4,984,467 Number with section 1619(a)............................... NA NA NA 406 (8/84) 992 (1/86) 19,920 \2\ 13,99 4 15,531 17,603 18,597 24,315 28,060 Number with section 1619(b)........................... NA NA NA 6,804 8,106 15,625 23,517 26,852 31,649 34,293 40,683 47,002 Annual payments (in millions): Total............................................... $5,246 $6,552 $7,940 $10,372 $12,081 $13,786 $16,599 $18,534 $22,238 $23,991 $25,870 $27,037 ------------------------------------------------------------------------------------------------------------------------------------- Federal benefits...................................... 3,833 4,881 5,866 8,281 9,498 10,734 12,894 14,765 18,247 20,722 22,175 23,919 Federal admin. State supp............................. 1,264 1,491 1,848 1,792 2,243 2,671 3,239 3,231 3,435 3,270 3,116 3,118 State admin. State supp............................... 149 180 226 299 340 381 466 538 \3\ 556 564 579 \4\ 620 ===================================================================================================================================== Annual payments (in millions of 1995 dollars)......... $17,034 $15,535 $15,024 $15,267 $16,740 $17,836 $19,526 $20,755 $24,174 $25,312 $26,596 $27,037 Monthly Federal benefits rates: Individuals........................................... $140.00 $177.80 $208.20 $314.00 $336.00 $354.00 $386.00 $407.00 $422.00 $434.00 $446.00 $458.00 Couples............................................... 210.00 266.70 312.30 472.00 504.00 532.00 579.00 610.00 633.00 652.00 687.00 687.00 Average Federal SSI payments: \1\ All Recipients........................................ $95.11 $111.98 $143.35 $196.16 $215.40 $227.49 $261.47 $286.03 $329.74 $317.41 $325.26 $358.40 Aged individuals...................................... 78.48 91.22 112.45 143.24 151.38 159.36 175.29 186.28 195.86 204.45 211.55 219.13 Aged couples.......................................... 93.02 120.48 157.56 221.98 246.07 273.18 322.82 414.26 448.61 478.42 505.64 534.00 Average federally administered: \1\ State supplementation................................. $70.92 $75.00 $99.15 $97.61 $115.41 $122.68 $139.79 $130.55 $118.08 $108.50 $101.46 $105.24 Income of recipients percent with: \1\ Social Security benefits.............................. 52.7 51.7 51.0 49.6 48.9 47.8 45.9 44.3 41.3 40.1 39.1 37.9 Other unearned income................................. 10.5 11.5 11.0 11.2 12.1 12.4 13.0 14.1 14.5 13.4 13.1 12.8 Earnings.............................................. 2.8 3.1 3.2 3.5 3.9 4.4 4.7 4.6 4.4 4.3 4.2 4.3 Average amount of: \1\ Social Security benefits.............................. $130.01 $156.50 $196.94 $250.61 $263.29 $286.49 $318.57 $329.19 $335.72 $338.85 $345.20 $354.47 Other unearned income................................. 61.10 66.93 74.35 84.56 86.40 85.92 98.13 94.71 91.96 100.44 101.13 105.32 Earnings.............................................. 80.00 99.32 106.95 126.47 142.17 173.09 195.64 206.86 207.55 210.22 225.01 234.94 Poverty thresholds (age 65 and over): Individual............................................ $2,364 $3,127 $3,949 $4,979 $5,255 $5,674 $6,268 $6,532 $6,729 $6,930 $7,108 $7,309 Couple................................................ 2,982 3,944 4,983 6,282 6,630 7,158 7,905 8,241 8,489 8,741 8,967 9,221 Federal benefit rate as a percent of poverty: Individual............................................ 74.1 72.7 72.3 75.6 76.7 74.9 73.9 74.8 75.3 75.2 75.3 75.2 Couple................................................ 88.1 86.4 86.0 90.2 91.2 89.2 87.9 88.8 89.5 89.5 89.5 89.4 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ \1\ December data. \2\ The decrease in 1619(a) participants in 1990 was caused by the increase in the substantial gainful activity level to $500 monthly. \3\ Fiscal year 1992 data. \4\ Fiscal year 1995 data. NA--Not available. Source: Social Security Administration (1995 and various years) and unpublished data. 2. Total annual benefits paid under the SSI Program rose from about $5.2 billion in 1974 to $27.0 billion in 1995. 3. The monthly Federal benefit rates for individuals and couples rose from $140 and $210 in 1974 to $470 and $705 in 1996 (1996 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 about 38 percent in 1995. The fraction of SSI recipients receiving some other type of unearned income rose from about 11 percent in 1974 to 13 percent in 1995, and the fraction with earnings increased from about 3 percent in 1974 to more than 4 percent in December 1995. 5. The Federal benefit rate as a percent of the appropriate poverty level for individuals has ranged from 72 to 77 percent and is currently 75 percent; for couples it has ranged from 86 to 91 percent and is currently at 89 percent. 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. 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'' is to earn $500 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. The child's impairment must be of severity comparable to that of an adult whose disability prevents him from working. The Supreme Court ruled in Sullivan v. Zebley (1990) that in determining the severity of a child's impairment, SSA must consider whether the limitations caused by the impairment substantially reduce the child's ability to do the things and behave in the ways that children of a similar age normally do. To be found disabled, children must have a medically determinable physical or mental impairment that substantially reduces their ability to function independently, and effectively engage in ``age-appropriate'' activities. This impairment must be expected to result in death or to last for a continuous period of not less than 12 months. To determine whether an adult is disabled, SSA compares the medical evidence to a ``Listing of Impairments'' that are presumed to be too severe to allow the individual to perform any ``substantial gainful activity'' (this listing also is used for Social Security Disability Insurance (DI) cases). If the individual has an impairment on the list, she qualifies for SSI benefits without further inquiry. If the individual's impairment is not on the list, SSA makes an individualized assessment to determine whether the person would be able to ``do his own past work or any other work that exists in the national economy given his age, education, and work experience.'' If the adult applicant cannot work based on these factors, she is eligible for SSI benefits. Before the 1990 Supreme Court ruling in Sullivan v. Zebley, SSA treated children in a different way. If the child's impairment did not match the listed impairment, the child was not eligible for SSI benefits. In contrast to adults, there was no additional functional assessment done. On February 20, 1990, the Supreme Court ruled in Sullivan v. Zebley that SSA's refusal to consider the functional limitations of children when assessing their SSI eligibility for disability benefits was ``manifestly contrary to the statute.'' On February 11, 1991, SSA published the revised regulations for determining whether a child is disabled. Under the disability determination process for children, individuals whose impairments do not meet or equal the ``Listing of Impairments'' in Federal regulations are subject to an individualized functional assessment (IFA). This assessment, established pursuant to the Zebley decision, examines whether the child can engage in ``age-appropriate'' activities effectively. If not, the child is determined to be disabled. Citizenship and Residency Requirements To qualify for SSI, a person must (1) be a U.S. citizen or an immigrant lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law and, (2) be a resident of the United States or the Northern Mariana Islands, or a blind or disabled child of military personnel stationed outside the United States, or a student temporarily abroad. Income and Resource Requirements Income Individuals and couples are eligible for SSI if their incomes fall below the Federal maximum monthly SSI benefit, currently $470 for an individual and $705 for a couple. 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 procedures is called ``deeming''). If a couple has been separated or living apart for over 6 months, each person is treated as an individual. If an unmarried child living at home is under age 18, some of the parent's income is deemed to that child. If an alien/immigrant is sponsored into the United States, some of the sponsor's income is 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 dollar-for-dollar reduction is made against the maximum payment. Not all income is counted for SSI purposes. Major exclusions include the first $20 of monthly income from virtually any source (such as Social Security benefits, but not needs-tested income such as veterans' pensions) 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 earned income exclusions. Table 4-2 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 4-2.--MAXIMUM INCOME FOR ELIGIBILITY FOR FEDERAL SSI BENEFITS, 1996 ---------------------------------------------------------------------------------------------------------------- Receiving only Social Receiving only wage Security income ----------------------------------------------- Monthly Annually Monthly Annually ---------------------------------------------------------------------------------------------------------------- Individual...................................................... $490 $5,800 $1,025 $12,300 Couple.......................................................... 725 8,700 1,495 17,940 ---------------------------------------------------------------------------------------------------------------- Source: Office of Supplemental Security Income, Social Security Administration. 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 her, the SSI benefit standard for such an individual is reduced by one-third. By regulation, SSA has also ruled that the value of any in-kind support and maintenance received (other than in the case of those receiving in-kind assistance 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 are also excluded from income. Assistance provided to an aged, blind, or disabled individual for the purpose of meeting home energy costs either in cash or in kind and which is furnished by a home heating oil or gas supplier or by a utility company is to be excluded. Assistance for home energy costs provided in-kind by a private nonprofit organization is also excluded. As countable income increases, a recipient's SSI benefit amount decreases. Ineligibility for SSI occurs when countable income equals the Federal benefit standard plus the amount of State supplementation, if any. Resources SSI eligibility is restricted to qualified persons who have resources/assets 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 has been separated or living independently for over 6 months, each person is treated as an individual. 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 is also 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 (plan for achieving self support) are also excluded. The cash surrender value of life insurance policies if the total face value of all policies on an individual's life is $1,500 or less are 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. Current law provides that as of July 1, 1988, an individual who gives away or sells any nonexcludable resource for less than fair market value will no longer be subject to a penalty for such a transfer. However, 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, etc. The purpose of the provision was to assist in alerting SSA of the potential ownership by SSI recipients of bank accounts in excess of the countable resources limit. In fiscal year 1987, computer matches between IRS tax files and SSI records resulted in 239,000 such 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, the matches totaled 508,000. 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 years 1994 and 1995 there were 297,000 and 181,000 matches, respectively. 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 it has 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 is also 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 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 personal needs allowance 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 1996 in a State with no supplementation, here is how the deeming procedure would work in the case of an ineligible spouse earning $550 per month living with an eligible individual with $200 of Social Security benefits: Unearned income of eligible individual..................... $200.00 Less $20 exclusion......................................... -20.00 ------------ Countable unearned income............................ 180.00 ============ Earned income of ineligible individual..................... 550.00 Less $65 earned income disregard........................... -65.00 Less one-half of remaining earnings ($485)................. -242.50 ------------ Countable earned income.............................. 242.50 Plus countable unearned income............................. 180.00 ------------ Couple's total countable income...................... 422.50 ============ SSI payment standard for couples........................... 705.00 Less countable income...................................... -422.50 ------------ Benefit payable to eligible individual............... 282.50 Thus, the benefit for the eligible individual will be $282.50. Without deeming and as an individual, the recipient would have received $290 [$470-($200 less $20 exclusion)]. The $20 exclusion can only be used once and is first applied 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 1995, there were about 109,000 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. In determining the eligibility of aliens applying for SSI, the income and resources of their sponsors are considered. After income and resources allowances for the needs of the sponsors and income allowances for their dependents, the remainder is deemed available for the support of the alien applicant. Prior to January 1, 1994, the remainder was deemed available for a 3-year period after the alien's entry into the United States. Effective January 1, 1994, through September 30, 1996, the remainder is deemed available for a 5-year period after the alien's entry into the United States. Under current law, the deeming period will revert to 3 years again on October 1, 1996. This provision does not apply to those who become blind or disabled after admission as a permanent resident, to refugees, and to persons granted political asylum. Presumptive SSI Eligibility for Persons with AIDS and HIV SSI law permits benefits to be paid to a person applying for SSI benefits on the basis of disability or blindness before a formal determination of disability or blindness has been made when available information indicates a high probability that the person is disabled or blind and the person is otherwise eligible. 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 SSI based on disability or blindness prior to the determination of the individual's disability or blindness 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) they may be made for any impairment category. On February 11, 1985, Acquired Immunodeficiency 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, not only to those who have been diagnosed with AIDS. The Social Security Administration 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 are therefore excluded. Others have argued that the Center for Disease Control definition and the somewhat broader SSA listing have failed to keep pace with changing manifestations of HIV disease. Public Institution Requirement In general, public institutions are prisons, hospitals, nursing homes, or any institution that is operated or administered by a governmental unit. This 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, Overview of Section 1619 Provisions'') 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 he 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. APPLICATION TO OTHER PROGRAMS REQUIREMENT Since SSI payments are reduced by other income, applicants and recipients must apply for any other money benefits due them. SSA works with recipients and helps them get any other benefits for which they are eligible. Eligibility for Social Security As noted, SSI law requires that SSI applicants file for all other benefits for which they may be entitled. 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 1995, 38 percent of all SSI recipients also received Social Security benefits (63 percent of the aged, 31 percent of the disabled, and 36 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 Aid to Families with Dependent Children (AFDC) An individual cannot receive both SSI payments and AFDC benefits and, if eligible for both, must choose which benefit to receive. Generally, the AFDC agency encourages individuals to file for SSI and, once the SSI payments start, the individual is removed from the AFDC filing unit. 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, 1996, 32 States and the District of Columbia chose this option, and SSI recipients in these States account for approximately 78 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. The seven States of Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah and the Commonwealth of the Northern Mariana Islands affecting about 2.6 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/or 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, regardless of whether or not the State has a medically needy program. As of January 1, 1996, 11 States use the 209(b) option for Medicaid coverage of aged, blind, and disabled SSI recipients. About 19.3 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 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 special section on ``Special SSI Provisions for the Working Disabled, Overview of Section 1619 Provisions''). The same legislation required States to provide for continued Medicaid coverage for those individuals who lose their 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 became disabled as a child (disabled adult child) or because of an increase in their benefits as an adult who became 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 Hospital Insurance. This provision has been effective since January 1, 1991. 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. VOCATIONAL REHABILITATION AND TREATMENT AND MONITORING REQUIREMENTS 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. Public Law 104-121, enacted in 1996, includes provisions which prohibit SSI and disability insurance eligibility for individuals whose drug addiction or alcoholism is a contributing factor material to the finding of disability. This law stipulates that recipients who are disabled due to another impairment, and who are determined by the Commissioner of Social Security to also have drug or alcohol problems are to be paid benefits via a representative payee and are to be referred for treatment. Previously, persons who were disabled because of drug addiction or alcoholism were required to accept appropriate treatment for their conditions as a condition of SSI eligibility. SSI BENEFITS Federal SSI Benefit Standard The Federal SSI benefit standard for an individual for 1996 is $470 a month and $705 for a couple. As is discussed later, most States supplement the Federal SSI benefit. The result is a combined Federal SSI/State supplemented benefit 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 need--especially special housing needs. In September 1995, 321,887 persons, or 5.0 percent of all SSI recipients, were eligible for benefits only because (federally administered) State supplementation increased the benefit. The Federal SSI benefits are indexed to the Consumer Price Index (CPI) and by the same percentage as Social Security benefits. This 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 COLA's from July 1983 to January 1984. However, in lieu of a COLA increase in the SSI benefit standard in July 1983, the Federal SSI benefit was increased in July, 1983, by $20 a month for an individual and $30 a month for a couple. Table 4-3 shows the Federal SSI benefit from the beginning of the SSI Program until the present time. Benefits for Persons Living in the Household of Another The SSI law provides that if an SSI 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 4-3, the Federal SSI benefit in 1996 for those determined to be living in the household of another is $313.34 for an individual and $470 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 September 1995, 4.6 percent, or about 298,800 SSI recipients, had their benefits determined on the basis of this ``one-third reduction'' benefit standard. Sixty-three percent of those recipients were receiving benefits on the basis of disability (see table 4-4). TABLE 4-3.--FEDERAL SSI BENEFIT LEVELS, 1974-96 [In dollars] ---------------------------------------------------------------------------------------------------------------- Eligibility status ---------------------------------------------------------------------- Own household Household of another Year Medicaid --------------------------------------------------------- institution Essential Essential Single Couple person Single Couple person ---------------------------------------------------------------------------------------------------------------- Initial.................................. 25.00 130.00 195.00 65.00 86.67 130.00 43.34 Jan. 1974................................ 25.00 140.00 210.00 70.00 93.34 140.00 46.67 July 1974................................ 25.00 146.00 219.00 73.00 97.34 146.00 48.67 July 1975................................ 25.00 157.70 236.60 78.90 105.14 157.74 52.60 July 1976................................ 25.00 167.80 251.80 84.00 111.87 167.87 56.00 July 1977................................ 25.00 177.80 266.70 89.00 118.54 177.80 59.34 July 1978................................ 25.00 189.40 284.10 94.80 126.27 189.40 63.20 July 1979................................ 25.00 208.20 312.30 104.20 138.80 208.20 69.47 July 1980................................ 25.00 238.00 357.00 119.20 158.67 238.00 79.47 July 1981................................ 25.00 264.70 397.00 132.60 176.47 264.67 88.40 July 1982................................ 25.00 284.30 426.40 142.50 189.54 284.27 95.00 July 1983................................ 25.00 304.30 456.40 152.50 202.87 304.27 101.67 Jan. 1984 \1\............................ 25.00 314.00 472.00 157.00 209.34 314.67 104.67 Jan. 1985................................ 25.00 325.00 488.00 163.00 216.67 325.34 108.67 Jan. 1986................................ 25.00 336.00 504.00 168.00 224.00 336.00 112.00 Jan. 1987................................ 25.00 340.00 510.00 170.00 226.67 340.00 113.34 Jan. 1988................................ 25.00 354.00 532.00 177.00 236.00 354.67 118.00 Jan. 1989................................ 30.00 368.00 553.00 184.00 245.34 368.67 122.67 Jan. 1990................................ 30.00 386.00 579.00 193.00 257.34 386.00 128.67 Jan. 1991................................ 30.00 407.00 610.00 204.00 271.34 406.67 136.00 Jan. 1992................................ 30.00 422.00 633.00 211.00 281.34 422.00 140.67 Jan. 1993................................ 30.00 434.00 652.00 217.00 289.34 434.67 144.67 Jan. 1994................................ 30.00 446.00 669.00 223.00 297.34 446.00 148.67 Jan. 1995................................ 30.00 458.00 687.00 229.00 305.34 458.00 152.66 Jan. 1996................................ 30.00 470.00 705.00 235.00 313.34 470.00 152.57 ---------------------------------------------------------------------------------------------------------------- \1\ Cost-of-living adjustments to Federal SSI benefit levels are rounded to the next lower whole dollar beginning with the increase effective January 1984. Source: Office of Research and Statistics, Social Security Administration. Of the 25 States and the District of Columbia that provide optional supplements to the Federal SSI benefit, 9 States and the District of Columbia provide the same amount of supplementation for those whose Federal SSI benefit amount is determined on the basis of the ``one-third reduction.'' Eight States provide a higher State supplementation for such recipients; in six States the amount of State supplementation is less; two States provide no supplementation for those recipients; and one State's supplementation varies depending upon need. 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 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 Federal PNA benefit of $25 was increased to $30 a month on July 1, 1988--the first increase since the SSI Program began in 1974. The annual cost-of-living increase for SSI does not apply to the personal needs allowance. The 1987 Budget Reconciliation Act does, however, provide 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. TABLE 4-4.--NUMBER AND PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS, BY LIVING ARRANGEMENT AND CATEGORY, SEPTEMBER 1995 ------------------------------------------------------------------------ Reason for eligibility Living arrangement \1\ Total ------------------------------ Aged Blind Disabled ------------------------------------------------------------------------ Own household................. 93.0 90.2 92.2 93.8 Another's household........... 4.6 7.4 4.9 3.8 Institutional care covered by Medicaid..................... 2.4 2.4 2.9 2.4 ----------------------------------------- Total percent................. 100.0 100.0 100.0 100.0 ========================================= Total number.............. 6,495,422 1,454,554 84,553 4,956,315 ------------------------------------------------------------------------ \1\ As used for determination of Federal SSI payment standard. Source: Office of Research and Statistics, Social Security Administration. Approximately 155,890 or 2.4 percent of SSI recipients received benefits in September, 1995, on the basis of this personal needs allowance. 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 them (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. Sixteen 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 1995, California, the District of Columbia, Maine, Massachusetts, Michigan, New Jersey, New York, Rhode Island, Vermont, and Washington had opted for Federal administration. Approximately 28 States allow some or all of those individuals affected by the Medicaid personal needs allowance regulations to retain more than $30 a month. Benefits of Former Recipients of State Assistance Another benefit affecting some persons involves Federal payments to an individual who was transferred to SSI from a former State program of aid to the aged, blind or disabled. The Federal benefits of these persons are increased by up to $235 monthly in 1996 to take into account an ``essential person'' living in the household. Essential persons are persons (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 to 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 a limit on the rate that overpayments made to SSI recipients can be recovered. 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 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. In fiscal year 1995, Social Security offices made 6,212 emergency advance payments in these new claims situations totaling $2,745,349 with an average payment amount of $441. Beginning in October 1985, local Social Security offices were given the authority to make ``immediate payments'' for certain Social Security and SSI cases when it is found that benefits are 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 bank drafts prepared by the local field office. Payments are limited to the maximum per beneficiary of $400 or the amount due, whichever is less, once in a 30-day period. The person's eligibility for benefits must be verified by the local office and payment approved by the office manager. During fiscal year 1995, 55,671 Social Security and 42,123 SSI immediate payments were issued under this procedure. The total amount of these payments equalled $34,114,510 for an average of $348 per payment. State Supplementation Mandatory State supplementation State supplementary payments are required by law to maintain income levels of former public 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 a result of the change from former State adult assistance programs to the SSI Program. 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 his or her other income. Thus, States must provide a supplementary payment to any individual who, because of special needs or other reasons, had a December 1973 payment higher than 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 December 1995, approximately 3,200 recipients or less than 0.1 percent of all recipients were receiving payments based in part or solely because of 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 eight 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, Texas, and West Virginia. States (or local jurisdictions) may elect to administer their supplementary payments themselves or may contract with SSA for Federal administration. Sixteen States and the District of Columbia have contracted with SSA to administer the State optional supplementation program. Since the SSI Program began in 1974, seven States have shifted from Federal to State administration of their optional State supplementation program. 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 population 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 $458 and $470 a month in 1995 and 1996, respectively, and often more than the combined Federal and SSI State supplementation for those classified as living independently. 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 a variety of other terms. The amount of supplementation by the State also varies a great deal. For example, in the State of Maryland under a State-administered supplementation program, a ``specialized and intensive supervision'' group living facility has a State supplementation of $666 a month in addition to the Federal benefit level of $470. The total Federal and State SSI payment in a month is $1,136. In one State, 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 is also partially met by direct State funding of the staff. In a number of States, the State makes 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 ``personal needs allowance'' 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 (i.e., from October 1, 1993 through September 30, 1994), a State with federally administered supplementary payments pays the Commissioner an administration fee of $1.67 per payment. The rate per payment changes 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. State SSI supplement levels over time Throughout the entire period from July 1975 to January 1996, 23 States have continuously provided supplemental SSI payments to aged individuals living independently, and 21 States continuously supplemented SSI payments to aged couples living independently. During the period from July 1975 to January 1996, no State increased supplements faster than inflation for aged individuals living independently (see table 4-5). Among the States which have supplemented SSI payments for aged couples living independently, only Alaska and Minnesota have kept their supplemental increases equivalent to or higher than inflation (see table 4-6). Other States have allowed inflation to erode the purchasing power of supplements or have reduced them in the face of State fiscal problems. Approximately 45 percent of SSI recipients receive 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 $2 a month to $362 a month for an individual. At present, 25 States and the District of Columbia supplement the Federal standard for individuals living independently. The District of Columbia, South Dakota, Utah, and Wyoming all began supplementing SSI payments to individuals between 1975 and 1980. TABLE 4-5.--STATE SSI SUPPLEMENTS FOR AGED INDIVIDUALS WITHOUT COUNTABLE INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-96 -------------------------------------------------------------------------------------------------------------------------------------------------------- Percent change State July July Jan. Jan. Jan. Jan. Jan. Jan. Jan. Jan. Jan. (constant 1975 1980 1985 1988 1990 1991 1992 1993 1994 1995 1996 dollars) 1975-96 \1\ -------------------------------------------------------------------------------------------------------------------------------------------------------- Alaska \2\................................................... $142 $235 $261 $305 $331 $349 $362 $374 $362 $362 $362 -11 California................................................... 101 182 179 221 244 223 223 186 157 157 156 -46 Colorado..................................................... 27 55 58 58 54 45 56 56 56 56 56 -27 Connecticut \3\.............................................. NA 102 141 403 366 359 325 313 301 NA \3\ N A NA District of Columbia......................................... 0 15 15 15 15 15 15 15 15 5 5 NA Hawaii....................................................... 17 15 5 5 5 5 5 5 5 5 5 -90 Idaho........................................................ 63 74 78 73 73 70 70 65 45 37 37 -79 Illinois \3\................................................. NA NA NA NA NA NA NA NA NA NA NA NA Maine........................................................ 10 10 10 10 10 10 10 10 10 10 10 -65 Massachusetts................................................ 111 137 129 129 129 129 129 129 129 129 126 -60 Michigan..................................................... 12 24 27 30 30 31 14 14 14 14 14 -59 Minnesota \4\................................................ 31 34 35 35 75 81 81 81 81 81 81 -8 Nebraska..................................................... 67 75 69 43 38 24 30 28 21 19 12 -94 Nevada....................................................... 55 47 36 36 36 36 36 36 36 36 36 -77 New Hampshire................................................ 12 46 27 27 27 27 27 27 27 27 27 -21 New Jersey................................................... 24 23 31 31 31 31 31 31 31 31 31 -55 New York..................................................... 61 63 61 72 86 86 86 86 86 86 86 -51 Oklahoma..................................................... 27 79 60 64 64 64 64 60 57 55 54 -30 Oregon....................................................... 17 12 2 2 2 2 2 2 2 2 2 -96 Pennsylvania................................................. 20 32 32 32 32 32 32 32 32 32 27 -53 Rhode Island................................................. 31 42 54 58 64 64 67 64 64 64 64 -28 South Dakota................................................. 0 15 15 15 15 15 15 15 15 15 15 NA Utah......................................................... 0 10 10 9 6 6 5 5 1 0 0 NA Vermont...................................................... 29 41 53 59 63 65 65 57 55 59 47 -43 Washington \5\............................................... 36 43 38 28 28 28 28 28 28 28 25 -76 Wisconsin.................................................... 70 100 100 103 103 103 93 93 85 84 84 -58 Wyoming...................................................... 0 20 20 20 20 20 20 10 10 10 10 NA ------------------------------------------------------------------------------------------ Median..................................................... 31 43 36 36 37 36 32 31 31 32 27 -69 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ The percentage change in constant dollars was computed by inflating July 1975 to January 1996 by the CPI-U price index. The July 1975 index value is 54.2 and the January 1996 value is 154.4. \2\ 1975 and 1980--less if shelter costs less than $35 monthly. \3\ State decides benefit on a case-by-case basis. \4\ State has two geographic payment levels--Hennepin County and the remainder of Minnesota. Level shown is for Hennepin County, the area with the largest number of SSI recipients. \5\ State has two geographic payment levels--highest levels are shown in table. Sum paid in King, Pierce, Kitsap, Snohomish, and Thurston Counties. NA--Not available. Source: Office of Supplemental Security Income, Social Security Administration, and Committee on Ways and Means staff calculations. TABLE 4-6.--STATE SSI SUPPLEMENTS FOR AGED COUPLES WITHOUT COUNTABLE INCOME LIVING INDEPENDENTLY, SELECTED YEARS 1975-96 -------------------------------------------------------------------------------------------------------------------------------------------------------- Percent change State July July Jan. Jan. Jan. Jan. Jan. Jan. Jan. Jan. Jan. (constant 1975 1980 1985 1988 1990 1991 1992 1993 1994 1995 1996 dollars) 1975-96 \1\ -------------------------------------------------------------------------------------------------------------------------------------------------------- Alabama...................................................... $9 0 0 0 0 0 0 0 0 0 0 -100 Alaska \2\................................................... 183 $338 $371 $444 $484 $510 $528 $544 $528 $528 528 1 California................................................... 251 389 448 534 588 557 557 488 440 415 396 -45 Colorado..................................................... 133 229 278 292 309 293 323 328 323 323 323 -15 Connecticut \3\.............................................. NA NA 86 602 525 522 461 442 425 NA \3\ N A NA District of Columbia......................................... 0 30 30 30 30 30 30 30 30 15 15 NA Hawaii....................................................... 28 24 9 9 9 9 9 9 9 9 9 -89 Idaho........................................................ 49 80 46 44 45 44 45 40 21 9 9 -94 Illinois \3\................................................. NA NA NA NA NA NA NA NA NA NA NA NA Maine........................................................ 15 15 15 15 15 15 15 15 15 15 15 -65 Massachusetts................................................ 173 214 202 202 202 202 202 202 202 202 197 -60 Michigan..................................................... 18 36 40 45 45 46 21 21 21 28 28 -45 Minnesota \4\................................................ 38 44 66 66 88 132 129 126 126 126 111 3 Nebraska..................................................... 67 114 100 66 65 34 48 39 40 22 14 -93 Nevada....................................................... 106 90 74 74 74 74 74 74 74 74 74 -76 New Hampshire................................................ 0 42 21 21 21 21 21 21 21 21 22 NA New Jersey................................................... 13 12 25 25 25 25 25 25 25 25 25 -33 New York..................................................... 76 79 76 93 102 103 103 102 102 102 103 -52 Oklahoma..................................................... 54 158 120 128 128 128 128 120 114 110 108 -30 Oregon....................................................... 17 10 0 0 0 0 0 0 0 0 0 -100 Pennsylvania................................................. 30 49 49 49 49 49 49 49 49 49 44 -49 Rhode Island................................................. 59 79 102 111 120 121 127 120 120 120 121 -28 South Dakota................................................. 0 15 15 15 15 15 15 15 15 15 15 NA Utah......................................................... 0 20 20 18 12 12 11 10 5 5 5 NA Vermont...................................................... 61 76 96 106 115 118 118 110 103 110 92 -47 Washington \5\............................................... 40 44 37 22 22 22 22 22 22 22 20 -82 Wisconsin.................................................... 105 161 161 166 166 166 146 146 134 132 132 -56 Wyoming...................................................... 0 40 40 40 40 40 40 19 19 25 25 NA ------------------------------------------------------------------------------------------ Median..................................................... 57 63 66 66 65 49 49 30 39 28 25 -85 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ The percentage change in constant dollars was computed by inflating July 1975 to January 1996 by the CPI-U price index. The July 1975 index value is 54.2 and the January 1996 value is 154.4. \2\ 1975 and 1980--less if shelter costs less than $35 monthly. \3\ State decides benefit on a case-by-case basis. \4\ State has various geographic payment levels. Level shown is for Hennepin County, the area with the largest number of SSI recipients. \5\ State has two geographic payment levels--highest levels are shown in table. Sum paid in King, Pierce, Kitsap, Snohomish, and Thurston Counties. NA--Not available. Source: Office of Supplemental Security Income, Social Security Administration. Maximum SSI and Food Stamp Benefits For Individuals Living Independently Table 4-7 for individuals and table 4-8 for couples illustrate the maximum potential payment from Federal SSI, State supplements, and food stamps for persons with no income, by State. These tables assume that the elderly individual or couple receive an excess shelter deduction of $247 (the maximum for nonelderly) and an excess medical cost deduction of $14 in the Food Stamp Program. Approximately 62 percent of SSI households in the Food Stamp Program claim a shelter deduction; it is estimated that approximately 17 percent of them are allowed a deduction that exceeds the excess shelter expense ceiling for nonelderly or nondisabled households ($247 per month). About 4 percent of SSI households claim a medical cost deduction. TABLE 4-7.--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED INDIVIDUALS LIVING INDEPENDENTLY, JANUARY 1996 \1\ ---------------------------------------------------------------------------------------------------------------- Combined benefits State Maximum SSI Food stamp ------------------- benefit benefit \2\ Monthly Annual ---------------------------------------------------------------------------------------------------------------- Alabama.......................................................... $470 $93 $563 $6,756 Alaska........................................................... 832 102 934 11,208 Arizona.......................................................... 470 93 563 6,756 Arkansas......................................................... 470 93 563 6,756 California....................................................... 626 \3\ 0 626 7,512 Colorado......................................................... 526 76 602 7,224 Connecticut...................................................... \4\ NA NA NA NA Delaware......................................................... 470 93 563 6,756 District of Columbia............................................. 475 92 567 6,804 Florida.......................................................... 470 93 563 6,756 Georgia.......................................................... 470 93 563 6,756 Hawaii........................................................... 475 198 673 8,076 Idaho............................................................ \5\ 507 88 595 7,140 Illinois......................................................... \6\ NA NA NA NA Indiana.......................................................... 470 93 563 6,756 Iowa............................................................. 470 93 563 6,756 Kansas........................................................... 470 93 563 6,756 Kentucky......................................................... 470 93 563 6,756 Louisiana........................................................ 470 93 563 6,756 Maine............................................................ 480 90 570 6,840 Maryland......................................................... 470 93 563 6,756 Massachusetts.................................................... 596 55 651 7,812 Michigan......................................................... 484 89 573 6,876 Minnesota........................................................ \7\ 551 69 620 7,440 Mississippi...................................................... 470 93 563 6,756 Missouri......................................................... 470 93 563 6,756 Montana.......................................................... 470 93 563 6,756 Nebraska......................................................... 482 89 571 6,852 Nevada........................................................... 506 82 588 7,056 New Hampshire.................................................... 497 85 582 6,984 New Jersey....................................................... 501 84 585 7,020 New Mexico....................................................... 470 93 563 6,756 New York......................................................... 556 67 623 7,476 North Carolina................................................... 470 93 563 6,756 North Dakota..................................................... 470 93 563 6,756 Ohio............................................................. 470 93 563 6,756 Oklahoma......................................................... 524 77 601 7,212 Oregon........................................................... 472 92 564 6,768 Pennsylvania..................................................... 497 85 582 6,984 Rhode Island..................................................... 534 74 608 7,296 South Carolina................................................... 470 93 563 6,756 South Dakota..................................................... 485 89 574 6,888 Tennessee........................................................ 470 93 563 6,756 Texas............................................................ 470 93 563 6,756 Utah............................................................. 470 93 563 6,756 Vermont.......................................................... \8\ 517 79 596 7,152 Virginia......................................................... 470 93 563 6,756 Washington....................................................... \9\ 495 86 581 6,972 West Virginia.................................................... 470 93 563 6,756 Wisconsin........................................................ 554 68 622 7,464 Wyoming.......................................................... 480 90 570 6,840 ---------------------------------------------------------------------------------------------------------------- \1\ In most States these maximums apply also to blind or disabled SSI recipients who are living in their own households; but some States provide different benefit schedules for each category. \2\ For one-person households, maximum food stamp benefits from October 1995 through September 1996 are $119 in the 48 contiguous States and the District of Columbia, $153 in Alaska (urban areas, benefit levels in rural Alaska are increased by about 50 percent to account for higher food prices in such areas), and $198 in Hawaii. For the 48 contiguous States and the District of Columbia, the calculation of benefits assumes: (1) a ``standard'' deduction of $134 per month; (2) an excess shelter deduction of $247 per month (the maximum allowable for nonelderly, nondisabled households); and (3) an excess medical expense deduction of $4 monthly (estimated from 1993 medical expense information). If smaller excess shelter costs were assumed, food stamp benefits would be smaller. For Alaska and Hawaii, higher deduction levels were used, as provided by law ($662 and $546, respectively, for combined standard and excess shelter allowance). \3\ SSI recipients in California are ineligible for food stamps. California provides increased cash aid in lieu of stamps. \4\ Individual budget process. \5\ State disregards $20 of SSI payment in determining the State supplementary payment. \6\ State decides benefits on case-by-case basis. \7\ Payment level for Hennepin County. State has two geographic payment levels--one for Hennepin County and the other for the remainder of the State. \8\ State has two geographic payment levels--highest are shown in table. \9\ Sum paid in King, Pierce, Kitsap, Snohomish, and Thurston Counties. NA--Not available. Source: Table prepared by the Congressional Research Service (CRS) based on data from the Social Security Administration. TABLE 4-8.--MAXIMUM POTENTIAL SSI AND FOOD STAMP BENEFITS FOR AGED COUPLES LIVING INDEPENDENTLY, JANUARY 1996 \1\ ---------------------------------------------------------------------------------------------------------------- Combined benefits State Maximum SSI Food stamp ------------------- benefit benefit \2\ Monthly Annual ---------------------------------------------------------------------------------------------------------------- Alabama.......................................................... $705 $122 $827 $9,924 Alaska........................................................... 1,233 108 1,341 16,092 Arizona.......................................................... 705 122 827 9,924 Arkansas......................................................... 705 122 827 9,924 California....................................................... 1,101 \3\ 0 1,101 13,212 Colorado......................................................... 1,028 25 1,053 12,636 Connecticut...................................................... \4\ NA NA NA NA Delaware......................................................... 705 122 827 9,924 District of Columbia............................................. 720 117 837 10,044 Florida.......................................................... 705 122 827 9,924 Georgia.......................................................... 705 122 827 9,924 Hawaii........................................................... 714 313 1,027 12,324 Idaho............................................................ \5\ 714 125 839 10,068 Illinois......................................................... \6\ NA NA NA NA Indiana.......................................................... 705 122 827 9,924 Iowa............................................................. 705 122 827 9,924 Kansas........................................................... 705 122 827 9,924 Kentucky......................................................... 705 122 827 9,924 Louisiana........................................................ 705 122 827 9,924 Maine............................................................ 720 117 837 10,044 Maryland......................................................... 705 122 827 9,924 Massachusetts.................................................... 902 62 964 11,568 Michigan......................................................... 733 113 846 10,152 Minnesota........................................................ \7\ 816 88 904 10,848 Mississippi...................................................... 705 122 827 9,924 Missouri......................................................... 705 122 827 9,924 Montana.......................................................... 705 122 827 9,924 Nebraska......................................................... 719 117 836 10,032 Nevada........................................................... 779 99 878 10,536 New Hampshire.................................................... 727 115 842 10,104 New Jersey....................................................... 730 114 844 10,128 New Mexico....................................................... 705 122 827 9,924 New York......................................................... 808 91 899 10,788 North Carolina................................................... 705 122 827 9,924 North Dakota..................................................... 705 122 827 9,924 Ohio............................................................. 705 122 827 9,924 Oklahoma......................................................... 813 89 902 10,824 Oregon........................................................... 705 122 827 9,924 Pennsylvania..................................................... 749 108 857 10,284 Rhode Island..................................................... 826 85 911 10,932 South Carolina................................................... 705 122 827 9,924 South Dakota..................................................... 720 117 837 10,044 Tennessee........................................................ 705 122 827 9,924 Texas............................................................ 705 122 827 9,924 Utah............................................................. 710 120 830 9,960 Vermont.......................................................... \8\ 797 94 891 10,692 Virginia......................................................... 705 122 827 9,924 Washington....................................................... \9\ 725 115 840 10,080 West Virginia.................................................... 705 122 827 9,924 Wisconsin........................................................ 837 82 919 11,028 Wyoming.......................................................... 730 114 844 10,128 ---------------------------------------------------------------------------------------------------------------- \1\ In most States these maximums apply also to blind or disabled SSI recipients who are living in their own households; but some States provide different benefit schedules for each category. \2\ For two-person households, maximum food stamp benefits from October 1995 through September 1996 are $218 in the 48 contiguous States and the District of Columbia, $280 in Alaska (urban areas, benefit levels for rural Alaska are about 50 percent higher to account for high food prices in such areas), and $364 in Hawaii. For the 48 contiguous States and the District of Columbia, the calculation of benefits assumes: (1) a ``standard'' deduction of $134 per month, (2) an excess shelter deduction of $247 per month (the maximum allowable for nonelderly, nondisabled households); and (3) an excess medical expense deduction of $4 monthly (estimated from 1993 medical expense information). If smaller excess shelter costs were assumed, food stamp benefits would be smaller. For Alaska and Hawaii, higher deduction levels were used, as provided by law ($662 and $546, respectively, for combined standard and excess shelter allowance). \3\ SSI recipients in California are ineligible for food stamps. California provides increased cash aid in lieu of stamps. \4\ Individual budget process. \5\ State disregards $20 monthly of SSI income in determining the State supplementary payment amounts. \6\ State decides benefits on case-by-case basis. \7\ Payment level for Hennepin County. State has two geographic payment levels--one for Hennepin County and one for the remainder of the State. \8\ State has two geographic payment levels--highest levels are shown in table. \9\ Sum paid in King, Pierce, Kitsap, Snohomish, and Thurston Counties. NA--Not available. Source: Table prepared by the Congressional Research Service (CRS) based on data from the Social Security Administration. Comparison of SSI Payment Levels to Poverty Thresholds Table 4-9 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, the 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 75 percent in 1984 and 1985 compared to 71 percent in the 1975 to 1982 period. In 1996, benefit levels were 77.2 percent of the poverty level. TABLE 4-9.--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 1975-96 -------------------------------------------------------------------------------------------------------------------------------------------------------- Calendar year Poverty threshold and benefits -------------------------------------------------------------------------------------------------- 1975 1980 1984 1986 1988 1990 1991 1992 1993 1994 1996 -------------------------------------------------------------------------------------------------------------------------------------------------------- Poverty threshold.................................... 2,572 3,941 4,980 5,255 5,672 6,268 6,532 6,729 6,930 7,107 7,309 Federal SSI benefits: Dollars per year................................. 1,822 2,677 3,768 4,032 4,248 4,632 4,884 5,064 5,208 5,352 5,640 Percent of poverty............................... 70.8 72.3 75.6 76.7 74.9 73.9 74.8 75.3 75.2 75.3 77.2 Federal SSI and Social Security: Dollars per year................................. 2,062 2,917 4,008 4,272 4,488 4,872 5,124 5,304 5,448 5,592 5,880 Percent of poverty............................... 80.2 74.0 80.5 81.3 79.1 77.7 78.4 78.8 78.6 78.7 80.4 Federal SSI, Social Security, and food stamps: \1\ Dollars per year................................. 2,350 3,345 4,294 4,488 4,848 5,318 5,580 5,820 5,952 6,072 6,372 Percent of poverty............................... 91.4 84.9 86.2 85.4 85.5 84.8 85.4 86.5 85.9 85.4 87.2 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ In computing the food stamp benefit for 1975, average deductions among all elderly households are assumed. For later years (except 1996), the applicable standard deduction plus average shelter and medical deductions among all elderly households is assumed. For 1996, the applicable standard deduction plus average shelter and medical deductions among all SSI households is assumed. Source: Congressional Research Service. Table 4-10 presents the same information for a couple. The SSI benefit for a couple is 91.7 percent of the poverty threshold in 1996. TRENDS IN THE SSI CASELOAD Number of Recipients As shown in table 4-11, in September 1995, 6.495 million persons received federally administered SSI payments. Of these, 1.455 million received federally administered payments on the basis of being aged, 4.956 million on the basis of being disabled, and 84,553 on the basis of blindness. However, 666,890 of those receiving benefits on the basis of disability or blindness were over the age of 65. Table 4-11 also indicates that approximately 4 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 321,887 received State supplements only. Table 4-12 shows the trends in the numbers of persons receiving federally administered SSI payments from December, 1975, through September, 1995, 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 12 years the number of SSI recipients has increased from about 3.9 million to more than 6.5 million, an increase of over 65 percent. Characteristics of Adult Disabled and Blind Recipients Major disabling diagnosis.--As shown in table 4-13, of the SSI disabled ages 18-64, 28.2 percent were eligible on the basis of mental retardation and 31 percent on the basis of other mental disorders. Therefore, over one-half of all SSI disabled recipients are eligible on the basis of a mental disability. The next three largest categories are: diseases of the nervous system and sense organs--10.0 percent; diseases of musculoskeletal and connective tissues--7.1 percent; and diseases of the circulatory system--5.0 percent. In December 1994, 1.3 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.--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 4-14, 16.2 percent of the SSI adult population receiving benefits on the basis of disability are age 65 or over (27.5 percent of the blind were age 65 or over). TABLE 4-10.--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: 1975-96 -------------------------------------------------------------------------------------------------------------------------------------------------------- Calendar year Poverty threshold and benefits -------------------------------------------------------------------------------------------------- 1975 1980 1984 1986 1988 1990 1991 1992 1993 1994 1996 -------------------------------------------------------------------------------------------------------------------------------------------------------- Poverty threshold.................................... 3,232 4,954 6,280 6,628 7,156 7,906 8,238 8,489 8,741 8,964 9,221 Federal SSI benefits: Dollars per year................................. 2,734 4,016 5,664 6,048 6,384 6,948 7,320 7,596 7,824 8,028 8,460 Percent of poverty............................... 84.6 81.1 90.2 91.2 89.2 87.9 88.9 89.5 89.5 89.6 91.7 Federal SSI and Social Security: Dollars per year................................. 2,974 4,256 5,904 6,288 6,624 7,188 7,560 7,836 8,064 8,268 8,700 Percent of poverty............................... 92.0 86.0 94.0 94.9 92.6 90.9 91.8 92.3 92.3 92.2 94.3 Federal SSI, Social Security, and food stamps: \1\ Dollars per year................................. 3,430 4,906 6,393 6,696 7,200 7,935 8,340 8,700 8,880 9,084 9,540 Percent of poverty............................... 106.1 99.0 101.8 101.0 100.6 100.4 101.2 102.5 101.6 101.3 103.5 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ In computing the food stamp benefit for 1975, average deductions among all elderly households are assumed. For later years (except 1996), the applicable standard deduction plus average shelter and medical deductions among all elderly households is assumed. For 1996, the applicable standard deduction plus average shelter and medical deductions among all SSI households is assumed. Source: Congressional Research Service. TABLE 4-11.--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS, TOTAL AMOUNT AND AVERAGE MONTHLY AMOUNT, BY SOURCE OF PAYMENT AND CATEGORY, SEPTEMBER 1995 ---------------------------------------------------------------------------------------------------------------- Source of payment Total Aged Blind Disabled ---------------------------------------------------------------------------------------------------------------- Number of persons ---------------------------------------------- With-- Federally administered payments \1\.......................... 6,495,422 1,454,554 \2\ 84,55 3 \3\ 4,956,3 15 Federal payment only..................................... 3,984,722 790,120 45,489 3,149,113 Both Federal and State supplementation................... 2,188,813 531,466 32,475 1,624,872 State supplementation only............................... 321,887 132,968 6,589 182,330 Total with-- Federal payment \4\.......................................... 6,173,535 1,321,586 77,964 4,773,985 State supplementation \5\.................................... 2,510,700 664,434 39,064 1,807,202 ---------------------------------------------- Amount of payments [in thousands] ---------------------------------------------- Total...................................................... 2,329,284 363,944 31,456 1,933,884 Federal payments................................................. 2,060,757 289,414 25,531 1,745,812 State supplementation............................................ 268,526 74,530 5,925 188,072 ---------------------------------------------- Average monthly amount ---------------------------------------------- Total...................................................... $358.60 $250.21 $372.02 $390.19 Federal payments................................................. 333.81 218.99 327.47 365.69 State supplementation............................................ 106.95 112.17 151.67 104.07 ---------------------------------------------------------------------------------------------------------------- \1\ All persons with Federal SSI payments and/or federally administered State supplementation. \2\ Includes an estimated 20,747 persons age 65 or older. \3\ Includes an estimated 646,149 persons age 65 or older. \4\ All persons with a Federal SSI payment whether receiving a Federal payment only or both a Federal and State supplementation. \5\ All persons with federally administered State supplementation whether receiving State supplementation only or both a Federal SSI payment and a State supplementation. Source: Office of Research and Statistics, Social Security Administration. TABLE 4-12.--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI PAYMENTS BY CATEGORY AND AGE, SELECTED YEARS 1975-95 [In thousands] -------------------------------------------------------------------------------------------------------------------------------------------------------- Year --------------------------------------------------------------------------------------- Reason for eligibility and age Dec. Sept. Sept. Sept. Sept. Sept. Sept. Sept. Sept. Sept. Sept. 1975 1983 1986 1988 1989 1990 1991 1992 1993 1994 1995 -------------------------------------------------------------------------------------------------------------------------------------------------------- Reason for eligibility: Aged.......................................................... 2,307 1,528 1,476 1,434 1,439 1,452 1,463 1,478 1,474 1,470 1,455 Blind......................................................... 74 79 83 83 83 84 85 86 86 85 85 Under 18.................................................... 3 6 7 7 7 7 7 8 8 8 8 18-21....................................................... 4 5 5 4 4 4 4 4 4 4 4 22-64....................................................... 46 45 48 49 49 50 51 52 52 52 52 65 or older................................................. 22 23 23 22 22 22 22 22 22 21 21 Disabled...................................................... 1,933 2,292 2,673 2,917 3,048 3,229 3,502 3,921 4,348 4,692 4,956 Under 18.................................................... 104 191 231 247 256 287 366 511 683 812 898 18-21....................................................... 90 122 138 136 139 143 150 167 186 202 219 22-64....................................................... 1,559 1,517 1,787 1,987 2,091 2,218 2,393 2,637 2,864 3,049 3,193 65 or older................................................. 179 462 517 548 563 579 592 606 615 629 646 Age: Under 18...................................................... 107 197 238 254 263 294 373 518 691 820 906 18-21......................................................... 93 127 143 140 143 147 154 171 190 206 223 22-64......................................................... 1,605 1,562 1,835 2,036 2,140 2,269 2,445 2,690 2,917 3,101 3,245 65 or older................................................... 2,508 2,013 2,016 2,003 2,023 2,051 2,078 2,107 2,110 2,120 2,121 --------------------------------------------------------------------------------------- Total....................................................... 4,314 3,898 4,232 4,434 4,570 4,764 5,050 5,486 5,908 6,247 6,495 -------------------------------------------------------------------------------------------------------------------------------------------------------- Source: Office of Research and Statistics, Social Security Administration. Sex.--In January 1996, 54.3 percent of those receiving SSI benefits on the basis of disability and 56.3 percent on the basis of blindness were women (table 4-15). Race.--In January 1996, 52.8 percent of those receiving SSI on the basis of disability were white; 31.3 percent were black; 12.3 percent were other races; and in 3.5 percent of the cases, race was not reported (table 4-15). TABLE 4-13.--DISABILITY DIAGNOSIS OF SSI AND SECTION 1619 DISABILITY RECIPIENTS, SEPTEMBER 1995 \1\ [Percentage distribution by diagnostic group] ------------------------------------------------------------------------ Supplemental Security Income--SSI ---------------------------------------- Diagnostic group All SSI SSI sec. SSI sec. disabled 18- 1619(a) 1619(b) 64 yrs. participants participants ------------------------------------------------------------------------ Individuals \2\................ 4,345,820 20,309 31,110 ======================================== Total percent............ 100.0 100.0 100.0 ---------------------------------------- Infectious and parasitic diseases...................... 1.7 1.0 1.5 Neoplasms...................... 1.5 1.4 1.7 Endocrine, nutritional, and metabolic disorders........... 4.1 2.1 2.5 Mental disorders (other than mental retardation)........... 31.2 29.6 32.5 Mental retardation............. 28.2 45.3 37.8 Diseases of: Nervous system and sense organs \3\................ 10.1 12.7 13.5 Circulatory system......... 5.0 1.6 2.4 Respiratory system......... 2.6 0.9 0.9 Digestive system........... 0.6 0.4 0.6 Musculoskeletal system..... 7.1 2.8 4.3 Congenital anomalies........... 1.6 0.9 0.8 Injuries....................... 2.8 2.4 3.1 Other.......................... 3.4 2.5 2.8 ------------------------------------------------------------------------ \1\ Information on diagnosis of SSI disabled recipients under age 65 is from the December 1995 SSI 10-percent disability file. Information on diagnosis for section 1619 recipients is available from SSI source files. \2\ Includes only recipients whose diagnosis information is specifically identified on the source files. \3\ Most of the section 1619(b) participants who are classified as blind individuals are included in this category. A few section 1619(b) blind participants have a primary impairment other than diseases of the eye and are coded in other categories in this table. Also, there are a few participants classified as having diseases of the eye who are not blind, whose impairment does not meet the definition of blindness, and are classified as disabled. Source: Office of Supplemental Security Income, Social Security Administration. Other income.--In September 1995, 31.0 percent of the disabled and 36.3 percent of the blind received Social Security benefits. Table 4-16 shows the number of SSI recipients with other sources of unearned income. Characteristics of Recipients Receiving Benefits on the Basis of Age Age.--In September 1995, of SSI recipients receiving benefits on the basis of age (65 or older) 34.5 percent were 80 years of age or older (table 4-14). Sex.--In January 1996, 73.2 percent of those receiving benefits on the basis of age were women (table 4-15). TABLE 4-14.--NUMBER AND PERCENTAGE DISTRIBUTION OF SSI RECIPIENTS RECEIVING FEDERALLY ADMINISTERED PAYMENTS BY CATEGORY AND AGE GROUP, SEPTEMBER 1995 ------------------------------------------------------------------------ Age group Total Aged Blind Disabled ------------------------------------------------------------------------ Children: Total number............ 960,009 ......... 9,108 950,901 =========================================== Total percent........... 100.0 ......... 100.0 100.0 ------------------------------------------- Under 5..................... 15.4 ......... 14.6 15.4 5-9......................... 28.5 ......... 27.2 28.5 10-14....................... 32.8 ......... 29.6 32.8 15-17....................... 17.7 ......... 16.6 17.7 18-21 \1\................... 5.6 ......... 12.0 5.6 Adults: Total number............ 5,535,413 1,454,554 75,445 4,005,414 =========================================== Total percent........... 100.0 100.0 100.0 100.0 ------------------------------------------- 18-21 \1\................... 3.1 ......... 3.9 4.2 22-29....................... 8.7 ......... 12.9 11.8 30-39....................... 14.6 ......... 16.9 19.8 40-49....................... 14.0 ......... 15.8 19.1 50-59....................... 14.0 ......... 14.6 19.1 60-64....................... 7.4 ......... 8.4 10.0 65-69....................... 10.6 20.2 8.2 7.2 70-74....................... 9.7 25.3 6.5 4.2 75-79....................... 7.2 19.9 4.8 2.6 80 or older................. 10.8 34.5 8.0 2.2 ------------------------------------------------------------------------ \1\ Persons aged 18-21 can be classified as either children or adults depending on their student status. Source: Office of Research and Statistics, Social Security Administration. Race.--In January 1996, 49.9 percent of those receiving SSI on the basis of age were white; 21.0 percent were black; 25.6 percent were other races; and in 3.5 percent of the cases, race was not reported (table 4-15). Other income.--In September 1995, 63.2 percent of SSI recipients receiving benefits on the basis of age also received Social Security benefits. Only 1.9 percent had earned income (table 4-16). The number of persons receiving federally administered SSI payment and unearned income, by type of income, is included in table 4-17. TABLE 4-15.--NUMBER AND PERCENTAGE DISTRIBUTION OF ALL PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS BY CATEGORY, RACE, AND SEX, JANUARY 1996 ------------------------------------------------------------------------ Race and sex Total Aged Blind Disabled ------------------------------------------------------------------------ Total number................ 6,475,500 1,444,300 87,100 4,944,100 =========================================== Total percent........... 100.0 100.0 100.0 100.0 ------------------------------------------- Race: White..................... 52.2 49.9 54.5 52.8 Black..................... 29.0 21.0 25.7 31.3 Other..................... 15.3 25.6 15.4 12.3 Not reported.............. 3.5 3.5 4.4 3.5 Sex and race: Men....................... 41.5 26.8 43.7 45.7 White................... 21.0 12.2 23.4 23.5 Black................... 12.1 4.4 10.9 14.4 Other................... 6.6 9.2 7.1 5.9 Not reported............ 1.8 1.0 2.3 2.0 Women..................... 58.5 73.2 56.3 54.3 White................... 31.2 37.7 31.1 29.3 Black................... 16.9 16.7 14.8 16.9 Other................... 8.7 16.5 8.3 6.5 Not reported............ 1.8 2.5 2.1 1.5 ------------------------------------------------------------------------ Source: Office of Research and Statistics, Social Security Administration. TABLE 4-16.--PERSONS RECEIVING FEDERALLY ADMINISTERED PAYMENTS AND INCOME AND AVERAGE MONTHLY AMOUNT, BY CATEGORY AND TYPE OF INCOME, SEPTEMBER 1995 ---------------------------------------------------------------------------------------------------------------- Reason for eligibility Type of income Total ----------------------------------- Aged Blind Disabled ---------------------------------------------------------------------------------------------------------------- Total number............................................... 6,495,422 1,454,554 \1\ 84,553 \2\ 4,956,315 ---------------------------------------------- Number ---------------------------------------------- Social Security benefits......................................... 2,489,246 919,797 30,688 1,538,761 Other unearned income............................................ 849,487 300,893 10,349 538,245 Earned income.................................................... 284,912 27,328 6,198 251,386 ---------------------------------------------- Average monthly income ---------------------------------------------- Social Security benefits......................................... $345.58 $351.40 $360.79 $341.80 Other unearned income............................................ 105.32 84.22 97.52 117.26 Earned income.................................................... 237.92 237.64 506.31 231.34 ---------------------------------------------------------------------------------------------------------------- \1\ Includes 20,747 persons aged 65 or over. \2\ Includes 646,149 persons aged 65 or older. Source: Office of Research and Statistics, Social Security Administration. TABLE 4-17.--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI PAYMENTS AND UNEARNED INCOME (OTHER THAN SOCIAL SECURITY) AND AVERAGE MONTHLY UNEARNED INCOME BY TYPE OF INCOME, SEPTEMBER 1995 ------------------------------------------------------------------------ Type of income Number \1\ Average \2\ ------------------------------------------------------------------------ Veterans' benefits............................ 115,967 155.50 Railroad retirement........................... 4,842 325.93 Black lung benefits........................... 1,685 310.91 Employment pensions........................... 50,096 112.27 Worker's compensation......................... 4,590 293.92 Support and maintenance in kind............... 236,700 102.40 Support from absent parents................... 79,531 152.61 Asset income.................................. 247,072 9.25 Assistance based on need...................... 40,596 94.86 Other \3\..................................... 69,408 290.10 ------------------------- Total................................... 849,487 $105.32 ------------------------------------------------------------------------ \1\ With unearned income other than social security benefits. \2\ Monthly amount of unearned income. \3\ Includes military, civil service pension, and demonstration projects. Source: Office of Research and Statistics, Social Security Administration. Characteristics of Children Receiving Benefits At the end of its first year (December 1974), the SSI Program paid benefits to 71,000 disabled and blind children, less than 2 percent of the SSI caseload. By comparison, in December 1980 payments were made to almost 229,000 blind and disabled children, 5.5 percent of the 4.1 million recipients in that month. In December 1995, 974,000 blind and disabled children were eligible for SSI payments, nearly a fourteenfold increase. These children made up 15.0 percent of the over 6.5 million SSI recipients, and represent a fast growing segment of the SSI population. Most notable has been the growth since 1989. Many analysts attribute the growth to outreach activities, the Supreme Court decision in the Zebley case (see below), expansion of the mental impairment category, and reduction in reviews of continuing disability. To be eligible for SSI payments as a child, an individual must be under age 18 (or under 22 if a full time student), be unmarried, and meet the SSI disability or blindness, citizenship/residency, and income and resources criteria. In December 1995, almost 63 percent of the SSI children were 12 years old or less, and an estimated 20 percent of the children were under age 6. About 31 percent, an estimated 300,000 children, were between the ages of 13 and 17. Child recipients were more likely to be boys than girls, by about 3 to 2. Approximately 46 percent were nonwhite. Eighty percent of the children live in their parents' home. Less than two percent are patients in a medical facility where more than half of the cost of their care is covered by the Medicaid Program. Another 16 percent live in other hospitals, nursing homes, residential schools, foster care, or independently. About 25 percent of the children had some type of unearned income. The three major types of unearned income were: in-kind support and maintenance (7 percent), Social Security benefits (8.1 percent), and support from absent parents (8 percent). In addition, about 11 percent of children had income ``deemed'' from their parents. Given the rapid growth in the number of children receiving SSI, as well as a growing debate over the procedures by which children's eligibility should be judged, Congress established the National Commission on Childhood Disability to review the definition of childhood disability and examine several related issues, and report its findings to Congress by November 30, 1995 (Public Law 103-296). The Commission, which reported in October of 1995, recommended that the SSI statute be amended to state that the purpose of the SSI Childhood Disability Program is to: help low-income families (and other individuals and organizations) who care for eligible children with disabilities in providing basic necessities to maintain the child at home or in another appropriate setting; cover the additional costs of caring for and raising a child with a disability; enhance the child's opportunity to develop; and offset lost family income because a parent remains out of the labor force or underemployed to care for the child. The Commission also recommended that the SSI definition of childhood disability be strengthened; that a benefit scale be created which reduces SSI benefits for multiple children in the same family to reflect economies of scale in the consumption of food, clothing, and shelter; that continuing disability reviews be performed at least every 2 years for children whose impairment is likely to improve; that appropriate health care treatment be required as a condition of continuing eligibility for SSI children; that parents or the child's representative payee be required to report financial expenditures on a periodic random basis; and that categorical eligibility for Medicaid be afforded all SSI children. In May 1995, another report on the children's SSI Program was released. This report conducted by the Committee on Childhood Disability of the National Academy of Social Insurance (responding to a study request from the House Committee on Ways and Means in the 102d Congress), was entitled ``Restructuring the SSI Disability Program for Children and Adolescents.'' The Academy's expert group contended that the basic purpose of SSI cash benefits for children is to support and preserve the capacity of families to care for their disabled children in their own homes. Thus, the SSI benefit was intended to provide for some of the additional, nonmedical, but disability-related, costs of raising a disabled child; to compensate for some of the income lost because of the everyday necessities of caring for a disabled child; and to meet the child's basic needs for food, clothing, and shelter. The Committee also urged that SSI childhood eligibility criteria be strengthened, that family benefits in cases where there are multiple eligible children in the household be limited, that disabled teens be encouraged to work, and that children be periodically reviewed (National Academy of Social Insurance, 1995). The General Accounting Office (GAO) also examined the growing children's caseload and attempted to understand why the caseload was growing so rapidly. GAO compared the results of SSA's decisions regarding children by type of disability and basis of award 2 years before and 2 years after the medical listings were expanded and a new procedure for determining disability called the Individualized Functional Assessment had been initiated. The study found that the number of children receiving SSI disability benefits more than doubled between 1989 and 1992, from almost 300,000 to 770,500. According to the report, although the new individualized functional assessment (IFA) process mandated by the Supreme Court in Sullivan v. Zebley added 87,900 children to the rolls, most of the children who received new awards during the 2 years after the IFA went into effect in 1991 met the medical listing. The report indicated that the huge increases in the diagnosis of mental impairments--including mental retardation and attention deficit hyperactivity disorder--accounted for more than two-thirds of the growth in awards. Given the rapidly growing number of children in SSI, GAO assessed the implementation of the IFA process. The GAO study found that from 1991 to 1994, SSA made about 219,000 IFA awards to children who did not meet SSA's more restrictive listing of impairments. These awards accounted for one-third of all awards made during this period and about $1 billion a year in benefit payments. GAO also found that the IFA process relies too heavily on adjudicator's judgments, rather than on objective criteria. The study found little evidence, however, that parents' coaching their children to act out in disruptive behaviors to improve chances of obtaining SSI was widespread, but could not rule out its existence. 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. --An increase from 107,000 in December 1975 to 906,000 in September 1995 of the number of disabled and blind children under 18 receiving SSI benefits. --A sharp increase of 1,683,000 between 1983 and 1995 in the number of persons ages 22-64 receiving benefits on the basis of disability or blindness. 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. Until recently, 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 they were likely to give in to threats, coercion, or persuasion of the recipient, thereby 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. By August 1995, there were about 135,000 SSI recipients whose disability was based solely on their drug addiction or alcoholism, although the Congressional Budget Office (CBO) estimates that perhaps as many of 75 percent of them would be eligible for SSI based on another sufficiently disabling condition. In March 1996, Congress passed legislation that ended drug and alcohol addiction as conditions that qualify individuals for SSI benefits. Under Public Law 104-121, individuals would not be considered disabled for either SSI or DI if drug addiction or alcoholism were the contributing factor material to their disability. Thus, eligibility for SSI and DI benefits ended for persons classified as substance abusers. The bill mandates the Commissioner of Social Security to require that persons who qualify for SSI or DI based on some other disabling condition, but who are determined to have a drug or alcohol condition receive their SSI or DI benefits through a representative payee and are referred to treatment. Public Law 104-121 also authorizes $50 million for fiscal year 1997 and $50 million for fiscal year 1998 for drug treatment services. Recipients classified as drug addicts or alcoholics will no longer be eligible for SSI beginning January 1, 1997. Applicants were no longer eligible for SSI beginning March 29, 1996 if they were disabled solely on the basis of drug or alcohol addiction. ELIGIBILITY OF LEGAL IMMIGRANTS (ALIENS) FOR SSI In addition to meeting the categorical requirements (aged, blind, or disabled) and the income and resource requirements, to qualify for SSI a person must be a citizen of the United States or an alien lawfully admitted to the United States for permanent residence or otherwise residing in the United States under color of law. For 5 years after entry into the United States, aliens are deemed to have available a portion of the income and resources of their immigration sponsors. (The deeming period was extended from 3 years to 5 years, effective January 1, 1994 through September 30, 1996.) ELIGIBILITY OF THE HOMELESS SSA has implemented specific legislation and developed outreach programs and administrative initiatives to better meet the needs of the homeless, who may be eligible for SSI. This action was prompted by evidence that approximately 30 to 40 percent of the residents of emergency homeless shelters are chronically mentally ill, and are former residents of mental institutions. These initiatives address the special problems related to the homeless: they are often difficult to locate and contact; they have limited ability to find information needed to apply for benefits; and they are often reluctant to follow through with the claims process or are incapable of doing so. While many of the chronically mentally ill live with family members or have other ongoing contact with those who can assist them with daily living activities, the homeless, mentally ill are more likely to have very limited contact with family or others who could assist them in obtaining housing or applying for benefits. SSA has identified homelessness as one barrier to filing for SSI benefits and, in response, has initiated a wide range of outreach activities aimed at this population. For example, local field offices have established ongoing programs in which local social service agencies, soup kitchens, shelters, and churches screen homeless people for possible SSI eligibility, refer them to SSA, and help them through the application process. Many of SSA's outreach demonstration programs deal specifically with the homeless or concentrate on the homeless in addition to other target populations, especially individuals who suffer from mental illness or AIDS. SSA is also participating in the Interagency Council on Homelessness (ICH) established by the Congress in 1987 to assist homeless individuals and families. SPECIAL SSI PROVISIONS FOR THE WORKING DISABLED Earned Income Disregards Since SSI began in 1974, the law has required that a portion of the earned income of SSI recipients be disregarded in determining the eligibility for and the amount of SSI benefits. In determining SSI eligibility and benefits, 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 are disregarded. In addition, any work- related expenses are disregarded in the case of blind persons and impairment-related work expenses are disregarded in the case of disabled persons. Also, income and resources set aside under a plan for achieving self-support are excluded. Eliminating Work Disincentives Prior to enactment of the section 1619 program in 1980, on a temporary 3-year basis, a disabled SSI recipient who worked faced a substantial risk of losing SSI benefits and frequently, Medicaid. Work was treated the same way it was under the Social Security Disability Insurance (SSDI) Program: after a trial work period, work at the level of substantial gainful activity ($500 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. (Many States provide automatic Medicaid coverage to all recipients of Federal SSI payments. Nearly all States follow the SSI definition of disability to establish Medicaid eligibility.) Thus, disabled individuals had a disincentive to work because of their fear of losing SSI benefits and Medicaid. Overview of Section 1619 Provisions 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 4-2, this earned income eligibility limit is $1,025 per month in 1996 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 under 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 or she 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 the 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 his or her earnings. In determining a person's income to compare to the individualized threshold, any applicable exclusions are deducted from his 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 medical care as well as 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 makes the ability to work erratic. This protection is not indefinite, but SSA cannot terminate the disability status of an individual for 12 months after her most recent 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. MEASURES OF SSI PARTICIPATION SSI Participation Rates Table 4-18 shows Federal SSI participation among the elderly and the total population using various measures. The numerator in the first three columns is the sum of columns two and four in table 4-21. Thus, the number of SSI aged participants includes the disabled and blind population over age 65. Column one 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 6.8 percent in 1994. Column two presents the number of elderly SSI recipients divided by the number of poor elderly. This rate has 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). After 1984, the rate declined to 56.5 percent in 1987, increased to 60.1 percent in 1989, declined to 53 percent in 1992, and increased to 57.9 percent in 1994. 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. Column three shows the number of SSI aged recipients as a percentage of the number of poor elderly before means tested transfers. TABLE 4-18.--SSI PARTICIPATION RATES, 1975-94 [In percent] ---------------------------------------------------------------------------------------------------------------- Among Among all Among pretransfer Among elderly elderly elderly entire poor poor population ---------------------------------------------------------------------------------------------------------------- 1975........................................................ 11.1 75.6 NA 2.0 1976........................................................ 10.3 72.4 NA 1.9 1977........................................................ 9.8 74.1 NA 1.9 1978........................................................ 9.4 71.5 NA 1.9 1979........................................................ 9.0 61.3 68.7 1.8 1980........................................................ 8.7 57.5 64.7 1.8 1981........................................................ 8.1 55.0 63.3 1.8 1982........................................................ 7.5 53.6 62.3 1.7 1983........................................................ 7.3 55.2 61.9 1.7 1984........................................................ 7.3 61.2 66.3 1.7 1985........................................................ 7.1 58.7 64.5 1.7 1986........................................................ 6.9 57.9 63.4 1.8 1987........................................................ 6.8 56.5 64.7 1.8 1988........................................................ 6.6 57.6 64.3 1.8 1989........................................................ 6.5 60.1 64.6 1.9 1990........................................................ 6.6 56.3 63.3 1.9 1991........................................................ 6.8 55.0 61.1 2.0 1992........................................................ 6.5 52.7 NA 2.2 1993........................................................ 6.7 56.3 NA 2.3 1994........................................................ 6.8 57.9 NA 2.4 ---------------------------------------------------------------------------------------------------------------- NA--Not available. Note.--The denominator for columns 1 and 4 is in table 15, appendix N, the denominator for column 3 is shown in table 3 of appendix J, and the denominator for column 3 is in table 19 of appendix J. Source: Staff of the Committee on Ways and Means. The final column of table 4-18 shows the number of Federal SSI participants as a percentage of the total population. The numerator for this calculation is the first column of table 21. As shown in the table, the percentage of the entire population receiving SSI benefits has declined from 2.0 percent in 1975 to 1.7 percent for the 1982 to 1985 time period. It has since increased to 2.4 percent in 1994. Table 4-19 shows the percentage of a given State's population receiving SSI benefits for selected years. As shown in table 4-19, the total percentage of the population receiving SSI benefits increased to 2.46 percent in 1995 from 2 percent in 1975. However, between these years, the percentage of the population receiving SSI benefits declined to 1.74 percent in 1985 (a 13-percent decline) and has since risen to 2.46 percent of the population in 1995. TABLE 4-19.--SSI RECIPIENCY RATES BY STATE, SELECTED YEARS 1975-95 ---------------------------------------------------------------------------------------------------------------- State 1975 1985 1990 1991 1992 1993 1995 ---------------------------------------------------------------------------------------------------------------- Alabama................................................. 3.98 3.29 3.29 3.35 3.43 3.64 3.86 Alaska.................................................. 0.81 0.65 0.84 0.87 0.90 0.96 1.09 Arizona................................................. 1.24 1.04 1.22 1.33 1.42 1.54 1.77 Arkansas................................................ 4.09 3.14 3.23 3.34 3.47 3.66 3.86 California.............................................. 3.09 2.59 2.93 3.03 3.10 3.14 3.17 Colorado................................................ 1.37 0.93 1.14 1.23 1.29 1.38 1.52 Connecticut............................................. 0.76 0.83 0.98 1.05 1.10 1.19 1.36 Delaware................................................ 1.19 1.21 1.21 1.23 1.27 1.34 1.51 District of Columbia.................................... 2.23 2.51 2.67 2.83 3.00 3.21 3.63 Florida................................................. 1.86 1.62 1.71 1.82 1.90 2.06 2.34 Georgia................................................. 3.27 2.56 2.46 2.51 2.55 2.65 2.80 Hawaii.................................................. 1.08 1.08 1.25 1.27 1.30 1.40 1.52 Idaho................................................... 1.06 0.84 1.03 1.10 1.21 1.28 1.44 Illinois................................................ 1.22 1.18 1.55 1.67 1.78 2.00 2.25 Indiana................................................. 0.83 0.87 1.09 1.17 1.26 1.39 1.52 Iowa.................................................... 1.00 0.96 1.18 1.23 1.29 1.37 1.47 Kansas.................................................. 1.05 0.87 0.99 1.05 1.14 1.26 1.44 Kentucky................................................ 2.83 2.65 3.11 3.27 3.42 3.71 4.23 Louisiana............................................... 3.90 2.87 3.15 3.29 3.49 3.84 4.18 Maine................................................... 2.31 1.89 1.93 1.97 2.03 2.17 2.47 Maryland................................................ 1.17 1.16 1.25 1.30 1.35 1.44 1.61 Massachusetts........................................... 2.30 1.91 1.98 2.12 2.23 2.40 2.72 Michigan................................................ 1.31 1.35 1.54 1.61 1.71 1.93 2.19 Minnesota............................................... 1.00 0.78 0.92 0.99 1.05 1.17 1.84 Mississippi............................................. 5.21 4.28 4.42 4.56 4.68 4.98 5.33 Missouri................................................ 2.10 1.58 1.66 1.75 1.83 1.96 2.15 Montana................................................. 1.12 0.92 1.25 1.33 1.38 1.44 1.61 Nebraska................................................ 1.06 0.88 0.99 1.05 1.09 1.19 1.30 Nevada.................................................. 1.00 0.85 0.95 0.98 1.04 1.14 1.37 New Hampshire........................................... 0.67 0.62 0.62 0.68 0.71 0.77 0.92 New Jersey.............................................. 1.11 1.23 1.36 1.44 1.52 1.66 1.81 New Mexico.............................................. 2.29 1.83 2.08 2.19 2.25 2.39 2.65 New York................................................ 2.24 2.00 2.31 2.46 2.60 2.85 3.20 North Carolina.......................................... 2.71 2.21 2.24 2.33 2.36 2.47 2.65 North Dakota............................................ 1.25 0.96 1.17 1.25 1.30 1.34 1.42 Ohio.................................................... 1.22 1.19 1.44 1.55 1.63 1.84 2.19 Oklahoma................................................ 3.03 1.81 1.92 1.97 2.02 2.13 2.27 Oregon.................................................. 1.12 0.95 1.11 1.18 1.24 1.35 1.43 Pennsylvania............................................ 1.24 1.39 1.60 1.69 1.77 1.90 2.16 Rhode Island............................................ 1.72 1.62 1.74 1.83 1.91 2.05 3.27 South Carolina.......................................... 2.84 2.60 2.59 2.61 2.67 2.80 2.97 South Dakota............................................ 1.32 1.19 1.45 1.53 1.62 1.72 1.87 Tennessee............................................... 3.24 2.71 2.87 2.98 3.06 3.22 3.42 Texas................................................... 2.23 1.57 1.73 1.81 1.87 2.00 2.17 Utah.................................................... 0.76 0.53 0.73 0.79 0.84 0.94 1.06 Vermont................................................. 1.93 1.76 1.79 1.89 1.99 2.08 2.25 Virginia................................................ 1.53 1.49 1.54 1.61 1.67 1.76 1.95 Washington.............................................. 1.46 1.09 1.27 1.34 1.39 1.50 1.66 West Virginia........................................... 2.37 2.24 2.63 2.78 2.91 3.17 3.66 Wisconsin............................................... 1.44 1.50 1.75 1.83 1.88 2.04 2.17 Wyoming................................................. 0.67 0.45 0.76 0.85 0.92 1.04 1.19 ------------------------------------------------------- Total \1\......................................... 2.00 1.74 1.94 2.03 2.11 2.26 2.46 ---------------------------------------------------------------------------------------------------------------- \1\ The total number of SSI recipients used to calculate the total recipiency rate includes a certain number of recipients whose State is unknown. For 1975, 1985, 1990, 1991, 1992, and 1993, the numbers of unknown (in thousands) respectively were 256, 14, 0, 96, 71, and 91. Source: Social Security Administration, Ways and Means Committee staff, and Congressional Research Service. Percentages are calculated as the average number of monthly SSI recipients over the total population of each State in July of the selected year. For 1995, percentages are calculated as the number of SSI recipients in July 1995 divided by the total population of each State in July 1995. Changes in Number of Recipients, 1970-95 SSI is one of the largest cash assistance programs for the poor and one of the fastest growing entitlement programs; program costs grew 20 percent annually from 1991 through 1994. According to GAO, three groups have accounted for nearly 90 percent of the SSI Program's growth since 1991: 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 has 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; little 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 4-20 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 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 1995, there were over 6.5 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 over age 65 are counted as aged) to 1.4 million individuals in 1995 (2.1 million if disabled over 65 are counted). Meanwhile, the number of blind or disabled receiving assistance increased sharply from 1.0 million in 1970 to roughly 5.1 million in 1995 (4.4 million if persons over age 65 are excluded). The number of persons receiving SSI payment, by State, in December 1995 is provided in table 4-21. TABLE 4-20.--NUMBER OF PERSONS RECEIVING FEDERALLY ADMINISTERED SSI PAYMENTS, 1974-2001; AND ADULT ASSISTANCE UNDER PRIOR PROGRAMS, 1970-73 [In thousands] ---------------------------------------------------------------------------------------------------------------- Blind or disabled ------------------------- Federal State Year \1\ Total \2\ Aged \3\ 65 and older SSI \6\ supplemental Total \4\ \5\ only ---------------------------------------------------------------------------------------------------------------- 1970....................................... 3,098 2,082 1,016 ............ ....... ............ 1971....................................... 3,172 2,024 1,148 ............ ....... ............ 1972....................................... 3,182 1,934 1,248 ............ ....... ............ 1973....................................... 3,173 1,820 1,353 ............ ....... ............ 1974....................................... 3,996 2,286 1,710 (\7\) (\8\) (\8\) 1975....................................... 4,314 2,307 2,007 201 3,893 421 1976....................................... 4,236 2,148 2,088 249 3,799 437 1977....................................... 4,238 2,051 2,187 302 3,778 460 1978....................................... 4,217 1,968 2,249 344 3,755 462 1979....................................... 4,150 1,872 2,278 386 3,687 462 1980....................................... 4,142 1,808 2,334 419 3,682 460 1981....................................... 4,019 1,678 2,341 443 3,590 429 1982....................................... 3,858 1,549 2,309 462 3,473 384 1983....................................... 3,901 1,515 2,386 485 3,590 311 1984....................................... 4,029 1,530 2,499 507 3,699 331 1985....................................... 4,138 1,504 2,634 525 3,799 339 1986....................................... 4,269 1,473 2,796 540 3,922 348 1987....................................... 4,385 1,455 2,930 560 4,019 366 1988....................................... 4,464 1,433 3,030 573 4,089 375 1989....................................... 4,593 1,439 3,154 587 4,206 387 1990....................................... 4,817 1,454 3,363 605 4,412 405 1991....................................... 5,118 1,465 3,654 615 4,730 389 1992....................................... 5,566 1,471 4,095 628 5,202 364 1993....................................... 6,011 1,475 4,536 638 5,664 347 1994....................................... 6,296 1,466 4,830 653 5,965 331 1995....................................... 6,514 1,446 5,068 669 6,194 320 1996 \9\................................... 6,767 1,437 5,330 684 6,446 321 1997 \9\................................... 6,946 1,423 5,523 698 6,625 321 1998 \9\................................... 7,113 1,411 5,702 712 6,793 320 1999 \9\................................... 7,282 1,403 5,879 726 6,962 320 2000 \9\................................... 7,429 1,394 6,035 740 7,110 319 2001 \9\................................... 7,566 1,387 6,179 754 7,246 320 ---------------------------------------------------------------------------------------------------------------- \1\ Data are for December of each year. \2\ All persons with Federal SSI payments and/or federally administered State supplementation; 1974-94. For 1970- 73, the total is the number of recipients under the Old-Age Assistance and Aid to the Blind and Aid to the Permanently and Totally Disabled Programs. \3\ For 1970-73, this column is the number of recipients under the Old-Age Assistance Program. \4\ For 1970-73, this column is the number of recipients under the Aid to the Blind and Aid to the Permanently and Totally Disabled Programs. \5\ For 1974-2001, this is the number of age 65 or older individuals who first received SSI benefits because of being blind or disabled. \6\ All persons with Federal SSI payments include those receiving Federal payments only or both Federal SSI and federally administered State supplementation. \7\ Data not available for December 1974. In January 1974, there were 87,000 blind and disabled recipients aged 65 or older. \8\ Data not available. \9\ For 1996-2001, data are projections based on the President's budget estimates of December 1996. Source: Office of the Actuary, Social Security Administration. TABLE 4-21.--NUMBER OF PERSONS RECEIVING SSI PAYMENTS, BY STATE, DECEMBER 1995 ---------------------------------------------------------------------------------------------------------------- Federally administered State State ------------------------------------------------ administered Total Aged Blind Disabled total \1\ ---------------------------------------------------------------------------------------------------------------- Total \3\................................. 6,514,134 1,446,122 83,545 4,984,467 299,858 ------------------------------------------------------------- Alabama \3\....................................... 165,093 38,052 1,465 125,576 1,985 Alaska \3\........................................ 6,879 1,217 116 5,546 4,726 Arizona \3\....................................... 72,961 13,505 891 58,565 674 Arkansas.......................................... 94,486 20,826 1,157 72,503 ............ California........................................ 1,031,872 332,090 21,979 677,803 ............ Colorado \3\...................................... 56,672 9,608 552 46,512 30,812 Connecticut \3\................................... 44,661 7,668 501 36,492 29,807 Delaware.......................................... 10,996 1,573 120 9,303 ............ District of Columbia.............................. 20,238 3,246 187 16,805 ............ Florida \3\....................................... 338,246 99,038 3,255 235,953 14,223 Georgia........................................... 198,933 43,666 2,549 152,718 ............ Hawaii............................................ 18,731 7,552 159 11,020 ............ Idaho \3\......................................... 16,605 1,968 151 14,486 \4\ 2,985 Illinois \3\...................................... 266,563 35,769 2,461 228,333 44,367 Indiana \3\....................................... 88,757 9,440 1,084 78,233 1,139 Iowa.............................................. 41,571 5,999 1,002 34,570 ............ Kansas............................................ 37,552 4,678 400 32,474 ............ Kentucky \3\...................................... 165,286 24,675 1,739 138,872 5,881 Louisiana......................................... 182,104 33,339 2,182 146,583 ............ Maine............................................. 30,841 5,956 281 24,604 ............ Maryland \4\...................................... 82,494 16,834 833 64,827 1,648 Massachusetts..................................... 163,528 46,829 4,563 112,136 ............ Michigan.......................................... 210,265 23,143 2,092 185,030 ............ Minnesota \3\..................................... 62,126 10,421 777 50,928 \5\ 17,571 Mississippi....................................... 141,061 32,026 1,461 107,574 ............ Missouri \3\...................................... 113,734 17,465 1,032 95,237 10,365 Montana........................................... 14,057 1,674 133 12,250 ............ Nebraska \3\...................................... 21,326 3,084 258 17,984 6,364 Nevada............................................ 20,783 6,072 610 14,101 ............ New Hampshire \3\................................. 10,533 1,314 106 9,113 6,881 New Jersey........................................ 144,004 35,450 1,123 107,431 ............ New Mexico \3\.................................... 44,755 9,844 644 34,267 231 New York.......................................... 588,538 145,502 3,784 439,252 ............ North Carolina \3\................................ 190,790 44,058 2,443 144,289 19,862 North Dakota \3\.................................. 8,970 1,820 92 7,058 \4\ 355 Ohio.............................................. 248,195 21,770 2,464 223,961 ............ Oklahoma \3\...................................... 74,281 15,208 971 58,102 \5\ 68,765 Oregon \3\........................................ 47,124 7,183 617 39,324 \5\ 16,971 Pennsylvania...................................... 264,564 42,952 2,719 218,893 ............ Rhode Island...................................... 24,245 4,948 244 19,053 ............ South Carolina \4\................................ 111,095 23,851 1,782 85,462 4,124 South Dakota \4\.................................. 13,631 2,506 130 10,995 232 Tennessee......................................... 179,676 32,697 1,860 145,119 ............ Texas \5\......................................... 404,097 126,932 5,652 271,513 ............ Utah.............................................. 20,462 2,210 292 17,960 ............ Vermont........................................... 13,015 2,101 131 10,783 ............ Virginia \3\...................................... 130,310 28,120 1,604 100,586 7,025 Washington........................................ 91,654 13,068 931 77,655 ............ West Virginia \6\................................. 67,791 7,737 708 59,346 ............ Wisconsin......................................... 111,585 18,548 1,188 91,849 ............ Wyoming \3\....................................... 5,759 682 58 5,019 2,865 Other: N. Mariana Islands.............................. 544 190 12 342 ............ ---------------------------------------------------------------------------------------------------------------- \1\ Includes fewer than 200 cases not distributed by State. \2\ September 1995 data. \3\ Data for Federal SSI payments only. State has state-administered supplementation. \4\ Data for Federal SSI payments and federally administered state supplementation only, State also has state- administered supplementation. \5\ Estimated data. \6\ Data for Federal SSI payments only, State supplementary payments not made. Source: Office of Research and Statistics and Office of Retirement and Survivors insurance and Supplemental Security Income Policy, Social Security Administration. SSI Program Costs Table 4-22 shows total expenditures for the SSI Program in each State, including not only the federally administered Federal and State supplementation payments but also the State administered State supplementation payments. Table 4-23 shows the total (Federal- and State-administered) State supplementation payments for SSI for fiscal years 1985 through 1995. Table 4-24 illustrates the total amount of Federal and State benefit payments from calendar years 1970 to 1987 and fiscal years 1988 to 2002. From 1970 to 1973, 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 1995, Federal benefit payments totaled $24.443 billion and State payments totaled $3.681 billion, amounting to an overall total of $28.124 billion. In fiscal year 1996, total (Federal and State) SSI benefits are estimated to total $27.9 billion and projected to increase to $41.5 billion in fiscal year 2002. TABLE 4-22.--SUPPLEMENTAL SECURITY INCOME: TOTAL PAYMENTS, FEDERAL SSI PAYMENTS, AND FEDERALLY ADMINISTERED AND STATE ADMINISTERED STATE SUPPLEMENTARY PAYMENTS, FISCAL YEAR 1995 [In thousands of dollars] ---------------------------------------------------------------------------------------------------------------- State supplementation Federal SSI --------------------------------- State Total \1\ Federally State administered \2\ administered ---------------------------------------------------------------------------------------------------------------- Total................................... $27,247,713 $23,512,463 $3,114,385 $620,865 ----------------------------------------------------------------- Alabama....................................... 594,372 593,002 ................ 1,370 Alaska \3\.................................... 39,456 26,484 ................ 12,972 Arizona....................................... 281,967 281,558 ................ 409 Arkansas...................................... 322,314 322,310 4 .............. California.................................... 5,335,712 3,354,710 1,981,002 .............. Colorado...................................... 269,875 213,172 ................ 56,703 Connecticut................................... 277,012 176,682 ................ 100,330 Delaware...................................... 39,356 38,539 817 .............. District of Columbia.......................... 83,153 78,811 4,342 .............. Florida....................................... 1,283,365 1,264,985 (\4\) 18,380 Georgia....................................... 681,292 681,277 15 .............. Hawaii........................................ 80,717 69,412 11,305 .............. Idaho \3\..................................... 70,928 61,469 ................ 9,459 Illinois...................................... 1,220,637 1,151,187 ................ 69,450 Indiana....................................... 345,508 341,722 ................ 3,786 Iowa.......................................... 145,538 142,587 2,951 .............. Kansas........................................ 137,252 137,251 1 .............. Kentucky...................................... 637,194 620,351 ................ 16,843 Louisiana..................................... 708,185 708,185 (\5\) .............. Maine......................................... 94,373 86,831 7,542 .............. Maryland...................................... 334,378 328,143 (\4\) 6,235 Massachusetts................................. 687,156 527,076 160,080 .............. Michigan...................................... 892,043 854,774 37,269 .............. Minnesota \3\................................. 294,510 230,790 ................ 63,720 Mississippi................................... 500,936 500,930 6 .............. Missouri...................................... 452,238 422,689 ................ 29,549 Montana....................................... 51,492 50,552 940 .............. Nebraska...................................... 80,478 74,508 ................ 5,970 Nevada........................................ 76,542 72,657 3,885 .............. New Hampshire................................. 48,422 37,383 ................ 11,039 New Jersey.................................... 588,426 551,771 76,655 .............. New Mexico.................................... 162,046 161,753 ................ 293 New York...................................... 2,672,815 2,162,719 510,096 .............. North Carolina................................ 741,847 626,602 ................ 115,245 North Dakota \3\.............................. 30,392 28,464 ................ 1,928 Ohio.......................................... 1,027,215 1,027,215 13 .............. Oklahoma...................................... 297,636 261,825 ................ 35,811 Oregon \3\.................................... 206,606 178,561 ................ 28,045 Pennsylvania.................................. 1,139,278 1,003,125 136,153 .............. Rhode Island.................................. 97,234 78,423 18,811 .............. South Carolina................................ 391,142 378,392 ................ 12,750 South Dakota.................................. 47,306 46,533 9 764 Tennessee..................................... 636,486 636,486 (\4\) .............. Texas......................................... 1,365,758 1,365,758 ................ .............. Utah.......................................... 79,406 79,346 60 .............. Vermont....................................... 49,195 38,799 10,396 .............. Virginia...................................... 481,064 461,908 ................ 19,156 Washington.................................... 391,780 363,264 28,516 .............. West Virginia................................. 269,671 269,671 ................ .............. Wisconsin..................................... 481,012 357,319 123,693 .............. Wyoming....................................... 21,165 20,505 ................ 660 N. Mariana Islands 2,351 2,351 ................ .............. ---------------------------------------------------------------------------------------------------------------- \1\ Includes $1.6 million not distributed by State. \2\ Total reduced by $176,000 due to adjustments not yet identified and credited by State. \3\ Data estimated for State-administered payments. \4\ Amount not shown; negative adjustment exceeds amount paid. \5\ Less than $500. Source: Office of Research and Statistics, Social Security Administration. TABLE 4-23.--STATE SSI SUPPLEMENTATION PAYMENTS, FISCAL YEARS 1985-95 [In thousands of dollars] ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Year State ---------------------------------------------------------------------------------------------------------------------------------------------- 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Alabama.......................................... $15,003 $13,659 $11,606 $10,436 $7,964 $6,594 $6,394 $3,845 $2,083 $1,673 $1,370 Alaska........................................... 12,970 12,970 12,970 12,970 12,970 12,972 12,972 12,972 12,972 12,972 12,972 Arizona.......................................... 2,194 2,668 3,045 3,309 2,691 2,560 3,129 3,129 3,129 411 409 Arkansas......................................... 30 28 32 20 14 15 12 8 0 6 4 California....................................... 1,288,260 1,466,079 1,729,305 1,862,170 2,038,339 2,274,296 2,303,637 2,433,459 2,212,330 2,014,831 1,981,002 Colorado......................................... 47,474 38,320 35,416 24,132 41,035 42,649 50,002 53,309 55,057 53,376 56,703 Connecticut...................................... 31,200 36,578 46,577 54,584 74,257 67,670 98,838 94,725 96,836 99,424 100,330 Delaware......................................... 457 671 703 730 725 708 721 750 747 819 817 Dist. of Columbia................................ 4,106 4,202 4,265 4,538 4,498 4,365 4,278 4,694 4,899 5,095 4,342 Florida.......................................... 8,174 9,718 11,314 11,309 12,609 14,656 18,055 18,899 18,608 18,608 18,380 Georgia.......................................... 13 8 19 18 10 16 9 12 19 18 15 Hawaii........................................... 3,598 3,740 3,893 4,263 6,799 10,885 10,314 10,698 11,066 11,299 11,305 Idaho............................................ 4,023 4,136 4,205 4,205 4,205 4,212 4,212 4,212 4,212 4,212 9,459 Illinois......................................... 44,491 51,197 56,856 59,573 55,716 57,137 65,756 64,241 65,836 73,398 69,450 Indiana.......................................... 1,191 1,744 2,666 3,619 3,099 3,285 3,405 3,563 3,817 3,884 3,786 Iowa............................................. 1,620 1,908 2,098 2,204 2,275 2,408 2,508 2,672 2,859 2,940 2,951 Kansas........................................... 32 27 34 25 21 21 17 12 0 2 1 Kentucky......................................... 9,947 9,795 10,109 10,467 10,473 11,611 14,801 15,492 15,313 16,612 16,843 Louisiana........................................ 51 42 47 33 23 25 19 12 4 (\1\) (\1\) Maine............................................ 5,372 5,413 7,454 7,540 7,452 7,494 7,371 7,325 7,233 7,415 7,542 Maryland......................................... 4,238 5,252 5,505 6,159 6,159 6,155 6,520 6,542 6,269 6,102 6,235 Massachusetts.................................... 109,954 109,452 112,561 120,010 114,691 117,113 124,761 137,516 147,866 153,034 160,080 Michigan......................................... 62,824 66,338 68,779 69,833 72,369 74,682 72,561 61,636 62,683 61,955 37,296 Minnesota........................................ 17,024 19,818 22,850 24,667 40,641 43,924 48,933 55,224 53,860 53,860 63,720 Mississippi...................................... 33 29 35 27 26 22 19 12 11 7 6 Missouri......................................... 6,027 5,132 4,410 4,009 3,102 2,808 8,476 26,158 25,866 24,286 29,549 Montana.......................................... 805 834 844 839 842 864 910 909 902 960 940 Nebraska......................................... 5,325 5,348 5,457 5,454 6,550 5,793 5,334 6,175 6,705 5,990 5,970 Nevada........................................... 2,421 2,531 2,594 2,704 2,771 2,928 3,029 3,184 3,586 3,717 3,885 New Hampshire.................................... 7,740 7,326 6,501 5,865 9,662 6,843 7,675 7,948 8,512 9,573 11,039 New Jersey....................................... 46,675 48,124 49,996 50,446 59,291 53,697 57,328 64,765 71,965 74,242 76,655 New Mexico....................................... 226 216 280 248 270 263 307 333 329 321 293 New York......................................... 225,075 277,035 305,678 317,504 366,972 388,150 410,081 440,374 476,029 494,345 510,096 North Carolina................................... 36,449 41,091 47,963 52,745 58,989 63,135 75,066 91,925 95,445 106,493 115,245 North Dakota..................................... 1,183 1,518 1,406 1,480 1,549 1,390 1,291 1,408 1,220 1,676 1,928 Ohio............................................. 1 35 37 31 30 34 31 31 28 18 13 Oklahoma......................................... 30,187 31,380 32,894 34,045 33,414 34,168 35,055 36,012 36,557 34,987 35,811 Oregon........................................... 9,781 9,767 10,342 11,843 15,419 17,946 20,169 20,169 20,169 20,169 28,045 Pennsylvania..................................... 65,203 69,186 75,502 74,670 76,565 79,571 84,668 94,971 109,947 128,339 136,153 Rhode Island..................................... 8,842 9,402 9,848 10,263 10,816 11,729 12,973 14,967 16,097 17,384 18,811 South Carolina................................... 3,932 4,812 4,927 5,004 9,785 8,897 11,994 11,685 12,377 11,880 12,750 South Dakota..................................... 499 591 636 587 590 567 620 652 681 709 773 Tennessee........................................ 6 0 6 1 4 4 1 1 0 (\2\) (\2\) Texas \1\........................................ 0 0 0 0 0 0 0 0 0 (\3\) (\3\) Utah............................................. 820 872 855 1,086 981 808 898 959 878 201 60 Vermont.......................................... 6,709 7,236 7,684 7,841 8,346 8,685 9,374 10,299 9,927 9,715 10,396 Virginia......................................... 11,267 12,164 12,846 14,432 15,949 15,296 16,863 16,782 17,317 17,752 19,156 Washington....................................... 20,022 17,443 19,424 18,058 18,994 19,915 21,558 24,043 26,808 28,374 28,516 West Virginia \1\................................ 0 0 0 0 0 0 0 0 0 (\3\) (\3\) Wisconsin........................................ 71,733 80,288 86,363 90,642 95,205 100,276 107,543 118,063 132,761 125,789 123,693 Wyoming.......................................... 199 216 218 226 296 279 326 440 527 597 660 ---------------------------------------------------------------------------------------------------------------------------------------------- Total...................................... 2,234,846 2,496,275 2,835,516 3,006,796 3,308,277 3,589,348 3,750,812 3,987,110 3,862,151 3,719,314 3,735,250 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ \1\ Less than $500. \2\ Amount not shown; negative adjustment exceeds amount paid. \3\ Texas and West Virginia do not pay State supplementation. Source: Office of Research and Statistics, Social Security Administration. TABLE 4-24.--FEDERAL AND STATE BENEFIT PAYMENTS UNDER SSI AND PRIOR ADULT ASSISTANCE PROGRAMS, CALENDAR YEARS 1970-87 AND FISCAL YEARS 1988-2002 \1\ [In millions of dollars] ---------------------------------------------------------------------------------------------------------------- Total State payments SSI constant Federal Total ---------------------------- administrative Year \2\ Total 1995 payments State Federally State costs (fiscal dollars payments administered administered year) ---------------------------------------------------------------------------------------------------------------- 1970........................ 2,939 11,779 1,801 1,138 ............ ............ .............. 1971........................ 3,206 12,218 (\3\) (\3\) ............ ............ .............. 1972........................ 3,392 12,479 1,993 1,398 ............ ............ .............. 1973........................ 3,418 12,088 1,987 1,432 ............ ............ .............. 1974........................ 5,246 17,034 3,833 1,413 1,264 149 \4\ 285 1975........................ 5,878 17,182 4,314 1,565 1,403 162 399 1976........................ 6,066 16,559 4,512 1,554 1,388 166 500 1977........................ 6,306 16,605 4,703 1,603 1,431 172 NA 1978........................ 6,552 15,535 4,881 1,671 1,491 180 539 1979........................ 7,075 15,205 5,279 1,796 1,590 207 610 1980........................ 7,941 15,026 5,866 2,074 1,848 226 668 1981........................ 8,593 14,636 6,518 2,076 1,839 237 718 1982........................ 8,981 14,246 6,907 2,074 1,798 276 779 1983........................ 9,404 14,411 7,423 1,981 1,711 270 830 1984........................ 10,372 15,267 8,281 2,091 1,792 299 864 1985........................ 11,060 15,701 8,777 2,283 1,973 311 953 1986........................ 12,081 16,740 9,498 2,583 2,243 340 1,022 1987........................ 12,951 17,446 10,029 2,922 2,563 359 976 1988........................ 14,375 18,598 11,368 3,007 2,645 362 975 1989........................ 14,707 18,163 11,399 3,308 2,881 427 1,051 1990........................ 16,095 18,933 12,507 3,589 3,159 431 1,075 1991........................ 17,979 20,133 14,228 3,751 3,235 516 1,257 1992........................ 21,258 23,109 17,270 3,987 3,431 556 1,538 1993........................ 24,173 25,504 20,312 3,862 3,298 564 1,467 1994........................ 28,288 29,082 24,461 3,827 3,219 608 1,781 1995........................ 28,124 28,124 24,443 3,681 3,060 621 1,978 1996 \4\ \6\................ 27,946 27,209 24,336 3,610 2,940 670 2,102 1997 \4\ \5\................ 31,991 30,215 28,151 3,840 3,125 715 2,123 1998 \4\ \5\................ 33,984 31,145 30,094 3,890 3,125 765 2,124 1999 \4\ \5\................ 35,847 31,906 31,912 3,935 3,125 810 2,124 2000 \4\ \5\................ 40,536 35,069 36,311 4,225 3,365 860 2,124 2001 \4\ \5\................ 36,784 30,922 32,999 3,785 2,880 905 2,124 2002 \4\ \5\................ 41,517 33,885 37,437 4,080 3,125 955 2,124 ---------------------------------------------------------------------------------------------------------------- \1\ Payments and adjustments during the respective year but not necessarily accrued for that year. \2\ 1970-73 refers to Old-Age Assistance, Aid to the Blind and Aid to the Permanently and Totally Disabled; 1974- 2002 refers to Supplemental Security Income. \3\ Data not available. \4\ Additional administrative costs are reflected for the SSI program share of the President's Disability Investment in fiscal years 1994-2002 and for the Automation Investment in fiscal years 1994-98. \5\ Estimated. Federal outlays are projections based on the President's budget estimates of January 1996. State outlays are rough estimates on an aggregate national basis. \6\ Fiscal year 1995 adminstrative expenses included funds to pay back the OASI Trust Fund with interest for SSI administrative funding shortfalls in prior years. Source: Office of Budget, Social Security Administration. LEGISLATIVE HISTORY Legislative Changes Made in the 92d Congress 1972 Public Law 92-603, the Social Security amendments of 1972, replaced existing Federal-State programs of assistance to the aged, blind, and disabled with a program fully financed and administered by the Federal Government, effective January 1, 1974. The old Federal-State programs remained in effect for Guam, Puerto Rico, and the Virgin Islands, since these jurisdictions are not covered by the new SSI Program. The SSI Program used the same definitions of ``blindness'' and ``disability'' as those used under the Old-Age Survivors and Disability Insurance (OASDI) Program and an individual had to be at least age 65 to be considered ``aged.'' To be eligible for SSI benefits, aged, blind, and disabled persons could not have resources of more than $1,500 and a couple could not have resources of more than $2,250. In determining resources, a number of items generally are not counted, such as the individual's home, household goods, automobile and personal effects. In January 1974, an aged, blind, or disabled individual with no other income received an SSI benefit payment of $140 per month. An eligible couple with no other income received $210 per month. The SSI law required that the amount of SSI payable was to be reduced by other income available to recipients, but the reductions were not on a dollar-for-dollar basis. The first $20 of almost any kind of income was to be disregarded as well as the first $65 of earned income plus one half of any earnings above that $65. It also required that individuals who were living in another person's household and receiving in-kind support and maintenance from that person were to have their SSI benefit based on a one-third reduction of the Federal SSI benefit standard. Persons in a medical facility where the Medicaid Program was paying at least 50 percent of the cost of the person's care received an SSI benefit based on a reduced Federal SSI benefit standard of $25 in the case of an individual and $30 in the case of a couple (i.e., a personal needs allowance). The 1972 law included a provision that prohibited persons receiving SSI benefits from participating in the food stamp or surplus commodity distribution programs. To protect individuals who were eligible for payments under the Federal-State programs of old-age assistance (enacted in 1935), aid to the blind (enacted in 1935), and aid to the permanently and totally disabled (enacted in 1950), but who would have been ineligible or eligible for a lesser payment under the SSI Program, the 1972 law contained several ``grandfather clauses.'' Under the grandfather clause provisions (1) persons who received aid to the blind or aid to the disabled in December 1973 were considered blind or disabled under the SSI Program if they met the definitions of blindness or disability in effect in their States as of October 1972 and (2) persons who received assistance in December 1973 and December 1972 were considered able to meet the resource requirement as long as their resources did not exceed the resource limits of the State assistance plan in effect in October 1972. The 1972 law permitted States to supplement the Federal SSI benefit payment (without such payments being counted as income for the SSI Program). It also allowed States to have the Federal Government make the supplementary payment and absorb the administrative costs of doing so. Under the 1972 law, States were guaranteed that if they were required to pay more than they paid in calendar year 1972 in order to maintain pre- SSI assistance levels, they would receive some financial relief under a fiscal savings provision, sometimes called the ``hold harmless'' clause. Under the fiscal saving provision, a State which elects to have the Federal Government administer its State supplementary payments (including required supplementary payments) is not required to contribute more toward the cost of these payments than the State's calendar year 1972 share of the cost of aid to the aged, blind, and disabled. The 1972 law required disabled and blind recipients to be referred to State agencies for vocational rehabilitation services. A recipient who refused without good cause any vocational rehabilitation services offered would no longer be eligible for SSI benefits. It also required that payments to persons classified as SSI drug addicts or alcoholics be made to a representative payee (i.e., person or agency responsible for managing the recipient's finances), that these recipients participate in drug treatment programs if available and appropriate, and that the treatment be monitored. In addition, the 1972 law provided States with several options, largely dependent on their previous coverage levels, for purposes of determining Medicaid eligibility for the aged, blind, and disabled. Legislative Changes Made in the 93d Congress 1973 Public Law 93-66 increased the SSI payment levels from $130 to $140 per month for an individual and from $195 to $210 per month for a couple, effective for July 1974. Public Law 93-66 required that States, in order to be eligible for Federal matching funds for Medicaid, provide additional payments to supplement the SSI payment of those who were receiving aid to the aged, blind, or disabled in December 1973. These payments must be sufficient to assure that the individual continues to have as much total income (SSI payment plus other income) as he had in December 1973 (aid to the aged, blind, or disabled plus other income). This requirement applied only to those individuals who were actually on the assistance rolls in December 1973. Public Law 93-66 also provided that in cases where an essential person (a person whose needs were taken into account under a State plan as a person whose presence in the household was considered necessary to provide care and essential services for the public assistance recipient) was included in the State's assistance payment in December 1973, the SSI benefit would also include the essential person (i.e., the amount would be increased by $65 per month ($70 per month effective July 1974)). Public Law 93-86 permitted SSI recipients to receive food stamp benefits only if the individual's SSI benefits were not equal to the total of the SSI payment (including any State supplement) plus the food stamp bonus that was available in December 1973. 1974 Public Law 93-233, the Social Security Act amendments of 1973, increased SSI payments to $140 per month for an individual and $210 per month for a couple effective January 1, 1974. Effective July 1, 1974 these amounts were increased to $146 for an individual and to $219 for a couple. The l973 Social Security Act amendments temporarily suspended the SSI- food stamp provision of Public Law 93-86 (effective January- June 1974). Thus, SSI recipients in all States except the States where food stamps were cashed out were eligible for food stamps if they met the income and resource requirements (Public Law 93-335 extended this provision for another 12 months--until July 1, 1975). Under the 1973 amendments, only persons who had received aid to the disabled before July 1973 and who were on the rolls in December 1973 would be grandfathered into the SSI Program. Moreover, the grandfather clause with respect to the resource limit was liberalized in that persons who met the State resource limits in October 1972 and who were on the rolls in December 1973 (in the same State) were eligible for SSI (as long as they were continuously eligible for SSI). Public Law 93-233 permitted the adjustment of the grandfather clause in such a way that it assures the same level of total family income (rather than the individual's income) in cases where the SSI recipient lived with an AFDC family. Another provision of Public Law 93-233 stipulated that the Federal SSI payment would be reduced dollar-for-dollar for any State supplementary payment which was made for care provided to institutionalized individuals, if the care could be provided under the State's Medicaid Program. Public Law 93-368 provided for automatic increases in Federal SSI benefits at the same percentages as cost-of-living increases for Social Security recipients. It also contained a provision giving the Federal Government the authority to reimburse States for assistance provided to individuals who applied for, but had not yet received, SSI benefits. Legislative Changes Made in the 94th Congress 1976 Public Law 94-585 established Federal SSI ``passthrough'' requirements, effective with the cost-of-living increase provided in July 1977. These provisions provide States with two options for meeting the passthrough requirements. One option is the aggregate spending level option, under which a State may make State supplementary payments in any current 12-month period that are no less, in the aggregate, than were made in the previous 12-month period. The other option is the individual payment level option, under which a State may maintain the supplementary payment levels that were in effect for categories of individual recipients in December 1976. Legislative Changes Made in the 96th Congress 1980 Public Law 96-265, the Social Security Disability amendments of 1980, established a new section, 1619, which authorized a 3-year demonstration project (beginning January 1, 1981) providing special cash benefits (equivalent to ``regular'' SSI benefits) and continued Medicaid eligibility to persons who had been eligible for SSI disability payments, but had earned income in excess of the ``substantial gainful activity'' standard (this provision is later referred to as the section 1619 provision). Public Law 96-265 allowed wages received by an SSI recipient for working in a sheltered workshop to be eligible for the earned income disregard used in computing benefits. It permitted disabled SSI and SSDI recipients to deduct costs of items and services (e.g., prostheses, medical devices and equipment, attendant care services, etc.) needed to enable the recipient to work from income in determining whether the recipient is engaging in substantial gainful activity and in determining the recipient's SSI benefit amount. The 1980 amendments extended to 24 months, from 9 months, the ``trial work period'' during which a disabled person could return to work without losing the right to an immediate reinstatement of SSI and/or SSDI benefits if continued employment proved impossible. Public Law 96-265 eliminated the ``deeming'' of income and resources requirement for children aged 18-20, so that all deeming of income and resources from parents to children would end when the child reached age 18. It also stipulated that a portion of the income and resources of a sponsor of an alien/ immigrant be deemed to the alien for 3 years after entry (excludes refugees, political asylees, and those who become blind or disabled after entry into the United States). Legislative Changes Made in the 97th Congress 1981 Public Law 97-35, the Omnibus Budget Reconciliation Act of 1981, established a new period for determining SSI eligibility and benefit amount. Under the 1981 law, eligibility and benefit amount which were based on an individual's income, resources, and other relevant circumstances in a calendar quarter are now to be based on a month. The 1981 Act stipulated that States would be paid only for vocational rehabilitative services provided to persons who were to return to the performance of substance gainful activity for a continuous period of at least 9 months. In addition, while the negotiability of SSI checks was not limited, the Secretary of the Treasury, on a monthly basis, was required to notify the Secretary of the Department of Health and Human Services of all benefit checks which were not cashed within 180 days of issuance. Moreover, the DHHS Secretary was required to return or credit amounts which represented State supplementary payments to the States. (Public Law 97-248 clarifies that State supplementary payments includes ``State supplementation only checks.'' 1982 Public Law 97-248, the Tax Equity and Fiscal Responsibility Act of 1982, established a prorating procedure under which SSI benefit levels for recipients during their first month on the program would be determined according to the day of the month on which they applied or met the eligibility requirements, whichever date is later, provided that a recipient's SSI benefit be rounded down to the next lower dollar, required that SSI benefits be reduced in the first month in which a recipient received a cost-of-living increase in Social Security payments, excluded from countable resources, for eligibility purposes, burial spaces and burial funds of up to $1,500 each for the individual and spouse. It also authorized reductions in the hold harmless payment (payments to limit State's financial liability for supplementing Federal SSI benefits to maintain benefit levels of pre-SSI recipients at their January 1972 benefit levels), as follows: 40 percent of what it would have otherwise been in 1983, to 20 percent in 1984, and no hold harmless payments in 1985 and years thereafter. In addition, it allowed States to shift from the aggregate spending option (States which supplement Federal SSI benefits are required to pass through the Federal SSI cost-of-living increases by (1) maintaining the December 1976 State supplementation payment level for recipients or (2) providing no less than the total aggregate amount of State supplementation paid by the State in the previous 12-month period) to the State supplementation payment level option by maintaining the payment level in the previous December rather than December 1976. Legislative Changes Made in the 98th Congress 1983 Public Law 98-21, the Social Security amendments of 1983, increased the Federal SSI benefit standard by $20 per month for an individual and by $30 per month for a couple, effective July 1, 1983, and delayed the annual cost-of-living adjustments from January to July, beginning January 1984 (thus, SSI and OASDI cost-of-living adjustments would continue to occur at the same time). It provided that aged, blind, and disabled residents of public emergency shelters for the homeless could be eligible for SSI payments for as many as 3 months in a 12-month period. Under Public Law 98-21, in-kind support and maintenance provided by a private nonprofit organization was excluded from income by the SSI Program if it was determined that the assistance was based on need. The 1983 amendments also required the DHHS Secretary to provide, before July 1984, a one-time notice to all elderly OASDI recipients who were potentially eligible for SSI payments of the availability of SSI. Moreover, similar information on SSI availability was to be included with the standard notice to OASDI recipients of upcoming eligibility for Supplementary Medical Insurance at age 65. Public Law 98-21 modified Public Law 94-585 by substituting the State supplementary payment levels in effect in March 1983 for those in effect in December 1976 as the levels that States must maintain in order to comply with the payment level passthrough requirement and with regard to the $20/$30 increase in the Federal SSI benefit standard in July 1983, by requiring States to pass through only as much as would have been required if the SSI cost-of-living adjustment had not changed from July 1983 to January 1984. 1984 Public Law 98-460, the Social Security Disability Benefits Reform Act of 1984, extended the section 1619 provision (continued SSI benefits and Medicaid coverage for persons working despite severe impairments) through June 30, 1987 (the demonstration was scheduled to end December 31, 1983). In addition, it required the Secretaries of the Department of Health and Human Services and the Department of Education to inform SSI applicants, recipients, and potentially interested public and private organizations of the Section 1619 program. It also permitted the DHHS Secretary to terminate OASDI or SSI benefits only if there was substantial evidence that an individual's medical condition had improved since the individual began receiving benefits and that the individual was able to work. Public Law 98-460 required that the combined effects of an individual's multiple impairments be weighed in making the disability determination. It continued the existing practice of rejecting as conclusive evidence of a disability an individual's claim that he or she was in pain, but required the Department of Health and Human Services to conduct a study on the role of pain in determining disability. It also continued the moratorium on reviews of mentally impaired recipients, which had been in place since June 7, 1983, until new standards were published in the Federal regulations. Public Law 98-460 required stricter rules for the appointing and monitoring of persons who receive OASDI or SSI payments on behalf of the eligible persons (representative payees--responsible for managing the recipient's finances). The penalties against misuse of OASDI or SSI funds by representative payees were raised. Legislative Changes Made in the 99th Congress 1986 Public Law 99-643, the Employment Opportunities for Disabled Americans Act, made permanent and simplified the provisions of section 1619. (As mentioned earlier, the section 1619 provisions seek to encourage disabled and blind recipients of SSI to work by providing special SSI payments and Medicaid coverage while they work.) It also authorized full SSI benefits for 2 months for persons in a public medical or psychiatric institution if they were eligible for section 1619 benefits or services in the month prior to their admission. Public Law 99- 643 provided that States shall not be required to follow the SSI rule that members of a couple sharing a room in a Medicaid institution be considered as two individuals if following the SSI rule would disadvantage either spouse in determining eligibility for any other program under the Social Security Act. Legislative Changes Made in the 100th Congress 1987 Public Law 100-203, the Budget Reconciliation Act of 1987, permanently extended the provision that authorized in-kind support and maintenance (that was based on need) provided by a private nonprofit organization to be excluded from income by the SSI Program (the provision was to expire September 30, 1987). Public Law 100-203 excluded real property from SSI eligibility calculations if the property could not be sold because it was jointly owned and the sale would cause a hardship to other owners, its sale was legally prevented, or reasonable efforts to sell it had been unsuccessful. It permitted the DHHS Secretary to waive the transfer of assets rule, which counted the value of assets sold at less than market value for 24 months after the transaction in computing benefit eligibility, if the absence of such a waiver would cause undue hardship. Public Law 100-203 extended to July 1, 1988, the period during which widows and widowers who would have lost eligibility for SSI because of the 1983 Social Security benefit increase for widows and widowers could apply for Medicaid as SSI recipients. It continued SSI eligibility for blind or disabled widows or widowers who were required to apply for Social Security benefits at age 60. It increased the amount of immediate emergency SSI payments from $100 to the Federal SSI benefit standard ($470 for an individual in 1996) plus, if any, the federally administered State supplementary payment. It permitted the Federal Government to reimburse States that paid SSI benefits to persons whose eligibility was terminated or suspended but who later were found to be eligible for SSI benefits. It continued full SSI benefits to persons in a Medicaid hospitals or in public institutions whose primary purpose is to provide medical or psychiatric care if a doctor certified that they were not likely to stay more than 3 months. Public Law 100-203 required that any interest on burial accounts must be disregarded in determining whether an individual met the SSI resource requirement. It required that AFDC payments be disregarded in determining SSI benefits (previously, under the SSI retrospective accounting period, AFDC benefits received in the month of SSI application were counted as income in determining SSI benefit for the first 2 months of SSI receipt). It gives the States the option of treating a husband and wife who have been living in a Medicaid institution for 6 months as a couple, if doing so would prevent a reduction or termination of Medicaid benefits. It increased the ``personal needs'' allowance for SSI recipients in Medicaid facilities from $25 to $30 in the case of an individual and from $50 to $60 in the case of a couple. It continues SSI benefits to individuals whose blindness has ceased if they are participating in an approved vocational rehabilitation program (under the same conditions that apply to the disabled). It required SSA to inform blind SSI recipients about their benefits by telephone, certified letter, or some other process agreed to by the recipient. Public Law 100-203 provided that a person in an emergency shelter could receive SSI benefits for 6 months in a 9-month period. It authorized several types of demonstration projects designed to help homeless persons who could qualify for SSI benefits. It provided that, for the 2-year period beginning October 1, 1987, retroactive SSI and Social Security payments received during the period must be disregarded as resource for 9 months. It required that death benefits and gifts and inheritances from a family member be disregarded from the determination of a person's SSI eligibility if the benefits were used to pay for the deceased person's last illness and burial. Legislative Changes Made in the 101st Congress 1989 Public Law 101-239, the Omnibus Budget Reconciliation Act of 1989, (1) established a permanent outreach program for disabled and blind children, (2) continued eligibility for disabled children in a military family that moves overseas, (3) waived the SSI income and resource deeming rules in the case of severely disabled children who were eligible for SSI while in a medical institution and who qualify for Medicaid under a State home care plan, (4) disregarded domestic commercial transportation tickets given as gifts to SSI recipients (unless they are converted to cash), (5) required that a married couple be treated as separate individuals beginning with the first month following the month of separation, (6) excluded interest and other accruals on burial spaces in determining income and resources for the purpose of the SSI Program, (7) required that the value of property which is used in a person's trade or business, or in the employment of a family member, be excluded from the equity value of the person's property, and (8) authorized demonstration projects to test the use of volunteer senior aides to provide basic medical assistance and support to families with disabled or chronically ill children. 1990 Public Law 101-508, the Omnibus Budget Reconciliation Act of 1990, included a provision that requires the Secretary of the Department of Health and Human Services to inform the family of a child who is awarded a retroactive payment as a result of the Sullivan v. Zebley Supreme Court decision that the family may be able to place the payment in a trust for the benefit of the child and that legal aid may be available for this. Public Law 101-508 also included a provision that requires the DHHS Secretary to make reasonable efforts to ensure that a qualified pediatrician or other specialist in a field of medicine appropriate to the disability of the child evaluate the child's disability for purposes of determining eligibility for SSI. The 1990 Omnibus Budget Reconciliation Act also liberalized the treatment of certain income by disregarding certain expenses and payments in determining SSI eligibility and/or benefits. Pursuant to the 1990 law, the SSA is to (1) exclude victim's compensation payments from income for purposes of SSI eligibility and benefits and exclude such payments from resources for the 9-month period beginning after the month of receipt, (2) treat royalties and honoraria as earned income rather than unearned income, and (3) exclude State or local relocation assistance from income and from resources for no more than 9 months (provision effective for 3 years). Public Law 101-508 included four provisions related to section 1619 of the Social Security Act. The first provision eliminates the age limit requirement for persons in the section 1619(b) program. The second provision requires that impairment- related work expenses be excluded from the earnings of a disabled individual in determining State supplementary payments and Federal SSI benefits. Previous law permitted only disabled persons who received Federal SSI benefits to deduct impairment- related work expenses from income in determining SSI eligibility and reeligibility. The third provision authorizes reimbursement for vocational rehabilitation services provided in months for which individuals were eligible for Medicaid coverage under section 1619(b), were in suspended benefit status, \1\ or were receiving federally administered State supplementary payments. Under previous law, State vocational rehabilitation agencies already were reimbursed for the costs incurred by regular SSI recipients and section 1619(a) recipients. The fourth provision provides that continuing disability and blindness reviews are required only once every 12 months for section 1619 recipients. Under previous law, a disabled or blind individual with income fluctuations was subject to several disability reviews in the course of a year. --------------------------------------------------------------------------- \1\ Disabled or blind persons are considered to be in ``suspended eligibility or benefit status'' if, within the last 12 months, they were recipients of regular SSI, section 1619(a) benefits or 1619(b) coverage. --------------------------------------------------------------------------- Public Law 101-508 also (1) required the Secretary of the Department of Health and Human Services and the Secretary of Agriculture to develop a procedure under which concurrent applications for the SSI and Food Stamp Programs are given to persons who are about to be released from an institution, and (2) extended the presumptive eligibility time period from 3 months to 6 months. Legislative Changes Made in the 103d Congress 1993 Public Law 103-66, the Omnibus Budget Reconciliation Act of 1993, required the DHHS Secretary to charge States fees for the Federal cost of administering SSI supplementary payments. The fees started at $1.67 for each monthly supplementary payment in fiscal year 1994, increasing to $3.33 in fiscal year 1995, and to $5 in fiscal year 1996. The fee in subsequent years would be $5 or an amount determined by the DHHS Secretary. It permanently excluded from consideration as income or resources any State or local relocation assistance received by SSI recipients, prevented SSI benefits from declining when the spouse or parent of a recipient was absent from home solely because of active military service (certain hazardous duty pay was also excluded from income), and required that children who were U.S. citizens would remain eligible for SSI when they accompanied their parents on U.S. military assignments to Puerto Rico or to U.S. territories and possessions (previous law continued payments only if the parents were on military assignments in foreign countries). In addition, to eliminate the unintended SSI benefit increase for January and February following a cost-of-living adjustment and the offsetting reduction for March (i.e., the 2- month retrospective benefit calculation rule), Public Law 103- 66 required that the benefit reduction for in-kind support and maintenance (generally one-third of the Federal SSI benefit standard plus $20 monthly) be based on the existing month's benefits. Public Law 103-66 also disregarded from income up to $2,000 received by American Indians that came from leases on individually owned trust or restricted American Indian lands (previously only income received by American Indians from tribally owned trust lands had been excluded as income). 1994 Public Law 103-296, the Social Security Independence and Program Improvements Act of 1994, made numerous changes to the SSI Program. In addition to establishing SSA as an independent agency (with responsibility for both OASDI and SSI, it included the provisions discussed below. Restrictions on benefits based on disability of substance abusers.--Places restrictions on SSI disability insurance payments to individuals disabled by drug addiction and alcoholism (DAA) and establishes barriers against a beneficiary's using SSI benefits to support an addiction. Payment limitation.--Limits the payment of SSI benefits to 36 months for individuals whose substance abuse is material to their disability, beginning with the first month for which treatment is available. This restriction sunsets October 1, 2004. Medicare, Medicaid, and dependent's benefits will continue as long as the terminated beneficiary continues to be disabled and otherwise eligible (i.e., except for the 36-month limit). The payment limit will not apply to individuals who are disabled independent of the alcoholism or drug addiction at the close of the 36-month period. Suspension for noncompliance.--Provides for suspending benefits for noncompliance with treatment for substance abusers, beginning the month after SSA sends notification of noncompliance. Once benefits are suspended for noncompliance, they may be reinstated only after demonstrated compliance with treatment requirements for specified periods--a minimum of 2 months, 3 months, and 6 months, respectively, for the first, second, third and additional instances of noncompliance. Suspension of benefits for 12 consecutive months will result in termination of benefits. Referral and monitoring.--Requires the establishment of referral and monitoring agency contracts in each State and issuance of regulations defining appropriate treatment for substance abusers. Retroactive benefits.--Requires gradual payment of retroactive disability benefits to substance abusers, except for beneficiaries who have outstanding debts related to housing and are at high risk of homelessness. Retroactive benefits due to an individual whose entitlement terminates will continue in prorated amounts until they are fully paid. In addition, if a beneficiary dies without having received all retroactive benefits, the unpaid amount becomes and underpayment. Representative payment.--Requires SSA to give preference to the appointment of social service agencies or to Federal, State, or local government agencies as representative payees for disability substance abusers, unless SSA determines that a family member would be a more appropriate payee. Permits organizations that serve as representative payees for substances abusers to retain, as compensation for their services, the lesser of 10 percent of the monthly benefit or $50, indexed to the CPI. Also indexes to the CPI the maximum payee service fee ($25) for other beneficiaries with a qualified organizational payee. Studies and reports.--Requires the following studies and reports: A study of (1) the feasibility, cost and equity of requiring representative payees for all disability beneficiaries who suffer from drug addiction or alcoholism, regardless of whether their addiction is material to their addiction; (2) the feasibility, cost and equity of providing noncash benefits; and (3) the extent of substance abuse among child recipients and their representative payees. A report on the studies is due by December 31, 1995. A report on the Secretary's activities relating to the monitoring and testing of disability beneficiaries. The report is due by December 1, 1996. Demonstration projects designed to explore innovative referral, monitoring, and treatment approaches with respect to disability beneficiaries who are subject to a treatment requirement. A report on these projects is due by December 31, 1997. Continuing disability review (CDRs) for SSI recipients.-- Requires SSA, in each of the fiscal years 1996, 1997, and 1998, to perform CDRs for a minimum of 100,000 SSI recipients and one-third of all childhood SSI recipients who are between age 18 and age 19. The latter provision applies to individuals who attain age 18 in or after the ninth month after enactment. Requires SSA to report its findings no later than October 1, 1998. SSI eligibility for students temporarily abroad.--Allows individuals who leave the United States temporarily as part of an educational program that is not available in the United States, that is designed for gainful employment, and that is sponsored by a school in the United States to continue receiving SSI benefits for up to 1 year if they were eligible for SSI the month they left the country. Disregard of cost-of-living increases for continued eligibility for work incentives.--Continues Medicaid under section 1619(b) for an individual whose Social Security cost- of-living increase otherwise would make them ineligible because of excess unearned income. Provisions to combat SSI Program fraud.--Strengthens present law in deterring fraud and abuse in the SSI Programs by: 1. Requiring that third-party translators certify under oath the accuracy of their translations, whether they are acting as the applicant's legal representative, and their relationship to the applicant. 2. Authorizing civil penalties to be imposed against third parties, medical professionals, and SSI recipients who engage in fraudulent schemes to enroll ineligible individuals in the SSI Program. In addition, medical professionals may be barred from participation in Medicare and Medicaid. 3. Treating SSI fraud as a felony. 4. Clarifying SSA's authority to reopen SSI cases where there is reason to believe that an application or supporting documents are fraudulent, and to terminate benefits expeditiously in cases where SSA determines that there is insufficient reliable evidence of disability. 5. Requiring the Inspector General to immediately notify SSA about SSI cases under investigation for fraud, and requiring SSA to immediately reopen such cases where there is reason to believe that an application or supporting documents are fraudulent, unless the U.S. Attorney or equivalent State prosecutor determines that doing so would jeopardize criminal prosecution of the parties involved. 6. Requiring SSA to obtain and utilize, to the extent it is useful, preadmission immigrant and refugee medical information, identification information, and employment history compiled by the Immigration and Naturalization Service or the Centers for Disease Control when developing SSI claims for aliens. 7. Requiring SSA to submit an annual report to the House Committee on Ways and Means and the Senate Committee on Finance on the extent to which it has reviewed SSI cases, including the extent to which the cases reviewed involved a high likelihood of probability of fraud. Exemption from adjustment in pass along requirements.-- Allows states the option of exempting Zebley-related retroactive State supplementary payments from the annual supplementary payments expenditure amount that a State must maintain in the following year in order to meet the pass along requirement. Nursing home notification.--Requires nursing homes to notify SSA within 2 weeks after they admit SSI recipients. Public Law 103-432, the Social Security Act amendments of 1994, replaced the words children under age 18 with individuals under age 18 with respect to the disability definition. The purpose of this provision was to enable all persons under age 18 to be evaluated under the childhood disabilities criteria. Under previous law a person who was married or the head of a household was not considered a child for SSI purposes even though he or she was under age 18. Legislative Changes Made in the 104th Congress 1996 Public Law 104-121, the Contract with America Advancement Act of 1996, among other things, 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 applies to current beneficiaries on January 1, 1997. It stipulates that SSI must: (1) notify current DAA beneficiaries of 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. 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, it retains the $50 fee that representatives can collect for beneficiaries who have a DAA condition. Public Law 104-121 authorizes an appropriation of $50 million for each of fiscal years 1997 and 1998 to carry out on a priority basis activities relating to the treatment of drug and alcohol abuse under the Public Health Service Act. In addition, Public Law 104-121 authorizes additional funds to SSA for fiscal years 1996 through 2002 for the purpose of conducting Social Security disability insurance (DI) continuing disability reviews (CDRs) and Supplemental Security Income (SSI) CDRs and disability eligibility redeterminations. This would be accomplished by increasing the amount of funds available for appropriations under the discretionary spending cap. It directs the Commissioner of Social Security to 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, it requires the Commissioner to report annually, for fiscal years 1996 through 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. REFERENCES Louis W. Sullivan, Secretary of Health and Human Services, petitioner, v. Brian Zebley, et al., No. 88-1377 (U.S. filed February 20, 1990). National Academy of Social Insurance. (1995). Restructuring the SSI disability program for children and adolescents. Washington, DC: Author. Social Security Administration. (1995 and various years). Annual statistical supplement to the Social Security Bulletin, 1995 (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. (1995, October). Supplemental Security Income for Children with Disabilities (Report to Congress of the National Commission on Childhood Disability). Washington, DC: Author. U.S. General Accounting Office. (1995, July). Supplemental security 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. Social Security Amendments of 1971 (House Report No. 92-231). Washington, DC: U.S. Government Printing Office. U.S. Senate, Committee on Finance. Social Security Amendments of 1972 (Senate Report No. 92-1230). Washington, DC: U.S. Government Printing Office.