Understanding the SSI Age 18 Redetermination Process January

Learning Objectives Upon completion of this training, CWICs should be able to: 1.Describe what the age 18 redetermination process is and to whom it applies. 2.Identify and describe the steps involved in the age 18 redetermination process. 3.Identify and describe 7 strategies for success in helping beneficiaries manage the age 18 redetermination process. 4.Describe how the age 18 redetermination process and section 301 continuation of payments are interrelated. 5.Describe the CWIC role in helping beneficiaries manage the age 18 redetermination. 2

What is the Age 18 Redetermination? SSI recipients who turn 18 years of age must have their eligibility reviewed as if they were applying for adult SSI for the first time, without consideration of previous disability determinations. The adult definition of disability is different from the definition of disability for children in the SSI program. The adult standard is more stringent. Based on 2014 Social Security data, approximately 55% of all childhood SSI recipients are initially determined ineligible for adult SSI during the age 18 redetermination. From 2014 SSI Annual Report at 3

Facts about The Age 18 Redetermination Process May occur at a regularly scheduled Continuing Disability Review (CDR), or at another point as determined by Social Security. Usually occurs within 12 months after the 18th birthday, although this is not required by regulation. Age 18 redeterminations are considered to be initial eligibility decisions rather than CDRs. This means that the Medical Improvement Review Standard (MIRS) is not used for the redetermination. The burden of proof lies with the individual in establishing that the adult disability criteria for SSI are met. 4

More Facts about the Age 18 Redetermination Cases are not initiated prior to the month before the month the individual attains age 18. An age 18 disability redetermination will not be initiated if the individual was not eligible in the month before the month of attainment of age 18. Social Security will obtain completed disability reports and functional reports appropriate to initial disability determinations. They do not take a new application and will not develop medical information back to the original onset date. 5

Age 18 Redeterminations and Employment The SGA step of the sequential evaluation process does NOT apply during age 18 redeterminations! Students may work before and during the age 18 redetermination and still be found eligible for SSI as adults. This is an important point to emphasize with students, teachers and families! An individual does not become eligible for the Ticket to Work program until they have established eligibility for SSI as an adult. CWICs should discuss this as an important benefit of completing the age 18 redetermination process. 6

Steps in the Age 18 Redetermination Process 1.Written notification of the redetermination (see notice template). 2.Interview by Social Security personnel. This may be face-to-face, telephone, or a combination of these methods. 3.Review by the Disability Determination Service (DDS). 4.Individual is notified of determination (see notice templates). 7

Information Collection Social Security personnel will complete the appropriate initial disability interview forms including: –Form SSA-3367-F4 (Disability Report Field Office), –Form SSA-3368-BK (Disability Report - Adult), and appropriate disability and functional reports (see DI ), andDI –Form SSA-827 (Authorization for Source to Release Information to the Social Security Administration). –Social Security will collect the names and addresses of medical sources and functional information for the year preceding the date of the interview. The individual will also be asked if he/she is receiving VR, employment, training, educational, or other support services from any source. 8

Reduced Development Cases For certain extremely severe permanent impairments classified as Medical Improvement Not Expected (MINE) cases, Social Security may curtail development and forward the case to DDS without completion of the usually required interview forms. Cases categorized as MINE cases may be sent to DDS without additional development if the file contains sufficient information for the DDS to identify current treating sources. DDS will decide whether to utilize the curtailed development procedures or request the FO to fully develop. The purpose of this procedure is to avoid inconveniencing individuals with very severe impairments and to avoid unnecessary development. 9

Concurrent Cases DDS may not simply adopt a Title II disability determination made before age 18 to an SSI age 18 disability redetermination. For Title II disability determinations made after age 18, DDS will follow existing adoption policies unless the title II determination was an adoption of an earlier SSI determination. If the Title II determination was an adoption of a pre age 18 determination, it will be treated in the same manner as a determination made before age

More about Concurrent Cases An unfavorable decision on an SSI age 18 disability redetermination could be reason to initiate a CDR on the Title II claim. The evidence used could also establish a reason to consider a reopening of the Title II determination. Because the initial standard employed in a disability redetermination differs from the MIRS employed in determining continuing disability, it is possible that entitlement could continue on the Title II claim. 11

Procedure – Favorable Determination Individual will receive written notice of the determination. Eligibility for SSI as an adult is established. SSI and Medicaid continue uninterrupted. Future medical CDRs will be diaried under the usual rules. 12

Procedure – Unfavorable Determination Age 18 redeterminations are not retroactive to the month the individual turned 18. Disability ceases as of the date of the disability redetermination decision. Eligibility ends the last day of the second month following the month of cessation. Benefits are paid for two months following the month of cessation if all other SSI eligibility criteria are met. In practice this means that benefits generally cease two months after the notice is received. 13

Age 18 Redeterminations and Section 301 Disability benefit payments may continue even though the young person is not found to meet the adult definition of disability if eligibility can be established for “section 301” status. Payment of benefits under section 301 requires that the beneficiary be actively participating in an appropriate program of VR, receiving special education services under an IEP, or has an approved PASS prior to the disability redetermination. For youth 18 through 21, Social Security assumes that continued participation in educational program under an IEP is likely to result in permanent removal from the disability rolls. 14

Strategies for Managing the Age 18 Redetermination There is no way to avoid an age 18 redetermination. CWICs must inform students and families about the redetermination process and prepare them to work through the process in the most efficient way possible. Planning for the possibility that benefits may be ceased is critical! 15

Strategy 1: Educate SSI Recipients and Families about the Redetermination Process SSI recipients and their families typically have no idea that this process occurs, nor how it differs from regularly scheduled CDRs. Students, families, school personnel, and VR staff should be given detailed, understandable information about the redetermination process and how it works. In particular, CWICs must discuss how information will be gathered that contributes to the part of the redetermination that examines the recipient’s future ability to earn income through paid employment. 16

Strategy 2: Identifying Individuals Most at Risk of Losing SSI Eligibility Students with certain disabilities tend to be more likely NOT to meet the adult disability standard than other youth (behavioral disorders, learning disabilities). See html html Students who were required to appeal their initial SSI medical determination in order to be awarded benefits as children may logically be more likely to be found ineligible as adults. Individuals who have experienced an improvement in their medical condition since their last CDR may also be at risk of an adverse redetermination. 17

Strategy 3: Start Planning Early for the Age 18 Redetermination Discuss how information will be gathered that contributes to the medical review under the more stringent adult disability standard. Gather contact information for various doctors, therapists, disability professionals, teachers, or others who have information to share on how the young person functions. Discuss how information will be gathered that contributes to that part of the redetermination process examining the individual's future ability to earn income through paid employment. Develop a contingency plan if the potential for loss of SSI benefits and Medicaid exists. This should include alternate plans for meeting the young adult's anticipated support needs for work or community living that are currently tied to SSI eligibility and receipt of Medicaid. 18

Strategy 4: Help Involved Parties Understand How Work Affects the Age 18 Redetermination The SGA step of the sequential evaluation process does not apply to age 18 redeterminations. If the student has participated in community-based work experiences, supplemental documentation should be provided that describes the level of performance in these settings and what supports are required to perform work activities. There is no reason not to engage in paid employment before, during or after the redetermination! 19

Strategy 5: Help Involved Parties Understand the Questions Asked by Social Security Teachers and others who provide information during redetermination should understand those questions attempting to identify prior fraud or misuse of benefits by families. Professionals should consider the questions carefully, clearly understand what they are communicating by their responses, and be certain that the observations providing the basis for their answers are accurate. 20

Strategy 6: Be Prepared to Request Continuation of Benefits under Section 301 Students at risk of termination due to the age 18 redetermination need to receive information about section 301 from a very early age! Don’t expect Social Security to identify section 301 candidates. Payment of benefits under section 301 requires that the beneficiary be actively participating in an appropriate program of vocational rehabilitation or be receiving special education services under an IEP prior to the disability redetermination. Section 301 payments are temporary! Students and families need to prepare for employment that leads to future financial stability. 21

Strategy 7: Provide Information about the Appeals Process Age 18 redeterminations are subject to the same appeals process provided for disability cessations in CDR cases. Individuals who appeal an age 18 redetermination are permitted to retain cash benefits while the appeal is pending, if the appeal is submitted within 10 days of the notice. If the appeal does not result in a favorable decision, the payments received since the date of the original determination will be subject to recovery. It is possible to appeal the original redetermination decision and request continuation of benefits under section 301 simultaneously. 22

Reminders about your Role! Information, information, information!!! It’s critical that students get connected with the state VR agency, EN or other VR program as early as possible – certainly prior to the 18 th birthday. Remember that individuals in section 301 status are not technically eligible for WIPA services. CWICs should provide information about section 301 but should not spend a lot of time assisting individuals with section 301 approval. Always emphasize the importance of preparing for employment! 23

Resources POMS DI Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law as Modified by P.L ) FO POMS DI Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) as Modified by P.L ) - DDS 24