TN 1 (05-09)
DI 23525.001 Title XVI Conversion Reentitlement Cases
Social Security Act § 1614
A. Definition of conversion cases
Section 1614 of the Social Security Act provides that an individual shall be considered to be disabled or blind for Title XVI purposes if he or she meets BOTH criteria:
Is permanently and totally disabled as defined under a State plan approved under Title XIV or XVI as in effect for October 1972, or is blind as defined under a State plan approved under Title X or XVI as in effect for October 1972.
Received aid under such a State plan (on the basis of either disability or blindness) for December 1973, and for disability cases, also received aid for at least one month prior to July 1973.
Section 1614 further provides that individuals who meet these criteria will continue to be disabled or blind for Title XVI purposes so long as they are continuously disabled or blind as defined under the State plan.
B. Definition of rollback cases
Rollback cases pertain to those individuals who:
were eligible for State Aid to the Permanently and Totally Disabled/Aid to the Blind (APTD/AB) in December 1973, but
did not receive aid for at least one month prior to July 1973.
Evaluate these cases solely under the Federal definitions of disability and blindness.
C. State plans
State plans define:
disability (in terms of permanence and totality), and
blindness (in terms of ophthalmic measurements).
In addition, State plans contain criteria that States may use
The definitions of disability and blindness approved under Title X, XIV, or XVI, in these State plans, were used to convert recipients to the Federal Supplemental Security Income (SSI) program.
The definitions and criteria set forth in the State plans will be used to evaluate whether recipients remain eligible for SSI benefits if they are selected for continuing disability reviews (CDRs).
D. Case processing
A nonrollback conversion recipient who has been ineligible for Title XVI benefits because of an event unrelated to disability may, upon removal of such an event, reestablish Title XVI eligibility on the basis of meeting the State plan criteria so long as the individual has been continuously disabled as defined by the State plan since December 1973.
Conversion reentitlement cases are processed by the Disability Determination Services (DDS) as CDRs.
The DDS may receive cases where eligibility has previously terminated for a non-disability reason, for example, following a suspension period of 12 consecutive calendar months.
The Field Office (FO) takes a new application, and the DDS develops medical and vocational evidence to the extent necessary. However, in cases where the individual's impairment is static or progressive, further medical evidence may not be necessary. Updated vocational development should include whether the individual has worked or undergone rehabilitation or other training since termination.
Persons who were originally found to be disabled under a State plan will be evaluated under current Federal guidelines.
If the recipient is found “not disabled” after the CDR evaluation process, evaluate under the appropriate State plan using the medical improvement review standard (MIRS). These conversion cases will be evaluated under the State Plan Criteria as well as the Federal definition of disability.
If the person's eligibility for disability benefits previously ceased because of substantial gainful activity (SGA) prior to August 12, 1994, the Federal definition of disability applies. The State Plan no longer applies.
Some former recipients of APTD/AB who have been converted to Title XVI rolls may have been determined to be disabled where DA/A was the only condition involved. Such individuals may not meet the Title XVI Federal standards discussed above. However, under the conversion provisions, their disability status is protected as long as they continue to meet the definition of disability under the applicable State plan, even though they do not meet the Federal definition of disability applicable to new claims.
20 CFR 416.260, Special Provisions for People Who Work Despite a Disabling Impairment
DI 21501.000, Title XVI – State Plans – Disability/Blindness
3. Forms completion
Prepare forms as usual
SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) and
SSA-4268 (Explanation of Determination). Show whether the individual has, or has not, continuously met the State Plan in the rationale.
If the conversion recipient meets the Federal definition of disability or the individual has, since December 1973 continued to be disabled as defined by the State Plan, the individual will be under a disability for Title XVI purposes.
NOTE: In concurrent Title II/Title XVI cases where a determination under the State plan is needed for the Title XVI case, prepare two rationales. The Title XVI rationale can incorporate the Title II rationale before including the evaluation of the case under the appropriate State plan.