SI 00501.300 Multicategory Eligibility - General Information
This section explains how a recipient can become eligible for supplemental security income (SSI) benefits under one category for Federal payments and a different category for optional State supplementation (OSS). For Federal payments this could mean issuing payments under one category while developing potential eligibility under another. We make these considerations, not only at the time of the initial application, but also in any posteligibility situation where a potential other category exists which will benefit the recipient.
B. Operating Policies
1. Determining Eligibility
Consider the following factors:
Does the individual appear to qualify under more than one category of eligibility; i.e., age, blindness, or disability?; and
Is the individual advantaged by any of the categories because of additional income/resource exclusions or criteria for determination?; or
Does the federally administered State supplement vary by category?
A positive response to the first question and either of the other two requires pursuing the existence of multicategory eligibility. Federal rules, including the definitions of aged, blind, and disabled, determine the appropriateness of the alleged category and the related eligibility for both Federal payment and State supplement purposes.
2. Federal Payments
Although basic Federal SSI payments are the same for each category, income/resource exclusions are not the same. Blind or disabled recipients could have less countable income and a larger Federal payment than an aged recipient. For receipt of the higher Federal payment, the blindness or disability must have an established onset of the month prior to attainment of age 65 or earlier.
Advantages the individual gains from change of Federal payment category include:
Conversion from disability with drug or alcohol involvement to aged permits competent individuals to receive direct payments.
In alien situations, the existence of blindness or disability should be developed even with an onset after age 65. Section 504 of P.L. 96-265 provides that an alien of any age is exempt from sponsor-to-alien deeming, if the established onset of blindness or disability is after the alien's date of entry into the United States (SI 01320.910B.3.).
3. Federally Administered OSS
Three States permit some variance in payments by category:
|State||Categories Providing Higher Supplements|
|Nevada||Aged or Blindness|
Effective Dates of Changes
If we change the Federal category retroactively and the State supplement for the new Federal category is higher than the State supplement previously paid, we must also change the State supplementation category retroactively effective with the date of the change in the Federal category.
If there is no change in the Federal category, the effective date of the new OSS category is the date of initial application or date of change; i.e., date of onset of disability or blindness or attainment of age 65, as appropriate, whichever is later. (See SI 00501.300 C.)
The effective date for a categorical change cannot precede the date the State first began to vary payment levels by category.
4. Field Office (FO) Involvement
FO responsibilities include:
Explaining advantages of multicategory eligibility if it benefits the claimant financially;
Assisting the claimant in applying for benefits;
Informing an individual applying for benefits under one category that if he/she is eligible under another category, we will make payment adjustment;
Explaining that refusal to change if it is advantageous could prevent the recipient from receiving full retroactive benefits in the future; also, a new request for benefits could only begin with the month following the month of refusal; and
Requiring a signed statement from the recipient if he chooses not to switch to an advantageous category.
5. Continued Eligibility
Recipients retain eligibility in their established categories whether they receive payment or not.
There are no restrictions on the number of times an individual changes categories; however, we require separate determinations for each change into the blindness/disability category.
Each request for change in category requires a new determination.
6. Notice Requirements
a. Denial of Disability Claim
If an individual receives an unfavorable determination based on medical criteria, the Disability Determination Service (DDS) will notify both the individual and the FO. The individual has the same appeal rights as an initial applicant.
b. Denial of an Aged Claim
If an individual receives an unfavorable determination because we cannot clearly establish that he/she is at least 65 years old, the FO must prepare an SSA-L8030-U2 (Notice of Disapproved Claim). Use standard language but modify where necessary to indicate the uniqueness of the individual's case. Although the individual is ineligible because of failure to meet the criteria as an aged individual, we will notify him/her as soon as we make a determination regarding eligibility based on disability/blindness.
C. Related Policies
1. Administrative Finality
Claimants have up to 2 years from the date of notice of initial determination on their application to provide additional information which can be considered for determining eligibility under another category (see SI 04070.001, administrative finality). If we cannot reopen a prior determination, the request for multicategory eligibility has no retroactivity.
Handle an appeal in a claimant-requested change of category case as if it were an initial application. Because each request for change in category requires a new determination on a category, each request has the same appeal rights as an initial application.
D. Operating Procedure — Initial Claims
1. Add Remark to Application Form
If an aged individual chooses to file a claim for disability/blindness, enter in “Remarks”:
“I (name of a member of a couple when both are filing) request a disability/ blindness determination.”
If a disabled or blind individual would be advantaged by filing an aged claim, enter in “Remarks”:
“I (name of member of a couple when both are applying) request a determination as an aged claimant.”
2. Process Both Aged and Blind/Disabled Claims Under Usual Procedures
Ask the claimant to bring in the necessary evidence of age and any other evidence appropriate to process the claim as an aged individual.
Complete the application process for the disability/blindness claim, including the Disability Report (SSA-3368-F8) and Authorization to Release Medical Information (SSA-827), and forward the claim to the DDS for a determination
Do not delay action on aged claims pending resolution of disability/blindness issues.
Insert wording “SSI multicategory disabled (or blind) (month/year)” in item 11. Include both the month and year. The date entered is the date of application, onset, State agreement, or election, whichever is later.
Enter the remark “SSI multicategory (the specific categories involved) forwarded to DDS (Code), (Month/Day/Year)” on the bottom line of item 2.
5. Advise Claimant
For both an aged and/or blind/disabled claimant, FO staff must inform them of the following:
That we may process his/her application before we evaluate eligibility for a second category and, if eligible, we will make payment based solely on one category pending determination of the other;
That new aged applicants must report any changes in their physical condition which affect their ability to get around; and
That changes in income for blind work exclusions and/or plans for achieving self-support may affect payments if we determine the individual to be blind or disabled.
E. Operating Procedure — Posteligibility
1. Obtain a Signed Statement from Recipient
If a redetermination reveals the possibility of multicategory eligibility, and the recipient wishes to file, obtain a signed statement as follows:
“I (name) request a (disability) (blindness) (aged) determination with any retroactivity to which I may be eligible. I want the determination to apply to my (Federal payment) (State supplement) (Federal payment and State supplement).”
2. Complete Appropriate Forms
Complete all necessary forms including the SSA-3368-F8 and SSA-827 for determinations involving disability/blindness. The recipient should submit any additional information needed to complete the request.
Do not complete another application form.
See SI 00501.300D.3.
See SI 00501.300D.4.