The "windfall offset" provision set forth in section 1127 of the Social Security Act,
42 U.S.C. § 1320a-6, applies to claimants who apply for both Social Security benefits
and SSI benefits, and is designed to prevent duplication of retroactive payments under
both programs. If the Title II claim is adjudicated first, SSA will pay the Title
II current month accrual (CMA), but hold the Title II retroactive payments. When the
Title XVI/SSI claim is adjudicated, SSA will pay the Title XVI/SSI retroactive payments,
and reduce the Title II retroactive payments by the Title XVI/SSI retroactive benefits
to protect Medicaid eligibility in the retroactive period. 20 C.F.R. §§ 404.408b,
416.1123(d); Program Operations Manual System (POMS) GN 02610.018.
Federal Law on Reimbursement of Interim Assistance
Section 1631 of the Social Security Act, 42 U.S.C. § 1383, provides:
(g)(1) Notwithstanding subsection (d)(1) and subsection (b) as it relates to the payment
of less than the correct amount of benefits, the Commissioner of Social Security may,
upon written authorization by an individual, withhold benefits due with respect to
that individual and may pay to a State (or a political subdivision thereof if agreed
to by the Commissioner of Social Security and the State) from the benefits withheld
an amount sufficient to reimburse the State (or political subdivision) for interim
assistance furnished on behalf of the individual by the State (or political subdivision).
42 U.S.C. § 1383(g)(1). For purposes of the foregoing section, the term "benefits"
includes Title XVI benefits or State supplementary payments that are due "at the time
the Commissioner of Social Security makes the first payment of benefits with respect
to the period" described in the definition of "interim assistance". 42 U.S.C. § 1383(g)(2);
20 C.F.R. § 416.1902. "Interim assistance" means "assistance financed from State or
local funds and furnished for meeting basic needs (A) during the period, beginning
with the month following the month in which the individual filed an application for
benefits (as defined in paragraph (2)), for which he was eligible for such benefits,
or (B) during the period beginning with the first month for which the individual's
benefits (as defined in paragraph (2)) have been terminated or suspended if the individual
was subsequently found to have been eligible for such benefits." 42 U.S.C. § 1383(g)(3);
20 C.F.R. §§ 416.1902, .1904, .1906; POMS SI 02003.001.
DSHS and SSA have entered into an Agreement for Reimbursement to State for Interim
Assistance Payments Pursuant to Section 1631(g) of the Social Security Act. See 20 C.F.R. § 416.1910 (requirements for interim assistance agreements).
DSHS provides general assistance unemployable (GAU) benefits to SSI claimants who
meet the GAU eligibility requirements and enter into an Interim Assistance Reimbursement
Authorization with DSHS. See WAC 388-400-0025 (describing the eligibility requirements and referencing WAC 388-448-0210).
WAC 388-448-0210 provides:
Assignment and recovery of interim assistance.
You can get assistance to meet your basic needs from only one government source at
a time. When you are approved for SSI, you may receive a payment going back to the
date you applied for SSI. This means you are being paid a back payment for your basic
needs. When you have received GAU during that time period, the amount paid to you
in the form of GAU must be reimbursed to the state.
1. "Assign" means that the Social Security Administration (SSA) will pay DSHS directly
from your reimbursement amount. The assignment will be up to the amount of interim
assistance we provide to you.
2. "Interim assistance" means the state funds we provide to you to meet basic needs
a. The time between your SSI application date and the month recurring SSI payments
b. The period your SSI payments were suspended or terminated, and later reinstated
for that period.
3. We pay up to twenty-five percent of the interim assistance reimbursement that we
receive from the SSA to the attorney who has successfully represented you in your
effort to receive SSI.
The SSI claimant signs DSHS Form 18-235, Interim Assistance Reimbursement Authorization,
agreeing to the following terms:
What am I authorizing the State to do by signing this authorization?
If I am found eligible to receive Supplemental Security Income (SSI) benefits, I understand
I am authorizing the Commissioner of the Social Security Administration (SSA) to send:
· My first retroactive payment of SSI benefits to the State; or
· If Federal law restricts the way my SSI money is released to me, send to the state
only an amount equal to the amount of reimbursable public assistance I received from
the State.Form 18-235 states how long the Interim Assistance Reimbursement Authorization
This authorization is binding on the State and me for one calendar year from the date
the State receives it. This authorization must be signed and dated by both a State
representative and me to be a valid authorization. SSA will keep this authorization
on file for one year.
This Form does not address what is to happen if the SSI claimant later withdraws his/her
Withdrawal of SSI Application and Effect on Interim Assistance Reimbursement
A SSI claimant may withdraw his/her application for SSI benefits either before or
after SSA makes a determination on the SSI claim. The regulation at 20 C.F.R. § 416.355
(a) Request for withdrawal filed before we make a determination. If you make a request to withdraw your application before we make a determination
on your claim, we will approve the request if the following requirements are met:
(1) You or a person who may sign an application for you signs a written request to
withdraw the application and files it at a place described in § 416.325.
(2) You are alive when the request is filed.
(b) Request for withdrawal filed after a determination is made. If you make a request
to withdraw your application after we make a determination on your claim, we will
approve the request if the following requirements are met:
(1) The conditions in paragraph (a) of this section are met.
(2) Every other person who may lose benefits because of the withdrawal consents in
writing (anyone who could sign an application for that person may give the consent).
(3) All benefits already paid based on the application are repaid or we are satisfied
that they will be repaid.
(c) Effect of withdrawal. If we approve your request to withdraw an application, we will treat the application
as though you never filed it. If we disapprove your request for withdrawal, we will
treat the application as though you never requested the withdrawal.
POMS SI 00601.050C instructs SSA to raise the issue of withdrawal when there is some definite advantage
to the claimant. POMS GN 02610.018A3 (governing windfall offset) instructs SSA to
"obtain a withdrawal of the SSI claim" if the claimant "insists that retroactive title
II benefits should be paid without delay and he/she understands the effect on Medicaid,
etc." The withdrawal request "must contain a statement acknowledging the effect withdrawal
may have on Medicaid eligibility." POMS SI 00601.050D.2c.
Your inquiry did not state when the claimants are requesting the withdrawal of their
SSI applications at Mr. S~' advice. If the withdrawal request is filed before SSA
has made a determination on the SSI claim, SSA will approve the request if the requirements
in section 416.355(a) are satisfied. SSA would not be involved in "enforcing" the
claimant's obligation to reimburse DSHS for any interim assistance paid while the
SSI application was pending.1_/
If the withdrawal request is filed after SSA has made a determination on the SSI claim,
but benefits have not yet been paid, SSA will approve the request if the requirements
of section 416.355(a) are satisfied and those who may lose benefits have consented
to the withdrawal. SSA would not be involved in "enforcing" the claimant's obligation
to reimburse DSHS for any interim assistance paid while the SSI claim was pending
or before any SSI was paid.2_/
If SSA has made a determination on the SSI claim before the withdrawal request is
filed, and benefits have been paid by SSA, including reimbursement to the DSHS from
the recipient’s first payment, section 416.355(b) explains that SSA will approve the
request if the requirements of section 416.355(a) are satisfied, those who may lose
benefits have consented to the withdrawal, and “[a]ll benefits already paid based
on the application are repaid or we are satisfied that they will be repaid.” Thus,
the claimant would need to reimburse SSA for the SSI monies owed to DSHS for reimbursement
of interim assistance and for all other SSI benefits.[3_/]
All benefits already paid based on the withdrawer’s application must be repaid or
SSA must be satisfied that they will be repaid. One method of assuring repayment is
by a one-time adjustment to a title II underpayment (cross-program adjustment). See instructions on cross-program adjustment in SI 02220.020. Accept repayment in the form of cash, money order, cashier’s check, or uncertified
check. Inform the individual that he/she is responsible for payments lost in the mail.
[1_/] A withdrawal request must contain "a statement of the effect on interim assistance
reimbursement, if applicable." POMS SI 00601.050D.2c. SSA is instructed to "[a]dvise the individual to contact the State agency prior to
withdrawing the SSI claim to determine if repayment of interim assistance is required."
[2_/] OGC's Office of Program Law and policy staff concur.
[3_/] POMS SI 00601.050D.4b states.