Public Health Law Map - Beta 5 - Medical and Public Health Law Site

1. Social Security Disability
The Social Security Administration (SSA) has responsibility for two disability
programs. Title II is the Social Security Disability Insurance program, which is an
insurance program for those who have worked and paid into the system. This is
comparable to private disability insurance. Title XVI is the Supplemental Security
Income program (SSI) that provides for individuals (including children under 18)
who are disabled and have limited income and resources. Many individuals who have
worked in the past but are now disabled qualify for payments from both programs.
The process for qualifying for Social Security Disability and for SSI are the same.
Once an individual has applied for benefits there will be a medical determination
made. If the medical evidence shows that the person is disabled, then the income and
payment history will determine whether the person qualifies for either or both of the
programs. Although it is not part of the medical evaluation, physicians who care for
disabled patients can be very helpful in qualifying for benefits.
a) SSA Disability or SSI
SSA Disability is an insurance program. To qualify, an individual must have paid
the premiums, which are Federal Insurance Contributors Act (FICA) or self-
employment taxes. If the individual has not worked for an employer who paid and
withheld FICA and has not filed and paid self- employment taxes, then this
individual has not paid the premiums and is not insured.
Unlike most private insurance, one does not lose coverage as soon as the premiums
stop being paid. An individual is insured under SSA Disability if they have paid
into the system for a certain number of quarters in the last five to ten years. The
calculations are complicated, but there is a simple principle to follow. Any worker
who has become disabled should file with the SSA as soon as possible. Someone
who has worked steadily for five years or more will be insured for five years after
they stop working. If the person has a less consistent work history, or has periods of
work where FICA was not paid, then the “date last insured” may come sooner than
five years.
SSI is the program for the poor. Eligibility for this program does not run out
because the patient has not been working. However, these benefits are available to
individuals who are also receiving SSA Disability if they have little other income.
Since neither program is particularly generous, it is not good to allow the insurance
to lapse just because SSI is available.
b) How To Qualify
When a person applies for disability benefits under the SSA programs, they must
state what medical problems they have that are disabling and who has been treating
them for these. They are also required to give their work history and discuss how
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