Social Security Benefits for Children and Adults with Disabilities

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Getting or keeping a Social Security disability benefit can be a difficult task.

The following self-help guides and videos will help you understand the different benefit programs for children and adults, what it takes to become eligible, how to apply or appeal a denial, working while receiving a benefit and much more. Some guides contain links to the Social Security Administration (SSA) website so you can easily contact SSA, apply or appeal or easily find information or forms. Click on the topics here to learn more

From Social Security’s Webpage

How to contact or communicate with the Social Security Administration if you are deaf, blind, or require a language interpreter

How to schedule, reschedule, or cancel an appointment with the Social Security Administration

dLCV’s Self-Help Guides

All about applying for social security disability benefits

Are You Considering Applying for a Social Security Disability Benefit? Understanding these programs and what you can do to prepare to apply

Social Security Administration (SSA) has several programs that provide monthly cash benefits and medical insurance. These programs include:

1.) Social Security Disability Insurance (SSDI) – available for:

  • a disabled insured worker under age 65 and their children.
  • a disabled adult child on a parent’s insured record if their disability began before age 22 and the parent is disabled, retired, or deceased
  • a disabled widow(er) if they are age 50-59 and meet other requirements.

NOTE: An insured worker is someone who has paid taxes on their earnings and has 5 years of work or 20 credits out of the last 10 years. You earn a credit each quarter of a year you pay taxes on a set amount of wages. You can earn up to 4 credits a year1. If approved for a benefit, this program begins payment of benefits 5 months after your onset date of disability which is stated in your Notice of Award letter from the Social Security Administration. You may receive a lump sum payment for the months you’ve been waiting to be approved. The amount of your monthly cash benefit is based on your wage history and will increase each year based on the federal cost of living adjustment. This program also pays a benefit to the children of the disabled parent. There is no limit on other income or resources you may have. Everyone eligible for Social Security Disability Insurance benefits is also eligible for Medicare health insurance after a 24-month waiting period which starts when the cash payments begin. See current amount that qualifies for a credit here.

2.) Supplemental Security Income (SSI) – is a needs-based program that provides monthly cash assistance and automatically qualifies you for Medicaid health insurance. SSI is available for Individuals with limited income and resources who are:

  • Age 65 or older
  • Blind or disabled children or adults

SSI Income and Resource Limits

SSI has income and resource limits. Your earned or unearned income may prevent you from receiving SSI or reduce the amount you receive. Resources available to you cannot exceed $2000 for an individual or $3000 for a couple. Examples of a resource may include a savings account, a 401k or other investments. You may own a home and one vehicle.

You May Qualify for Both SSI and SSDI

Some adults who have worked but lack enough credits may qualify under SSI. Someone who qualifies for a low SSDI benefit may also qualify for SSI but these benefits would be no more than the SSI maximum when combined. Both programs use the same medical rules to decide if someone is eligible.

When Do SSI Benefits Start and How Much is the Cash Payment?

Once approved, Social Security pays SSI from the month following the date of your application forward so you will get a lump sum for the months you’ve been waiting. The SSI benefit increases each year based on the federal cost of living adjustment. Unlike SSDI, the adult SSI benefit does not pay a benefit to the beneficiary’s children. See the SSI rate for the current year here. See what Social Security counts as a resource here.

In determining whether you may meet the criteria for a disability benefit SSA will ask the following questions in this order:

1. Are you currently earning over the Substantial Gainful Activity (SGA) limit?

View the current SGA limit here.

If you are earning over SGA Social Security will consider you not disabled and they will not accept an application. If you are not earning over SGA, SSA will ask…

2. Has or will your condition last at least 12 months or is it expected to end in death? Note: Social security disability benefits are not intended for people with short term medical problems such as an illness, injury, or surgery for which it may take less than a year to recover. If your medical evidence meets this criteria SSA will then ask…

3. Do you have one or more physical and/or mental conditions that are diagnosed and are they considered severe enough to affect your ability to work? Note: Having symptoms is not enough. Your disabling condition must be diagnosed by a physician or psychologist and require ongoing treatment usually by a specialist rather than a primary care doctor. If you meet this criteria SSA will ask…

4. Does your disability meet or equal the criteria for a listing? A listing is a specific medical condition that is well known to cause very significant limitations and would more obviously prevent someone from working.

Note: Your condition must meet the listing criteria exactly. You can find these conditions (for a child or an adult) in “Disability Evaluation Under Social Security” at the following pages: Childhood Listings and Adult Listings.

If your conditions meets or equals a listing SSA will automatically approved your claim for SSDI or SSI. If your condition does not meet or equal a listing, SSA will ask…

5. Can you perform any of the work you have done in the last 15 years? If not, SSA will ask…

6. Can you perform any other work, even simple, unskilled work?

Note: If you are under age 50 and your condition does not meet or equal a listing then you must prove that your medical condition(s) prevents you from working any job available in the national economy regardless of how skilled your work was in the past. However, once you are over age 50, 55, and then 60 the rules change in your favor by expecting that you will have less and less ability to adapt to other work.

Other things to consider about applying

A disability decision is based on medical and vocational evidence. Therefore,

Your medical evidence should…

1. Consistently document all physical and mental conditions that are part of your disability and interfere with working, and

2. Consistently support the symptoms and limitations you list in your application and related forms as disabling, and

3. Support that the condition has or will last 12 months or is expected to end in death

Note: If you lack current medical evidence because you lack health insurance you should apply immediately for health care coverage and begin seeing physicians that specialize in your medical conditions. If you are in search of medical coverage see dLCV’s guide entitled:

Do you Have a Disability and Need Healthcare?

Your vocational evidence should…

1. Provide a complete work history (of your last 15 years of employment) including information about how your disabilities prevent you from working.

2. For each job you lost because of your disability explain why (example: too many absences due to symptoms and/or medical appointments and treatments, fell asleep on the job, couldn’t keep up with other employees, couldn’t get along with co-workers or supervisors).

3. Document any special conditions related to your disability that you had to enable you to work as long as you did such as longer or more frequent breaks, more supervision than usual, a job coach, or fewer duties than the other employees, etc..

Other things to consider about applying:

Applying for social security disability benefits can take a long time especially if your medical evidence does not support that your condition meets a listing. An initial decision can take 3-6 months depending on if Social Security is experiencing backlogs. If your claim is denied you are encouraged to appeal, however, this will add many more months to the process. If you are denied again you are encouraged to appeal again. Often claims at this stage take a year or more for a decision.

Things you can do to prepare for or speed up the process:

1. Make sure you have solid and current medical evidence. If necessary, obtain health coverage immediately so your conditions are consistently documented.

2. If possible, be prepared financially. As stated, the process can take many months or a year or more if denied. If you have written evidence that eviction or home foreclosure may occur provide this to SSA when you apply or when this occurs.

3. If you are denied you must appeal within 60 days. Your case may require a hearing. See dLCV’s guide: TIPS When Appealing a Decision on Your Claim for Social Security Disability (SSDI) or Supplemental Security Income (SSI) for more information.

4. To determine whether you have enough credits to apply for SSDI, as well as the amount of benefit you will receive if your claim is approved call 800-772-1213 or go to the Social Security Administration’s website and set up a secure My Social Security Account. You will find other information there including a list of all your earnings. You should review this information and make sure it is accurate. If it is not accurate, you should collect W-2’s from missing or incorrect years and bring them into your local Social Security office.

5. If you decide to apply for either SSDI and/or SSI see dLCV’s guide: TIPS When Applying for a Social Security Benefit

5 TIPS When Seeking a Social Security Disability Benefit as an Adult

In order to view all text in this video, we recommend you watch it in full-screen.

Each year, thousands of people in Virginia apply or Social Security Disability benefits.  Unfortunately, 70 percent of initial claims are denied.

For Social Security Disability claimants in Virginia who appeal, it can take more than a year until a hearing before an Administrative Law Judge.  No one wants to wait a year or more before being approved for disability benefits.

There are ways you can improve your chances of getting approved for benefits

If you are applying for Social Security Disability benefits, it is important to understand the top 5 Tips When Seeking a Social Security Disability Benefit.  Understand if you are eligible and follow the tips below to maximize your chances of a successful Social Security Disability application.

1. Know what you have to prove to be approved

To meet Social Security’s definition of disability, you must have

1) a severe physical and/or mental impairment
2) that is expected to last at least 12 months or result in death, and
3) that meets or equals a medical listing or prevents you from earning wages above the substantial gainful limit.

Click here to determine the current gainful limit. View Social Security’s adult medical listing and their criteria here.

If you suffer from an especially severe condition, such as certain cancers or rare diseases, Compassionate Allowance is one way to fast-track your claim to the front of the line. Social Security generally approves these cases quickly. Check the Social Security Administration’s Compassionate Allowances list.

If you don’t meet a listing or don’t have a compassionate allowance condition, you have to prove you are unable to sustain any regular work (8 hours a day, 40 hours a week) including simple, unskilled work. However, at age 50 Social Security begins to relax that criteria.

2. Determine which program(s) you may qualify for

If you have worked and paid FICA payroll taxes you probably have enough credits in the Social Security System to apply for Social Security Disability Insurance (SSDI).  With adequate wages you can earn up to 4 credits a year which count toward social security eligibility.  You need 20 credits, or 5 years of credits out of the last 10 years.  Your benefit amount depends on how much FICA tax you have paid.  You must satisfy a 5-month waiting period.

To determine if you have enough credits and your estimated benefit, set up a Social Security account.

If you have not worked, or earned enough credits, you can apply for Supplemental Security Income (SSI).  This benefit is a flat amount to be used for housing and food expenses.  There is a resource limit of $2000 for an individual or $3000 for a couple.  Once approved, SSI pays benefits from the date you applied.  SSI benefits may be reduced by one-third if you are not paying your fair share of household expenses. Determine the current benefit rate for SSI here.

You may also go to Social Security’s Benefit Estimate Screening Tool to explore benefits available to you and your family.

3. Maintain healthcare

Your case is only as good as the ongoing and consistent record of your medical condition(s).  If you lose your health insurance, due to your disability, apply for Medicaid, which is now available to many low or no income Virginians who are uninsured.

Once approved for Medicaid, set up appointments with specialists that treat each of your conditions.  Follow your treatment plan.  Avoid canceling appointments and re-schedule if necessary.  Disability Determination Services will collect and review your records thoroughly to determine if your condition(s) meet Social Security’s criteria.  Large gaps in treatment can be harmful to your case.

4. Educate your doctors about your symptoms and limitations

Your medical records need to support the conditions you claim are disabling.  To educate your doctors and improve your records, create a list of your symptoms, their frequency and severity, and how they limit you.  Update your list from time to time and share it with your doctors at each appointment so they better understand and document how your impairments affect you. Symptoms are things like dizziness, weakness, pain, insomnia, anxiety, irritability, depression, difficulty with focus and/or memory.  Limitations can include difficulty bathing, cooking or cleaning your home; sitting, standing or walking for long periods; driving beyond a mile or two; getting along with others; or paying attention or recalling important things.  The more you detail each symptom limitation the better.

For example: headache pain occurs 1 day a week and lasts 6-10 hours requiring me to rest in a dark room. The pain is a 6-8 on the pain scale and medications provide limited relief. When working, I had to call in sick 4 days a month and I am unable to help at home when the symptoms occur.

5. Understand the process and hang in!

Obtaining a social security benefit can take time.  When you apply, it can take up to 120 days for a decision.  Most people are denied, especially those with weak documentation.  If you are denied you have the right to appeal within 60 days.  This appeal is called Request for Reconsideration and will require another 60-120 days for a decision.

If your Request for Reconsideration is also denied you can appeal, again, within 60 days.  This appeal is called Request for Hearing by an Administrative Law Judge.  This will involve a face-to-face hearing with a Social Security judge and can take a year or more to schedule.  With each appeal, you can submit more documentation to prove your case.  If you require a hearing, be sure to obtain legal help from someone with expertise in Social Security and even your specific condition.  To learn more about the application and appeal process see the disAbility Law Center of Virginia’s fact sheets called TIPS When Applying and TIPS When Appealing.

TIPS When Applying for a Social Security Disability Benefit as an Adult

You may also download this guide in the following languages: Spanish, Vietnamese, Arabic, and Chinese.

Before applying to the Social Security Administration (SSA) for social security disability benefits you should review the disAbility Law Center of Virginia’s publication entitled: Considering Applying for a Social Security Disability Benefit?  This will help you determine if you are a good candidate for these benefits and, if so, whether to apply for Social Security Disability Insurance (SSDI) which is for adults only and/or Supplemental Security Income (SSI) which is for children or adults. These guides will help you understand the process and what to expect. If you are applying for a child see our guide called TIPS When Applying for SSI for  Children

Ways to apply for SSDI and/or SSI

To apply for Social Security Disability Insurance (SSDI):

This is the fastest way to apply. The process is secure and user-friendly and will guide you every step of the way. You will be given a PIN number to re-enter as often as it takes to complete the application.

Or, you may:

  • Schedule an appointment with a local Social Security office by calling Social Security Administration’s national toll-free number 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday or go to your local social security office to ask for an appointment.  Most of these are telephone appointments so you don’t have to leave your home. You will receive a confirmation letter with a list of the information needed to apply. Be sure to gather all information before the appointment. You will sign a form that allows SSA to collect the actual records.

If you are deaf or hard of hearing call TTY 1-800-325-0778 or go here to the following web pages for other communication options:

To apply only for Supplemental Security Income (SSI) for adults:

Social Security does not offer the online application for SSI applicants (for children or adults). But you can request an appointment to apply by going to the Social Security Administration’s website here.

You will receive an appointment confirmation letter with a list of the information needed to apply. Be sure to gather this information before the appointment. SSA usually conducts this appointment by telephone.

Tips When Applying for SSDI and/or SSI as an Adult

  • If you currently have less than $2000 in resources (cash or things that can be turned into cash) you should apply for both SSDI and SSI. The SSI can cover the 5-month waiting period for SSDI and add to a low SSDI payment.
  • In general, SSA will expect you to supply information about your medical conditions, where and when you have received treatment, and your work history over the last 15 years. Social Security does not require you to collect your records for your claim. You will sign a release form that gives SSA permission to collect them.
  • Provide complete answers to ALL questions.
  • Include ALL doctors (including psychiatrists) and hospitals used to treat your disabilities to include the addresses, dates of service and diagnostics, and reason for visit or hospitalization. Other treating sources should also be included such as mental health therapists, physical therapists, and chiropractors.
  • Include a complete list of ALL medications with the correct dosage and reason for taking. Be sure to state side effects of each medication if any.
  • Include a complete job history providing all information requested and include the reason for leaving a job especially if it is disability related. If you have not worked recently or had interruptions in work due to our disability, explain why.
  • Under the Vocational Section include the name of any vocational agency you have worked with.
  • When you receive the Function Report be sure to fill it out completely and provide examples of things you can no longer do, can only do in a limited way, or for which you need help. Describe your symptoms and limitations as they exist on your worst day, not your best day. Use the “Remarks Section” to add any other information about your inability to perform daily activities and perform any This form is due within 10-days of when you received it. Don’t delay!
  • To check on your case, or add new evidence, call the Examiner at Disability Determination Services (DDS). Their name and number is in the letter they send when they notify you they have received your application. Or, you can find the number to the closest DDS office here. If you are calling on someone’s behalf they must be with you to give DDS permission to discuss their application.
  • If SSA schedules a medical appointment for you (at their expense) you must go but you can change to a more convenient time. If you need to cancel or reschedule call the DDS Examiner using the method above.
  • Meet ALL deadlines and, if denied, appeal for “reconsideration” within the 60 days allowed. To appeal you may return to your online application or call the toll free number 1-800-772-1213. If you miss this deadline for a good reason you have a right to ask for an extension. This is called “good cause for late filing”. Otherwise, you will have to re-apply.
  • If your claim is denied a second time, file the appeal called “Request for Hearing by an Administrative Law Judge” within 60-days and seek representation as soon as possible.
  • A hearing will be scheduled but this may take up to a year or more. The judge at the hearing expects you to have representation (or an advocate). You may want to review the dLCV publication entitled: “TIPS When Appealing a Social Security Disability Insurance or Supplemental Security Income Claim”. This guide explains the appeal process and provides links to SSA’s appeal forms.

Note: The disAbility Law Center of Virginia (dLCV) does not provide representation.  

TIPS When Applying for Supplemental Security Income (SSI) for Children

Financial Screening

When a child applies for SSI, SSA must first determine the family’s income and resources. The Social Security Administration (SSA) calls this deeming. If the parent(s) have too much income or resources the child may not qualify for SSI or may receive a lower benefit even if the child meets the medical eligibility requirements. View SSA’s guide on parental deeming here.

Applying for SSI for a Child

Social Security does not offer an online application. The best way to apply for your child is to request an appointment to apply here.

After you submit this short online questionnaire you will receive a call from the local SSA office to schedule an appointment. Then you will receive a confirmation letter with the date and time of the appointment and a list of the information needed to apply. Be sure to gather this information before the appointment. Note: Usually SSA conducts this appointment by telephone.

What to Expect

  • In general, SSA will expect a parent to supply information about the child’s medical conditions, contact information for all treatment and other evidence to include doctors, hospitalizations, evaluations and other diagnostic results, therapies in-home of in facilities, medications, and their school records. Social Security does not require you to collect your child’s records for this claim. You will sign a release form that gives SSA permission to collect them.
  • To be medically eligible a child must prove they have an inability to function as their age-related peers in their home, school, and community.
  • When you receive the Function Report – Third Party be sure to fill it out completely and provide examples of things your child cannot do, can only do in a limited way, or for which they need help. Describe their symptoms and limitations as they exist on their worst day, not their best day. Use the “Remarks Section” to
  • Add any other information about their inability to perform daily activities and function in the family, the school, or the community. This form is due within 10-days of when you received it. Don’t delay!
  • To check on your child’s case, or add new evidence, call the disability examiner at Disability Determination Services (DDS). The examiner’s name and phone number is in the letter they send when they notify you they have received your child’s application. Or, you can find the number to the closest DDS office online
  • If SSA schedules a medical appointment for your child (at their expense) they must go but you can change to a more convenient time. If you need to cancel or reschedule call the DDS Examiner using the method above.
  • Meet ALL deadlines.
  • If denied, you may appeal. You may want to review the dLCV publication entitled: “TIPS When Appealing a Social Security Disability Insurance or Supplemental Security Income Claim”. This guide explains the appeal process and provides links to SSA’s appeal forms. The denial letter will also state how to appeal.

Note: The disAbility Law Center of Virginia (dLCV) does not provide representation.

VETERANS: Are you a veteran with a 100% Permanent & Total Disability and applying for a social security disability benefit?

The Social Security Administration (SSA) will expedite disability claims filed by veterans who have a U.S. Department of Veteran’s Affairs Compensation rating of 100% Permanent & Total (P&T).

What do you need to know?

The Veterans Administration and Social Security Administration pay disability benefits to qualifying individuals however, their programs, processing, and criteria for receiving benefits are different. A Veterans Administration compensation rating of 100% P&T does not guarantee that you will receive Social Security disability benefits but does ensure a faster decision. To receive disability benefits from Social Security, a person must have a severe impairment that is expected to last one year or result in death. The impairment must prevent the person from being able to perform substantial work. The veteran must also meet certain financial criteria.

If you receive Veterans Affairs compensation, this will not affect your Social Security benefits.

How can you be sure SSA will expedite your claim?

When you apply in person or over the phone:

  • Identify yourself as a “Veteran rated 100% P&T”

If you apply online:

  • Enter “Veteran 100% P&T” in the “Remarks” section of the application.

Provide Social Security with your Veterans Administration notification letter which verifies your rating. If you apply in person bring this form with you. If you apply by phone or online you will have to mail the form to your Social Security office. Make sure to make a copy. Mail using a certified return receipt so you have proof you sent it and be sure to put your social security number on your correspondence.

How will my claim be expedited?

Once Social Security identifies you as a veteran rated 100% P&T, they will treat your claim as a high priority and rush it through the application and the appeal process if that is necessary. If you live abroad your claim will still be expedited.

How to apply for Social Security Disability or Supplemental Security Income

There are three ways to apply for these benefits:

  • Apply online and be sure to save your PIN #.
  • Call the toll-free number, 1-800-772-1213. If you are deaf or hard of hearing, you may call the SSA toll-free TTY number 1-800-325-0778
  • Visit your local Social Security office. Find your local office here.

How Long Does the Process Take?

The length of time it takes Social Security to make a disability decision depends on several factors including:

  • The nature of your disability
  • How quickly they obtain medical evidence from your doctors or other medical sources
  • Whether it is necessary to send you for a medical examination

You can assist in the process by gathering the names, addresses and treatment dates of all doctors or other medical professionals treating you for the disability. Also, prepare a list of your medications and your work history. Keep in mind, if SSA denies you can appeal online or by calling using the numbers listed above.

Do You have a Disability and Need Healthcare?

You may also download this guide in the following languages: Spanish, Vietnamese, Arabic, and Chinese.

If you have a disability and lack health insurance there are many options available for healthcare in Virginia. If you are applying for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) it is VERY important to maintain treatment to prove your case.  If Social Security approved your SSDI claim and you are within the 24-month waiting period for Medicare these options may enable you to continue your medical care while you wait. Ask your doctor, case manager, or your local social services department to connect you with these programs:

1) Virginia Medicaid – Health Coverage for Adults as of 1/1/19

Visit: www.coverva.org or call 1-855-242-8282

  • Must be a Virginia resident between the ages of 19-64
  • Must be at or below 138% of the Federal Poverty Level
  • You pick your health plan (insurance provider) and choose a doctor within that plan. If you like your current doctor, check with them to see if they are participating in your plan.
  • There are no monthly premiums, deductibles, or co-pays
  • If you meet the other requirements for Medicaid, but your income is above 138% of the Federal Poverty Level, you may qualify for a spenddown which functions like an insurance deductible
  • While your SSDI Medicare is pending you may qualify for Virginia Medicaid
  • Application takes up to 45 days to be processed

2)  Healthcare Marketplace – Affordable Care Act (also known as Obamacare)

Visit: www.healthcare.gov or call 1-800-318-2596

  • Allows more freedom in choosing an insurance provider
  • Usually requires a monthly premium and deductible
  • Only available during open enrollment periods unless you qualify for a special enrollment period due to: losing your insurance, a change in household size, change in residence or income, change in status (citizenship, incarceration, etc.), or belonging to a federally recognized tribe
  • Low income households may be eligible for a Tax Credit that helps to ease the burden of insurance costs
  • Some households may be eligible for Extra Savings that lower the costs of monthly premiums

3) Community Health Centers

Find a Health Center

  • Serves high-need communities
    • Serves both insured and uninsured individuals
    • Serves as primary healthcare
    • Some offer dental, mental health and inpatient services as well
    • Fees are adjusted to the individual’s ability to pay

4) Hospital Financial Aid Programs

  • Many hospitals offer a financial aid program if you don’t have insurance or a discount for self-pay
  • Check with each hospital to determine their financial aid options
  • State Sponsored Indigent Care:

VCU Health (Richmond) and UVA Medical Center (Charlottesville) participate in a state funded program to provide primary and specialized care to those without insurance

5) Local Health Departments

  • Offer varying degrees of primary care
  • Some offer dental and mental health care as well
  • Often free or on a sliding scale depending on your income
  • Best for individuals with minor health problems or needing a well visit/physical

6) Free Clinics

Visit: www.vafreeclinics.org/clinics-in-virginia or call 1-804-340-3434

  • Clinics use a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or mental health services to low income individuals
    • Often have fluctuating hours
    • Some charge a small/or sliding scale fee

7) Patient Advocate Foundation (PAF)

Visit: www.patientadvocate.org or call 1-800-532-5274

  • Guides patients with chronic, life-threatening, or debilitating diseases through complex healthcare challenges to access care and treatment
  • Provides co-pay relief and financial aid grants
At Age 18 or Older: Applying for Supplemental Security Income (SSI) and/or Disabled Adult Child benefits on a Parent’s Record

Applying for SSI for the first time as an adult

If you did not receive Supplemental Security Income (SSI) as a child because of your family’s income and resources, you can apply for SSI any time after age 18 as long as you have less than $2000 (such as cash, life insurance, burial policy, or an inheritance) and you do not earn more than Social Security allows. Social Security will not consider your parent’s income and resources when deciding if you meet the financial requirements for the SSI program.

Adult definition of disability

Social Security bases the new decision on their disability rules for adults. Some conditions are assumed to be disabling and are automatically approved, others are not. In general, in order to qualify for SSI as an adult, your disability must:

  1. Significantly limit your ability to work
  2. Be expected to or has lasted a year or more
  3. Prevent Substantial Gainful Activity (SGA)*
    *Substantial Gainful Activity is Social Security’s limit on how much you can earn and still be considered disabled. This amount changes every year. For more information on earning limits, click here.

To continue Medicaid Waivers as an Adult you Must Obtain SSI

Medicaid waivers for a child do not depend on a family’s income or resources. As an adult, in order to keep your waivers you must apply for SSI and be approved by the time you reach age 19.

How to start an SSI application

To start an SSI application as an adult call Social Security to make an appointment in your local office (800-772-1213) or visit the recommended Social Security Administration website.

Social Security will schedule a telephone interview to conduct a financial screening and collect medical information for the application. They will send you a letter to confirm your appointment with a list of the information needed to apply. Be sure to gather this information before the appointment.

Applying for the Disabled Adult Child benefit as an adult on a parent’s record

If you received benefits as a child because a parent was on disability, retired or deceased this was unrelated to you having a disability. That child benefit on a parent’s record ends when you turn 18 or up to age 19 if you are still in school.

An adult who became disabled before age 22 may be eligible for the Disabled Adult Child benefit at 18 or older when:

  • a parent starts receiving social security retirement, or
  • receives a social security disability benefit, or
  • is deceased

You do not qualify for this benefit if you are married. You will need solid medical evidence to prove your disability began before age 22 and meet all other rules. Keep these records safe until they are needed. This benefit may replace an SSI benefit which is often less but you will be able to keep your Medicaid insurance.

To apply for the Disabled Adult Child benefit you must contact SSA directly.

How to Avoid the One-Third Reduction to the SSI cash benefit

The adult SSI benefit amount you qualify for can be reduced by wages from work.  Social Security can also reduce it by one-third if you live with family or friends and don’t pay your share of household expenses. Social Security calls this the “One-Third Reduction” and it will greatly reduce your benefit. For example, the 2023 maximum SSI benefit is $914; a one-third reduction would mean about $300 less in your payment! View the current SSI Maximum here.

If you are living with a parent or other adult, you need to submit a simple statement to Social Security (at the time you apply or undergo the Age-18 redetermination) stating you will pay your “fair share” of household expenses or you will rent space in the home at a “flat rate.” Either way, the amount you plan to pay must be under the current SSI rate. Otherwise, Social Security will decide you can’t afford it and will reduce your SSI by one-third.

Steps to avoid the one-third reduction in SSI: Prepare a statement for Social Security

The fair share method:

Add up the monthly household expenses: food, rent or mortgage, and utilities (electricity, water, and sewer). The family you live with must be prepared to prove these expenses to Social Security. Then divide the total monthly expenses by the number of people in your household.

Example: if the household expenses come to $2000/month and there are 4 people living in the home, then your fair share = $2000 divided by 4 which is $500. As long as you intend to pay your fair share you should receive the full SSI payment. If not, then it will be reduced by 1/3. If the “fair share” calculation is greater than the maximum SSI rate in effect consider using the “flat rate rental method”.

The flat rate rental method:

Rent space in the home at a fair and flat rate. For example, a bedroom and bathroom with access to kitchen and laundry could be worth $500/month. The amount must be affordable and, therefore, under the maximum SSI rate in effect.

Prepare a statement explaining the method you plan to use and submit it to Social Security. It can be typed or handwritten and must be signed by adult receiving the benefit or their representative payee. Remember, it is best to submit this when you apply or undergo an Age -18 redetermination. If Social Security denies this you can appeal. This is considered a non-medical appeal because it is a separate matter unrelated to the disability determination. Begin your appeal of a non-medical denial here.

For college students: Removing Barriers Faced by College Students with Disabilities Applying for or Receiving Social Security Disability Benefits

All about Social Security benefits when you turn 18 or as a young adult

At Age 18 or Older: Applying for Supplemental Security Income (SSI) and/or Disabled Adult Child benefits on a Parent’s Record

Applying for SSI for the first time as an adult

If you did not receive Supplemental Security Income (SSI) as a child because of your family’s income and resources, you can apply for SSI any time after age 18 as long as you have less than $2000 (such as cash, life insurance, burial policy, or an inheritance) and you do not earn more than Social Security allows. Social Security will not consider your parent’s income and resources when deciding if you meet the financial requirements for the SSI program.

Adult definition of disability

Social Security bases the new decision on their disability rules for adults. Some conditions are assumed to be disabling and are automatically approved, others are not. In general, in order to qualify for SSI as an adult, your disability must:

  1. Significantly limit your ability to work
  2. Be expected to or has lasted a year or more
  3. Prevent Substantial Gainful Activity (SGA)*
    *Substantial Gainful Activity is Social Security’s limit on how much you can earn and still be considered disabled. This amount changes every year. For more information on earning limits, click here.

To continue Medicaid Waivers as an Adult you Must Obtain SSI

Medicaid waivers for a child do not depend on a family’s income or resources. As an adult, in order to keep your waivers you must apply for SSI and be approved by the time you reach age 19.

How to start an SSI application

To start an SSI application as an adult call Social Security to make an appointment in your local office (800-772-1213) or visit the recommended Social Security Administration website.

Social Security will schedule a telephone interview to conduct a financial screening and collect medical information for the application. They will send you a letter to confirm your appointment with a list of the information needed to apply. Be sure to gather this information before the appointment.

Applying for the Disabled Adult Child benefit as an adult on a parent’s record

If you received benefits as a child because a parent was on disability, retired or deceased this was unrelated to you having a disability. That child benefit on a parent’s record ends when you turn 18 or up to age 19 if you are still in school.

An adult who became disabled before age 22 may be eligible for the Disabled Adult Child benefit at 18 or older when:

  • a parent starts receiving social security retirement, or
  • receives a social security disability benefit, or
  • is deceased

You do not qualify for this benefit if you are married. You will need solid medical evidence to prove your disability began before age 22 and meet all other rules. Keep these records safe until they are needed. This benefit may replace an SSI benefit which is often less but you will be able to keep your Medicaid insurance.

To apply for the Disabled Adult Child benefit you must contact SSA directly.

The Automatic Age-18 Redetermination of Child SSI and Using Section 301 to Continue SSI if SSA Decides you are Capable of Working

At age 18, since the child eligibility rules no longer apply, a soon-to-be adult on Supplemental Security Income (SSI will go through a review called the Age-18 Redetermination. The Social Security Administration (SSA) will automatically send you a form requesting information to decide if you meet the adult rules and to make sure you meet their guidelines on income and resources since the family’s income and resources are no longer considered.

Adult definition of disability

Social Security bases the new decision on their disability rules for adults. Some conditions are assumed to be disabling and are automatically approved, others are not.   In general, in order to qualify for SSI as an adult, your disability must:

  1. Significantly limit your ability to work
  2. Be expected to or has lasted a year or more
  3. Prevent Substantial Gainful Activity (SGA)*
    *Substantial Gainful Activity is Social Security’s limit on how much you can earn and still be considered disabled. This amount changes every year. For more information on earning limits, click here. 

What if my benefits are denied?

If Social Security decides at the Age-18 Redetermination that you do not meet the adult definition of disability, your benefits will end after 2 months.

Actions you can take immediately to disagree with this decision

After a denial, if you believe your disability limits your ability to work, you must act quickly if you want to try to keep your benefit.

  • To disagree you must APPEAL within 60 days. Follow the instructions in the denial letter to appeal or call Social Security’s toll free number 800-772-1213 to request appeal form; and
  • You may also continue your SSI child benefits during the appeal period if you go to a Social Security office and request this WITHIN 10 CALENDAR DAYS of the date on the letter. Be aware, you can appeal several times but if all appeals are denied, your SSI will end and you will have to pay back the benefits paid to you during the appeal period. Fortunately, you can appeal this, too.
  • Keep in mind: if all appeals are denied and your SSI stops you can re-apply later when you have better proof that you can’t work or sustain gainful activity.

What can I do to avoid a denial at the age 18 re-determination?

Make sure evaluations of your disability are current: Before you turn 18, be sure to get updated medical, educational and/or psychological evaluations that clearly tell how the disability affects you and how it will limit your ability to work. Be sure Social Security knows how to collect this information by adding the evaluators contact information to the form you receive from Social Security.

Tell Social Security about your school or vocational assistance: In the Remarks Section of the form that you receive from Social Security, state if you plan to remain in high school and/or if you are a client of DARS or any other work or training assistance program. If you continue your education or are getting help to work, Social Security may continue your SSI benefit while you complete these programs even if they decide you do not meet the adult definition of disability. This called a Section 301 rule.

Explain any work efforts you have had so far: In the Remarks Section of the form, list each work effort, even those that only lasted a few days, weeks, or months. List the title of the job, # of hours a week you worked, your hourly wage, difficulties you had on the job, and why the job ended. Include all assistance you needed to get and keep the job such as a special work program, a job coach, or even if it is a parent finding the job or setting up an interview.

Keeping Medicaid and Your Waiver Services if you Were Not on SSI as a Child: Once you turn 18, keeping your waiver services under Medicaid depends on you receiving SSI. If you did not receive SSI benefits as a child you will have to apply when you turn 18 and undergo a Medicaid Disability Determination 90 days before turning 18. Your Medicaid eligibility worker should contact your parent or responsible person to start this process so your Medicaid benefits remain in place as you apply for SSI at age 18. A parent can also start this process to be sure it happens on time.

How can I still receive SSI benefits if Social Security decides I do not meet the adult rules for disability?

If your SSI is denied at the age 18 redetermination, you may still qualify for continued SSI payments under Section 301 if:

  • You remain in high school past age 18; or
  • You are receiving vocational rehabilitation, training or education.

You will receive SSI payments under the Section 301 rule while you make efforts to work and increase your independence as long as you are involved in an approved program. These programs may qualify you for Section 301 because they will prepare you for work so you will be less likely to need SSI in the future. Once you complete or stop the program the SSI benefit will end.

Examples of school or vocational programs that may count toward Section 301:

  • An Individualized Education Program (IEP) in a public or private school between ages 18 and 21
  • Department of Aging and Rehabilitation Services (DARS), Department for the Blind and Vision Impaired (DBVI)
  • Employment Network
  • Ticket to Work
  • Workforce Investment Opportunity Act (WIOA) program
  • Job Coaching or supported employment
  • Virginia Commonwealth University’s “Project Search”, PAVE – Program for Adults in Vocational Education or Wilson Workforce and Rehabilitation Center’s PERT (Post-Secondary Education Rehabilitation Transition)

To claim Section 301 be sure to tell Social Security about these efforts when they start your Age 18 redetermination or if you are denied. Give Social Security the program’s contact information. They will collect proof of your participation in a program and decide about continuing your benefits.

Social Security Resources for Youth with Disabilities Turning 18

Applying for SSI as an Adult or the Disabled Adult Child benefit on a Parent’s Record

Applying for SSI for the first time as an adult

If you did not receive Supplemental Security Income (SSI) as a child because of your family’s income and resources, you can apply for SSI any time after age 18 as long as YOU have less than $2000 (such as cash, life insurance, burial policy, or an inheritance) and you do not earn more than Social Security allows. Social Security will not consider your parents income and resources when deciding if you meet the financial requirements.

To start an SSI application as an adult call Social Security to make an appointment in your local office (800-772-1213) or learn how to apply on the Social Security Administration’s website

Social Security will schedule a telephone interview to conduct a financial screening and collect medical information for the application. They will send you a letter to confirm your appointment with a list of the information needed to apply. Be sure to gather this information before the appointment.

Applying for the Disabled Adult Child benefit as an adult on a parent’s record

If you received benefits as a child because a parent was on disability, retired or deceased this was unrelated to you having a disability. That child benefit on a parent’s record ends when you turn 18 or up to age 19 if you are still in school. An adult who becomes disabled before age 22 may be eligible for the Disabled Adult Child benefit at 18 or older when:

  • a parent starts receiving social security retirement, or
  • receives a social security disability benefit, or
  • is deceased

You do not qualify for this benefit if you are married. You will need solid medical evidence to prove your disability began before age 22 and meet all other rules. Keep these records safe until they are needed. This benefit may replace an SSI benefit which is often less but you will be able to keep your Medicaid insurance.

TIPS When Applying for a Social Security Disability Benefit

You may also download this guide in the following languages: Spanish, Vietnamese, Arabic, and Chinese.

Before applying to the Social Security Administration (SSA) for social security disability benefits you should review the disAbility Law Center of Virginia’s publication entitled: Considering Applying for a Social Security Disability Benefit?  This will help you determine if you are a good candidate for these benefits and, if so, whether to apply for Social Security Disability Insurance (SSDI) which is for adults only and/or Supplemental Security Income (SSI) which is for children or adults. These guides will help you understand the process and what to expect. If you are applying for a child see our guide called TIPS When Applying for SSI for  Children

Ways to apply for SSDI and/or SSI

To apply for Social Security Disability Insurance (SSDI):

This is the fastest way to apply. The process is secure and user-friendly and will guide you every step of the way. You will be given a PIN number to re-enter as often as it takes to complete the application.

Or, you may:

  • Schedule an appointment with a local Social Security office by calling Social Security Administration’s national toll-free number 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday or go to your local social security office to ask for an appointment.  Most of these are telephone appointments so you don’t have to leave your home. You will receive a confirmation letter with a list of the information needed to apply. Be sure to gather all information before the appointment. You will sign a form that allows SSA to collect the actual records.

If you are deaf or hard of hearing call TTY 1-800-325-0778 or go here to the following web pages for other communication options:

To apply only for Supplemental Security Income (SSI) for adults:

Social Security does not offer the online application for SSI applicants (for children or adults). But you can request an appointment to apply by going to the Social Security Administration’s website here.

You will receive an appointment confirmation letter with a list of the information needed to apply. Be sure to gather this information before the appointment. SSA usually conducts this appointment by telephone.

Tips When Applying for SSDI and/or SSI as an Adult

  • If you currently have less than $2000 in resources (cash or things that can be turned into cash) you should apply for both SSDI and SSI. The SSI can cover the 5-month waiting period for SSDI and add to a low SSDI payment.
  • In general, SSA will expect you to supply information about your medical conditions, where and when you have received treatment, and your work history over the last 15 years. Social Security does not require you to collect your records for your claim. You will sign a release form that gives SSA permission to collect them.
  • Provide complete answers to ALL questions.
  • Include ALL doctors (including psychiatrists) and hospitals used to treat your disabilities to include the addresses, dates of service and diagnostics, and reason for visit or hospitalization. Other treating sources should also be included such as mental health therapists, physical therapists, and chiropractors.
  • Include a complete list of ALL medications with the correct dosage and reason for taking. Be sure to state side effects of each medication if any.
  • Include a complete job history providing all information requested and include the reason for leaving a job especially if it is disability related. If you have not worked recently or had interruptions in work due to our disability, explain why.
  • Under the Vocational Section include the name of any vocational agency you have worked with.
  • When you receive the Function Report be sure to fill it out completely and provide examples of things you can no longer do, can only do in a limited way, or for which you need help. Describe your symptoms and limitations as they exist on your worst day, not your best day. Use the “Remarks Section” to add any other information about your inability to perform daily activities and perform any This form is due within 10-days of when you received it. Don’t delay!
  • To check on your case, or add new evidence, call the Examiner at Disability Determination Services (DDS). Their name and number is in the letter they send when they notify you they have received your application. Or, you can find the number to the closest DDS office here. If you are calling on someone’s behalf they must be with you to give DDS permission to discuss their application.
  • If SSA schedules a medical appointment for you (at their expense) you must go but you can change to a more convenient time. If you need to cancel or reschedule call the DDS Examiner using the method above.
  • Meet ALL deadlines and, if denied, appeal for “reconsideration” within the 60 days allowed. To appeal you may return to your online application or call the toll free number 1-800-772-1213. If you miss this deadline for a good reason you have a right to ask for an extension. This is called “good cause for late filing”. Otherwise, you will have to re-apply.
  • If your claim is denied a second time, file the appeal called “Request for Hearing by an Administrative Law Judge” within 60-days and seek representation as soon as possible.
  • A hearing will be scheduled but this may take up to a year or more. The judge at the hearing expects you to have representation (or an advocate). You may want to review the dLCV publication entitled: “TIPS When Appealing a Social Security Disability Insurance or Supplemental Security Income Claim”. This guide explains the appeal process and provides links to SSA’s appeal forms.

Note: The disAbility Law Center of Virginia (dLCV) does not provide representation.  

5 TIPS When Seeking a Social Security Disability Benefit as an Adult

In order to view all text in this video, we recommend you watch it in full-screen.

Each year, thousands of people in Virginia apply or Social Security Disability benefits.  Unfortunately, 70 percent of initial claims are denied.

For Social Security Disability claimants in Virginia who appeal, it can take more than a year until a hearing before an Administrative Law Judge.  No one wants to wait a year or more before being approved for disability benefits.

There are ways you can improve your chances of getting approved for benefits

If you are applying for Social Security Disability benefits, it is important to understand the top 5 Tips When Seeking a Social Security Disability Benefit.  Understand if you are eligible and follow the tips below to maximize your chances of a successful Social Security Disability application.

1. Know what you have to prove to be approved

To meet Social Security’s definition of disability, you must have

1) a severe physical and/or mental impairment
2) that is expected to last at least 12 months or result in death, and
3) that meets or equals a medical listing or prevents you from earning wages above the substantial gainful limit.

Click here to determine the current gainful limit. View Social Security’s adult medical listing and their criteria here.

If you suffer from an especially severe condition, such as certain cancers or rare diseases, Compassionate Allowance is one way to fast-track your claim to the front of the line. Social Security generally approves these cases quickly. Check the Social Security Administration’s Compassionate Allowances list.

If you don’t meet a listing or don’t have a compassionate allowance condition, you have to prove you are unable to sustain any regular work (8 hours a day, 40 hours a week) including simple, unskilled work. However, at age 50 Social Security begins to relax that criteria.

2. Determine which program(s) you may qualify for

If you have worked and paid FICA payroll taxes you probably have enough credits in the Social Security System to apply for Social Security Disability Insurance (SSDI).  With adequate wages you can earn up to 4 credits a year which count toward social security eligibility.  You need 20 credits, or 5 years of credits out of the last 10 years.  Your benefit amount depends on how much FICA tax you have paid.  You must satisfy a 5-month waiting period.

To determine if you have enough credits and your estimated benefit, set up a Social Security account.

If you have not worked, or earned enough credits, you can apply for Supplemental Security Income (SSI).  This benefit is a flat amount to be used for housing and food expenses.  There is a resource limit of $2000 for an individual or $3000 for a couple.  Once approved, SSI pays benefits from the date you applied.  SSI benefits may be reduced by one-third if you are not paying your fair share of household expenses. Determine the current benefit rate for SSI here.

You may also go to Social Security’s Benefit Estimate Screening Tool to explore benefits available to you and your family.

3. Maintain healthcare

Your case is only as good as the ongoing and consistent record of your medical condition(s).  If you lose your health insurance, due to your disability, apply for Medicaid, which is now available to many low or no income Virginians who are uninsured.

Once approved for Medicaid, set up appointments with specialists that treat each of your conditions.  Follow your treatment plan.  Avoid canceling appointments and re-schedule if necessary.  Disability Determination Services will collect and review your records thoroughly to determine if your condition(s) meet Social Security’s criteria.  Large gaps in treatment can be harmful to your case.

4. Educate your doctors about your symptoms and limitations

Your medical records need to support the conditions you claim are disabling.  To educate your doctors and improve your records, create a list of your symptoms, their frequency and severity, and how they limit you.  Update your list from time to time and share it with your doctors at each appointment so they better understand and document how your impairments affect you. Symptoms are things like dizziness, weakness, pain, insomnia, anxiety, irritability, depression, difficulty with focus and/or memory.  Limitations can include difficulty bathing, cooking or cleaning your home; sitting, standing or walking for long periods; driving beyond a mile or two; getting along with others; or paying attention or recalling important things.  The more you detail each symptom limitation the better.

For example: headache pain occurs 1 day a week and lasts 6-10 hours requiring me to rest in a dark room. The pain is a 6-8 on the pain scale and medications provide limited relief. When working, I had to call in sick 4 days a month and I am unable to help at home when the symptoms occur.

5. Understand the process and hang in!

Obtaining a social security benefit can take time.  When you apply, it can take up to 120 days for a decision.  Most people are denied, especially those with weak documentation.  If you are denied you have the right to appeal within 60 days.  This appeal is called Request for Reconsideration and will require another 60-120 days for a decision.

If your Request for Reconsideration is also denied you can appeal, again, within 60 days.  This appeal is called Request for Hearing by an Administrative Law Judge.  This will involve a face-to-face hearing with a Social Security judge and can take a year or more to schedule.  With each appeal, you can submit more documentation to prove your case.  If you require a hearing, be sure to obtain legal help from someone with expertise in Social Security and even your specific condition.  To learn more about the application and appeal process see the disAbility Law Center of Virginia’s fact sheets called TIPS When Applying and TIPS When Appealing.

How to Avoid the One-Third Reduction to the SSI cash benefit

The adult SSI benefit amount you qualify for can be reduced by wages from work.  Social Security can also reduce it by one-third if you live with family or friends and don’t pay your share of household expenses. Social Security calls this the “One-Third Reduction” and it will greatly reduce your benefit. For example, the 2023 maximum SSI benefit is $914; a one-third reduction would mean about $300 less in your payment! View the current SSI Maximum here.

If you are living with a parent or other adult, you need to submit a simple statement to Social Security (at the time you apply or undergo the Age-18 redetermination) stating you will pay your “fair share” of household expenses or you will rent space in the home at a “flat rate.” Either way, the amount you plan to pay must be under the current SSI rate. Otherwise, Social Security will decide you can’t afford it and will reduce your SSI by one-third.

Steps to avoid the one-third reduction in SSI: Prepare a statement for Social Security

The fair share method:

Add up the monthly household expenses: food, rent or mortgage, and utilities (electricity, water, and sewer). The family you live with must be prepared to prove these expenses to Social Security. Then divide the total monthly expenses by the number of people in your household.

Example: if the household expenses come to $2000/month and there are 4 people living in the home, then your fair share = $2000 divided by 4 which is $500. As long as you intend to pay your fair share you should receive the full SSI payment. If not, then it will be reduced by 1/3. If the “fair share” calculation is greater than the maximum SSI rate in effect consider using the “flat rate rental method”.

The flat rate rental method:

Rent space in the home at a fair and flat rate. For example, a bedroom and bathroom with access to kitchen and laundry could be worth $500/month. The amount must be affordable and, therefore, under the maximum SSI rate in effect.

Prepare a statement explaining the method you plan to use and submit it to Social Security. It can be typed or handwritten and must be signed by adult receiving the benefit or their representative payee. Remember, it is best to submit this when you apply or undergo an Age -18 redetermination. If Social Security denies this you can appeal. This is considered a non-medical appeal because it is a separate matter unrelated to the disability determination. Begin your appeal of a non-medical denial here.

Information for Youth and Young Adults with Disabilities: dLCV’s Coming of Age Manual: I Have a Choice, I Have a Voice!
For college students: Removing Barriers Faced by College Students with Disabilities Applying for or Receiving Social Security Disability Benefits

All about appealing (or disagreeing with) a decision made by the Social Security Administration

TIPS When Appealing a Decision on Your Claim for Social Security Disability (SSDI) or Supplemental Security Income (SSI)

Obtaining a disability benefit (SSDI or SSI) from the Social Security Administration (SSA) can be a long process. Most people are denied when they apply the first time and must appeal, often several times. You appeal when you disagree with the decision. The following information will help you know what to expect with your case and how to move through the stages. Note – If you received a denial notice over 65 days ago and did not appeal you must re-apply.

Think of it as a 3-stage process:

Stage 1 – Application – SSA approves about 20% of cases. This stage may take between 3-6 months and will depend on your disability and the quality of your evidence. If SSA denies your case you should consider appealing right way.

Stage 2 – Request for Reconsideration is the first appeal. SSA approves about 20% of these appeals. This stage may take 3-6 months and depends on new evidence in your case. If SSA denies your case you should consider appealing right way.

Stage 3 – Request for Hearing by An Administrative Law Judge is the second appeal. SSA approves about 50-60% of these appeals. It may take a year or more to obtain a date for your hearing which is often needed to further build your case.

When is appealing necessary?

Appeal when your denial letter states:

  • Notice of Disapproved Claim – this would occur if our application is denied
  • Notice of Reconsideration – this would occur if your Request for Reconsideration is denied

It is to your advantage to appeal.

All appeals MUST be filed within 60 days of the date on the denial notice.

There is a 5-day grace period. Beyond that, you must have “good cause” for a late filing which requires good documentation of your reason otherwise you will have to re-apply. Avoid using the entire 60 days to file your appeal as a delay on your end adds to the wait times.

How to Appeal?

To appeal you may return to your online application using the PIN number provided when you applied.  Or visit the Social Security Administration’s website here.

If you filed your application with a telephone interview or paper application call SSA’s toll-free number 1-800-772-1213 and you will be sent the proper forms to appeal. Have your denial notice available so they know which forms to send. Appeal forms can be faxed, mailed or dropped off at your local SSA office. Always obtain delivery confirmation such as a fax transmission sheet, certified return receipt when mailing or a time stamped receipt when dropping off.

If you are filing a Request for Reconsideration you need the following forms:
SSA 561-U2, SSA-3441 BK, SSA-827.

If you are filing a Request for Hearing by an Administrative Law Judge you need the following forms:
SSA HA-501-U5, SSA-3441 BK, SSA-827.

These forms can also be found here.  SSA’s office addresses and telephone/fax numbers can be found here:

When Do I Need A Representative?  

If you require a second appeal (Request for Hearing) it is very important for you to get an advocate to help you. This is called “representation”. Attorneys and non-attorneys provide representation but usually not before this stage. You can file the appeal by yourself but find a representative right away as it will take many months to prepare your case.

Note: disability Law Center of Virginia does not provide representation on social security disability benefit cases.

What can I do to improve my case?

  • Review each denial notice carefully. See if any of the doctors or other treatment records you told them to collect are missing. Be sure to state this on the SSA-3441 for appeal and provide the contact information again. If you have new medical evidence be sure to include the providers contact information and dates of service.
  • Keep going to the doctors that treat your disabilities. It is best to see a doctor who specializes in the treatment of your diagnosis rather than a primary care
  • You should schedule follow up appointments so they can document your ongoing symptoms and limitations. Attend all appointments and follow your doctor’s advice including taking medications or going to therapy as prescribed. If you miss an appointment, reschedule it.
  • If you lack medical insurance apply immediately or review our guide entitled: Do You Have a Disability and Need Healthcare?
  • Complete all forms by the deadlines.
  • Make sure all information submitted repeats the same information. For example, don’t say in one form “I walk one-half mile every day” and the next form: “I can only walk one block occasionally”. If this happens to be true because your condition is worsening than say so.
  • Prepare a list of the ways your condition affects you such as pain, fatigue, dizziness, shortness of breath, anxiety, depression, poor concentration or memory loss. Update it often. Bring the list to your doctors each time you visit and discuss ways your condition has gotten worse. Leave a copy of the list with your doctor for your file.
  • Find an advocate or representative immediately after the second denial.

What does the representative do?

  • A representative is an advocate. They will take time to review your file and get to know you and your disabilities. Some will ask to review any paper evidence that you have.
  • They will ask you how your disabilities prevent you from working.
  • They will collect your records and other important information throughout the entire waiting period as long as you keep them informed of who is treating you.
  • They will electronically submit all new evidence to the hearing office including opinions they collect from your doctors prior to 5 days before your scheduled hearing.
  • Sometimes they collect statements or special forms about your condition from your doctors.
  • They will prepare an argument on your behalf based on why you meet the SSA definition of disability. Often, they prepare a letter to the judge to present this argument.
  • They will prepare you and any witnesses for the hearing.
  • They will keep you informed every step of the way before, during, and after the hearing.

What should I look for when hiring a representative?

  • Find an individual or firm that specializes in social security disability law.
  • Find an individual or firm that is local so they are familiar with the judges in your community and so you have easier access to them when you need them.
  • Find someone who agrees to stay in touch with you throughout the process and agrees to take your calls when you have a question or new information.
  • Ask around for a recommendation.

What does it cost to hire a representative?

  • You should pay nothing upfront unless the representative requires you to cover the cost of collecting your records.
  • You only pay your representative if SSA approves your case. At that time, your representative may collect 25% of your past-due benefits not to exceed $7000. You will sign a “Fee Agreement” agreeing to this.
  • SSA usually pays this fee directly out of your past-due benefit. If not, the representative will collect the fee from you. Be sure to ask how this will take place.

What forms will I and the representative sign to make this official?

  • SSA-1696 Appointment of Representative
  • Fee Agreement

What if the administrative law judge denies me?

There are two more stages to the process. The first is called “Request for Review”. This appeal is submitted to the Appeals Council.  Ask your representative to appeal. This appeal can take over a year, sometimes longer.

The Appeals Council can:

  • Approve your case, or
  • Deny your request for review, or
  • Send it back to the judge for another hearing and a new decision which may or may not be favorable.

The last and final stage on any claim is Federal District Court. This requires an attorney.  Non-attorneys cannot take cases at this level unless they represent with an attorney. These cases can take several years to resolve.  In the unlikely case this appeal is approved your attorney is entitled to collect 25% of all the past-due benefits. This level may require a new fee agreement.

Very few cases are approved by the Appeals Council or Federal District Court. Once again, it is not recommended that you appeal these appeals on your own.

Can I Re-Apply while I have an appeal pending with the Appeals Council or Federal District Court?

Yes, you can re-apply.  However, if your new claim is approved, past-due benefits cannot cover any time prior to the date of the hearing judge’s decision. A new SSDI claim, if approved, will require a 5-month waiting period whereas an SSI claim will be paid from the day you apply forward.

What if I am not satisfied with my representative?

Sometimes people become dissatisfied with their representative. Perhaps, they are not returning your calls or they don’t appear to be doing anything. You do have a right to change representatives. Be careful when you do this. Here are some things to keep in mind:

  • These cases move slowly and that is often outside of your representative’s control.
  • Many law firms use paralegals to communicate with their clients. It is reasonable to ask for periodic communication with the attorney.
  • If you decide to terminate your representative they must agree to state in writing that they are withdrawing from your case. They must send a copy to you and SSA.
  • Your representative may agree to “waive” their right to the fee if your case is approved. If so, they should put this in the letter to SSA so a new representative knows they will not have to share the fee.

How can I find a representative?

The disAbility Law Center of Virginia (dLCV) does not provide representation. You may use the list of referrals provided by the Social Security Administration’s Office of Hearing Operations. It is important to find someone who specializes in social security disability in your community and who you can meet with in person. You may also use the following sources to obtain referrals in your community:

Do You have a Disability and Need Healthcare?

You may also download this guide in the following languages: Spanish, Vietnamese, Arabic, and Chinese.

If you have a disability and lack health insurance there are many options available for healthcare in Virginia. If you are applying for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) it is VERY important to maintain treatment to prove your case.  If Social Security approved your SSDI claim and you are within the 24-month waiting period for Medicare these options may enable you to continue your medical care while you wait. Ask your doctor, case manager, or your local social services department to connect you with these programs:

1) Virginia Medicaid – Health Coverage for Adults as of 1/1/19

Visit: www.coverva.org or call 1-855-242-8282

  • Must be a Virginia resident between the ages of 19-64
  • Must be at or below 138% of the Federal Poverty Level
  • You pick your health plan (insurance provider) and choose a doctor within that plan. If you like your current doctor, check with them to see if they are participating in your plan.
  • There are no monthly premiums, deductibles, or co-pays
  • If you meet the other requirements for Medicaid, but your income is above 138% of the Federal Poverty Level, you may qualify for a spenddown which functions like an insurance deductible
  • While your SSDI Medicare is pending you may qualify for Virginia Medicaid
  • Application takes up to 45 days to be processed

2)  Healthcare Marketplace – Affordable Care Act (also known as Obamacare)

Visit: www.healthcare.gov or call 1-800-318-2596

  • Allows more freedom in choosing an insurance provider
  • Usually requires a monthly premium and deductible
  • Only available during open enrollment periods unless you qualify for a special enrollment period due to: losing your insurance, a change in household size, change in residence or income, change in status (citizenship, incarceration, etc.), or belonging to a federally recognized tribe
  • Low income households may be eligible for a Tax Credit that helps to ease the burden of insurance costs
  • Some households may be eligible for Extra Savings that lower the costs of monthly premiums

3) Community Health Centers

Find a Health Center

  • Serves high-need communities
    • Serves both insured and uninsured individuals
    • Serves as primary healthcare
    • Some offer dental, mental health and inpatient services as well
    • Fees are adjusted to the individual’s ability to pay

4) Hospital Financial Aid Programs

  • Many hospitals offer a financial aid program if you don’t have insurance or a discount for self-pay
  • Check with each hospital to determine their financial aid options
  • State Sponsored Indigent Care:

VCU Health (Richmond) and UVA Medical Center (Charlottesville) participate in a state funded program to provide primary and specialized care to those without insurance

5) Local Health Departments

  • Offer varying degrees of primary care
  • Some offer dental and mental health care as well
  • Often free or on a sliding scale depending on your income
  • Best for individuals with minor health problems or needing a well visit/physical

6) Free Clinics

Visit: www.vafreeclinics.org/clinics-in-virginia or call 1-804-340-3434

  • Clinics use a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or mental health services to low income individuals
    • Often have fluctuating hours
    • Some charge a small/or sliding scale fee

7) Patient Advocate Foundation (PAF)

Visit: www.patientadvocate.org or call 1-800-532-5274

  • Guides patients with chronic, life-threatening, or debilitating diseases through complex healthcare challenges to access care and treatment
  • Provides co-pay relief and financial aid grants
Social Security’s I-Appeal – How and When to Use it

iAppeal is a new feature which allows an individual to appeal (or dispute) a social security denial on the Social Security Administration’s (SSA) website.

You may use iAppeal if you SSA recently denied your claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for medical or non-medical reasons and you disagree with the decision. You can also provide documents electronically to support your appeal.

Appealing online using iAppeal will save time and can help return a faster decision.

TIP – You can file an iAppeal even if you started your application on paper, in a telephone interview, or at a local office.

Who Can Benefit from an iAppeal?

  • People with mobility or mental disabilities who cannot go to a Social Security office
  • People who cannot afford to travel to a Social Security office
  • People whose deadline to appeal is coming up soon
  • People who want to speed up an appeal decision

Examples of medical denials:

  • Notice of Disapproved Claim for SSDI and/or SSI
  • Notice of Reconsideration for SSDI and/or SSI
  • Unfavorable decision by an administrative law judge for SSDI/SSI
  • Notice of Cessation of SSDI and/or SSI Benefits

Examples of non-medical denials:

  • SSA decides to reduce, stop or suspend your SSI benefits due to changes in your income, resources, or living arrangements
  • SSA sends to a letter saying you owe them money (i.e. benefit overpayments)

How Do I Begin my iAppeal?

TIP – print or save the page as a receipt for your records

Once I file my iAppeal can I check the status of my case online?

Yes! Whether you applied online, by phone, or in an office, you can check the status of your SSDI and SSI claim or appeal using your personal MySocialSecurity account.

Set up or sign into your MyAccount here.

All about keeping a benefit once you have it

The Continuing Disability Review: How to prepare for a Social Security Disability benefit review

Social Security Administration’s Review Process

Social Security disability benefits are not always permanent. When you were awarded either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits you received a Notice of Award from the Social Security Administration (SSA) that had a paragraph entitled Things to Remember. That paragraph states when your benefits will be reviewed. This is called a Continuing Disability Review (CDR) and usually takes place every 1, 3, 5 or 7 years depending on your disability. SSA does not always conduct a review within the timeframe stated but you can expect a review at some point. The purpose of the review is to determine if you have medically improved enough to work.

SSA also reviews a child’s SSI benefits periodically. Then, at age 18 SSA conducts an Age 18 Redetermination. This occurs because SSA’s definition of “disability” changes from childhood to adulthood so a new determination must take place. For more information on this review see our guide entitled SSI: What Happens at 18?

What steps do I take to prepare for these reviews?

Keeping accurate and up to date medical evidence is key to documenting that your disability continues. It is important to see your doctors at least twice a year even if your condition has not changed and there are no new treatment options. This will keep your condition and its symptoms and limitations documented for the eventual review. It can be helpful to keep a log of your symptoms and limitations that you have on a daily or regular basis.  Prepare a summary of this and bring it to each doctor’s appointment using the following format and examples (be sure to state the frequency, duration, and intensity of each symptom and how it limits you). These are some examples of statements that will help SSA determine if you have improved enough to work:

  • Can’t focus longer than 15 minutes: affects reading, understanding instructions, learning new information. This occurs daily (or 2-3 times a week) and prevents me from completing tasks such as following a recipe, filling out forms, or completing simple household task.
  • Memory is a daily problem: forget appointments, to pay bills, to take medicine, conversations, important information, etc. I am frequently confused. This interferes with me safely managing my household responsibilities and taking care of myself.
  • Can’t cope with changes or stress; my mood changes often and I am frequently irritable and have meltdowns daily/weekly.
  • Physical limitations: pain prevents me from standing and sitting longer than 30 minutes and walking more than one block. I can only occasionally lift and carry 1-5 pounds safely. This prevents me from walking to mailbox, sustained seated work, managing household task alone, and concentrating.

Other things to keep in mind regarding the reviews

  • Any statements you make regarding your condition must be backed up by current medical evidence which can only be done if you see your doctors regularly and report all your symptoms and limitations.
  • If your condition has worsened since SSA first awarded benefits it can be helpful to have a new evaluation or other test results available within 1 year of when you expect the review to occur.
  • The worst thing you can do when receiving disability benefits is to stop seeing your doctors or other health professionals. SSA may interpret this as medical improvement. It is up to you to keep your conditions documented.
  • SSA also conducts “work reviews” for beneficiaries who work to determine if an individual is eligible for monthly benefits. This is different from the Continuing Disability Review.
  • SSA waives a review for anyone in the Ticket to Work program.

How will I know SSA is reviewing my case?

The SSI Age-18 Re-determination is automatic. You will receive a form around your 18th birthday.

For the adult Continuing Disability Review, you will receive a letter and one of two forms from SSA.

  • The short form is for people with the most significant disabilities who are not as likely to improve. Simply fill in the bubbles, make no comments on the form, and return in the envelope provided immediately. Delayed returns can result in denial.
  • The long form is for people whose disabilities are more likely to improve. This form asks you to report any changes in your condition for better or worse and for the names and addresses of the doctors you’ve seen since SSA first approved benefits. Any tests, hospitalizations or surgeries that are related to your disability should be included at this time. The form will also ask if you have worked. Be sure to state whether this work was short term (especially if under 3 months) and if it ended because of your disability. Be sure to explain if you had any accommodations and/or difficulties on the job. Be sure to state if you are using a Ticket to Work and are involved in a program of vocational rehabilitation or use a job coach.

View more information on SSA’s reviews here

What if SSA decides I am no longer disabled?

If the information Social Security collects suggests that you have medically improved enough to work your case your benefits will end. If you disagree you have a right to appeal.

Appealing a Continuing Disability Review denial

If you are still unable to work you should appeal your case immediately following the instructions in the letter (you have 60 days to file the appeal with a 5-day grace period). This appeal is called a Request for Reconsideration-Disability Cessation Right to Appear. To appeal you must file SSA-789 within 60 days of receiving your cessation notice (denial letter). But if you want your disability benefits to continue while you appeal the cessation, you must file the form within 10 calendar days of the denial. Make this decision very carefully as often keeping the benefits in place while you appeal can cause an overpayment of benefits if your case is ultimately denied.

If SSA denies this appeal you can appeal again within 65 days and this is called a Request for Hearing by Administrative Law Judge. This appeal requires you to file HA-501.

How can Section 301 continue my benefit if SSA decides I am no longer disabled?

If SSA was unaware during the review process that you are receiving vocational rehabilitation be sure to notify them when you appeal by stating that you may qualify under Section 301 which allows SSA to continue your benefits even if they think your condition has improved enough to work.

View more information on SSA’s Section 301 rule here

Do I need to get professional help with an appeal?

Not usually. The information requested is straightforward. It can be helpful to have a family member, friend, or medical professional assist you to ensure the information is accurate and complete and submitted within the deadline.  If SSA denies you twice and you decide to file a Request for Hearing you can seek representation.  A representative’s fee is paid out of your past due benefits if your case is approved. However, if you elect to continue receiving your benefits during this period it can be difficult to find a representative as there would be no past due benefits from which to collect a fee.

At Age 18 or Older: Applying for Supplemental Security Income (SSI) and/or Disabled Adult Child benefits on a Parent’s Record

Applying for SSI for the first time as an adult

If you did not receive Supplemental Security Income (SSI) as a child because of your family’s income and resources, you can apply for SSI any time after age 18 as long as you have less than $2000 (such as cash, life insurance, burial policy, or an inheritance) and you do not earn more than Social Security allows. Social Security will not consider your parent’s income and resources when deciding if you meet the financial requirements for the SSI program.

Adult definition of disability

Social Security bases the new decision on their disability rules for adults. Some conditions are assumed to be disabling and are automatically approved, others are not. In general, in order to qualify for SSI as an adult, your disability must:

  1. Significantly limit your ability to work
  2. Be expected to or has lasted a year or more
  3. Prevent Substantial Gainful Activity (SGA)*
    *Substantial Gainful Activity is Social Security’s limit on how much you can earn and still be considered disabled. This amount changes every year. For more information on earning limits, click here.

To continue Medicaid Waivers as an Adult you Must Obtain SSI

Medicaid waivers for a child do not depend on a family’s income or resources. As an adult, in order to keep your waivers you must apply for SSI and be approved by the time you reach age 19.

How to start an SSI application

To start an SSI application as an adult call Social Security to make an appointment in your local office (800-772-1213) or visit the recommended Social Security Administration website.

Social Security will schedule a telephone interview to conduct a financial screening and collect medical information for the application. They will send you a letter to confirm your appointment with a list of the information needed to apply. Be sure to gather this information before the appointment.

Applying for the Disabled Adult Child benefit as an adult on a parent’s record

If you received benefits as a child because a parent was on disability, retired or deceased this was unrelated to you having a disability. That child benefit on a parent’s record ends when you turn 18 or up to age 19 if you are still in school.

An adult who became disabled before age 22 may be eligible for the Disabled Adult Child benefit at 18 or older when:

  • a parent starts receiving social security retirement, or
  • receives a social security disability benefit, or
  • is deceased

You do not qualify for this benefit if you are married. You will need solid medical evidence to prove your disability began before age 22 and meet all other rules. Keep these records safe until they are needed. This benefit may replace an SSI benefit which is often less but you will be able to keep your Medicaid insurance.

To apply for the Disabled Adult Child benefit you must contact SSA directly.

The Automatic Age-18 Redetermination of Child SSI and Using Section 301 to Continue SSI if SSA Decides you are Capable of Working

At age 18, since the child eligibility rules no longer apply, a soon-to-be adult on Supplemental Security Income (SSI will go through a review called the Age-18 Redetermination. The Social Security Administration (SSA) will automatically send you a form requesting information to decide if you meet the adult rules and to make sure you meet their guidelines on income and resources since the family’s income and resources are no longer considered.

Adult definition of disability

Social Security bases the new decision on their disability rules for adults. Some conditions are assumed to be disabling and are automatically approved, others are not.   In general, in order to qualify for SSI as an adult, your disability must:

  1. Significantly limit your ability to work
  2. Be expected to or has lasted a year or more
  3. Prevent Substantial Gainful Activity (SGA)*
    *Substantial Gainful Activity is Social Security’s limit on how much you can earn and still be considered disabled. This amount changes every year. For more information on earning limits, click here. 

What if my benefits are denied?

If Social Security decides at the Age-18 Redetermination that you do not meet the adult definition of disability, your benefits will end after 2 months.

Actions you can take immediately to disagree with this decision

After a denial, if you believe your disability limits your ability to work, you must act quickly if you want to try to keep your benefit.

  • To disagree you must APPEAL within 60 days. Follow the instructions in the denial letter to appeal or call Social Security’s toll free number 800-772-1213 to request appeal form; and
  • You may also continue your SSI child benefits during the appeal period if you go to a Social Security office and request this WITHIN 10 CALENDAR DAYS of the date on the letter. Be aware, you can appeal several times but if all appeals are denied, your SSI will end and you will have to pay back the benefits paid to you during the appeal period. Fortunately, you can appeal this, too.
  • Keep in mind: if all appeals are denied and your SSI stops you can re-apply later when you have better proof that you can’t work or sustain gainful activity.

What can I do to avoid a denial at the age 18 re-determination?

Make sure evaluations of your disability are current: Before you turn 18, be sure to get updated medical, educational and/or psychological evaluations that clearly tell how the disability affects you and how it will limit your ability to work. Be sure Social Security knows how to collect this information by adding the evaluators contact information to the form you receive from Social Security.

Tell Social Security about your school or vocational assistance: In the Remarks Section of the form that you receive from Social Security, state if you plan to remain in high school and/or if you are a client of DARS or any other work or training assistance program. If you continue your education or are getting help to work, Social Security may continue your SSI benefit while you complete these programs even if they decide you do not meet the adult definition of disability. This called a Section 301 rule.

Explain any work efforts you have had so far: In the Remarks Section of the form, list each work effort, even those that only lasted a few days, weeks, or months. List the title of the job, # of hours a week you worked, your hourly wage, difficulties you had on the job, and why the job ended. Include all assistance you needed to get and keep the job such as a special work program, a job coach, or even if it is a parent finding the job or setting up an interview.

Keeping Medicaid and Your Waiver Services if you Were Not on SSI as a Child: Once you turn 18, keeping your waiver services under Medicaid depends on you receiving SSI. If you did not receive SSI benefits as a child you will have to apply when you turn 18 and undergo a Medicaid Disability Determination 90 days before turning 18. Your Medicaid eligibility worker should contact your parent or responsible person to start this process so your Medicaid benefits remain in place as you apply for SSI at age 18. A parent can also start this process to be sure it happens on time.

How can I still receive SSI benefits if Social Security decides I do not meet the adult rules for disability?

If your SSI is denied at the age 18 redetermination, you may still qualify for continued SSI payments under Section 301 if:

  • You remain in high school past age 18; or
  • You are receiving vocational rehabilitation, training or education.

You will receive SSI payments under the Section 301 rule while you make efforts to work and increase your independence as long as you are involved in an approved program. These programs may qualify you for Section 301 because they will prepare you for work so you will be less likely to need SSI in the future. Once you complete or stop the program the SSI benefit will end.

Examples of school or vocational programs that may count toward Section 301:

  • An Individualized Education Program (IEP) in a public or private school between ages 18 and 21
  • Department of Aging and Rehabilitation Services (DARS), Department for the Blind and Vision Impaired (DBVI)
  • Employment Network
  • Ticket to Work
  • Workforce Investment Opportunity Act (WIOA) program
  • Job Coaching or supported employment
  • Virginia Commonwealth University’s “Project Search”, PAVE – Program for Adults in Vocational Education or Wilson Workforce and Rehabilitation Center’s PERT (Post-Secondary Education Rehabilitation Transition)

To claim Section 301 be sure to tell Social Security about these efforts when they start your Age 18 redetermination or if you are denied. Give Social Security the program’s contact information. They will collect proof of your participation in a program and decide about continuing your benefits.

Social Security Resources for Youth with Disabilities Turning 18

Do You have a Disability and Need Healthcare?

You may also download this guide in the following languages: Spanish, Vietnamese, Arabic, and Chinese.

If you have a disability and lack health insurance there are many options available for healthcare in Virginia. If you are applying for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) it is VERY important to maintain treatment to prove your case.  If Social Security approved your SSDI claim and you are within the 24-month waiting period for Medicare these options may enable you to continue your medical care while you wait. Ask your doctor, case manager, or your local social services department to connect you with these programs:

1) Virginia Medicaid – Health Coverage for Adults as of 1/1/19

Visit: www.coverva.org or call 1-855-242-8282

  • Must be a Virginia resident between the ages of 19-64
  • Must be at or below 138% of the Federal Poverty Level
  • You pick your health plan (insurance provider) and choose a doctor within that plan. If you like your current doctor, check with them to see if they are participating in your plan.
  • There are no monthly premiums, deductibles, or co-pays
  • If you meet the other requirements for Medicaid, but your income is above 138% of the Federal Poverty Level, you may qualify for a spenddown which functions like an insurance deductible
  • While your SSDI Medicare is pending you may qualify for Virginia Medicaid
  • Application takes up to 45 days to be processed

2)  Healthcare Marketplace – Affordable Care Act (also known as Obamacare)

Visit: www.healthcare.gov or call 1-800-318-2596

  • Allows more freedom in choosing an insurance provider
  • Usually requires a monthly premium and deductible
  • Only available during open enrollment periods unless you qualify for a special enrollment period due to: losing your insurance, a change in household size, change in residence or income, change in status (citizenship, incarceration, etc.), or belonging to a federally recognized tribe
  • Low income households may be eligible for a Tax Credit that helps to ease the burden of insurance costs
  • Some households may be eligible for Extra Savings that lower the costs of monthly premiums

3) Community Health Centers

Find a Health Center

  • Serves high-need communities
    • Serves both insured and uninsured individuals
    • Serves as primary healthcare
    • Some offer dental, mental health and inpatient services as well
    • Fees are adjusted to the individual’s ability to pay

4) Hospital Financial Aid Programs

  • Many hospitals offer a financial aid program if you don’t have insurance or a discount for self-pay
  • Check with each hospital to determine their financial aid options
  • State Sponsored Indigent Care:

VCU Health (Richmond) and UVA Medical Center (Charlottesville) participate in a state funded program to provide primary and specialized care to those without insurance

5) Local Health Departments

  • Offer varying degrees of primary care
  • Some offer dental and mental health care as well
  • Often free or on a sliding scale depending on your income
  • Best for individuals with minor health problems or needing a well visit/physical

6) Free Clinics

Visit: www.vafreeclinics.org/clinics-in-virginia or call 1-804-340-3434

  • Clinics use a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or mental health services to low income individuals
    • Often have fluctuating hours
    • Some charge a small/or sliding scale fee

7) Patient Advocate Foundation (PAF)

Visit: www.patientadvocate.org or call 1-800-532-5274

  • Guides patients with chronic, life-threatening, or debilitating diseases through complex healthcare challenges to access care and treatment
  • Provides co-pay relief and financial aid grants

All about working when receiving a benefit

Can I Keep my Benefits if I Work? (Video)

Do you want to learn about working and keeping a social security benefit?  This video will introduce you to the Social Security Administration’s work incentives that help social security beneficiaries work without losing their benefit.

Social Security Administration’s Online Guide to Working While Disabled
Social Security’s Online Guide to Employment Supports for Individuals who receive SSDI and/or SSI
Social Security’s Ticket to Work

All about social security benefits when in State Hospitals or Jails/Prisons

Social Security Benefits When in a State Hospital

What happens to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) when you enter a state hospital?

SSDI benefits continue unless a person is determined to be not guilty by reason of insanity (NGRI). However, the facility will ask that this resource be used to help pay for their hospital expense. In some instances, the facility will become your representative payee, but this should not be necessary if you or your representative payee can continue to manage these funds.

  • If NGRI, you will have to re-apply for SSDI upon discharge.

SSI benefits may continue for up to 3 months during a temporary stay in an institution if:

  • A doctor certifies that the person is expected to be there 3 months or less: and
  • The person has a home and pays permanent living expenses such as rent or mortgage

After 3 months, SSI is suspended (placed on hold).

After 12 months, the SSI ends and will require a new application upon discharge.

When benefits are suspended or stopped how do you get SSDI/SSI re-started upon discharge?

Ask your social worker if the facility has a pre-release agreement with your local Social Security office. If so, the facility will verify your upcoming discharge and work with Social Security to help you re-start your benefits or re-apply. Your facility will notify Social Security if you are likely to meet the eligibility rules and provide them records of your disability. Social Security can begin processing your re-instatement or new application so your benefits can start soon after your release.

  • TIP – If your facility does not have a pre-release agreement with Social Security they can easily start one at any time by contacting your local security office.
  • TIP – If it has been several years since your SSDI/SSI benefit started your benefits may be ready to undergo a review to determine if you still meet the disability rules. This process may take extra time.

What about your Medicare or Medicaid coverage?

  • Medicare – Once your SSDI is re-started your Medicare should be available again.
  • Medicaid – If your SSI terminated while in an institution, then your Medicaid also terminated. Upon discharge the facility social worker should connect you to your local Department of Social Services (DSS) office to re-apply.

How to Contact Social Security or Make an Appointment

Call 800-772-1213 or TTY 1–800–325–0778 if you are deaf or hard of hearing. They are open from 7 am to 7 pm Monday through Friday.

Other Resources on this topic:

Social Security Benefits When in a Jail or Prison

What happens to SSDI or SSI when entering jail or prison?

If you were receiving Social Security Disability Insurance (SSDI) before jail or prison these benefits were suspended if you were incarcerated longer than 30 days. Benefits received by your dependents will not be suspended or terminated. Upon release your benefit can be re-started in the month following the month of your release.

If you were receiving Supplemental Security Income (SSI) before jail or prison these benefits were suspended when you were incarcerated. If you remain in jail longer than 12 consecutive months your eligibility for SSI ends and you must file a new application when released.

When benefits are suspended how do you re-start your SSDI or SSI?

You need to contact Social Security and provide a copy of your release documents from the jail or prison where you were held. If you know your release date you can call Social Security beforehand and schedule an appointment to occur after you are released.

Is there a way to speed up getting my benefits re-started?

Yes. Ask your prison facility about their pre-release agreement with your local Social Security office. If they don’t have an agreement they can easily start one by contacting your local Social Security office. Using the pre-release agreement the facility will verify your upcoming release and work with Social Security to re-start your benefits or re-apply if necessary.

  • TIP – if it’s been several years, your case may be ready for a review to determine if you still meet the disability rules.

Do you want to apply for SSDI or SSI before you are released?

If your SSI ended while in prison or you are applying for SSDI or SSI for the first time, notify someone at your facility within a few months of release that you want to file an application for benefits.  Using their pre-release agreement your facility can notify your local Social Security office of your release date, state whether you are likely to meet the eligibility rules, and provide them records of your disability.

Social Security can begin processing your application so your benefits can start soon after your release.

What about your Medicare or Medicaid coverage?

Medicare – Part A (hospital insurance) will continue while you are in prison but Part B (medical insurance) will stop if your premiums are not paid. To re-start it you must apply during the enrollment period from January to March; it will then begin on July 1 of that year.

Medicaid – If your SSI terminated while in prison then your Medicaid also terminated. To re-apply contact your local Department of Social Services (DSS) office.  Social Security can provide a referral form for you to take to DSS.

How to Contact Social Security or Make an Appointment

Call 800-772-1213 or TTY 1–800–325–0778 if you are deaf or hard of hearing. They are open from 7 am to 7 pm Monday through Friday.

Other Resources on this topic:

Resources

  • Social Security Forms

    All Social Security forms are free. Not all forms are listed.

  • Social Security Publications

    The Social Security Publications page provides several links to publications available from the Social Security Administration.

  • Setting up a ″MySocialSecurity″ Account

    Setting up a MySocialSecurity account with the Social Security Administration is free and allows you to check your earnings record, estimate your benefits under each program, and check on the status of a claim.

  • Maximizing your Social Security Benefits: Perks & Pitfalls to be Aware of to Get all you Deserve!

    A presentation by Elizabeth Horn, Senior Disability Rights Advocate at dLCV, on maximizing you social security benefits [PDF Version]