SSI Eligibility & Appeals
Nuts & Bolts
This tool covers the basics of the Supplemental Security Income (SSI) program, how it works and is administered, how disability is determined, and how to appeal SSI program decisions.
What Is Supplemental Security Income?
Supplemental Security Income (SSI) provides monthly payments to people with disabilities who have limited income and savings. It is administered by the Social Security Administration (SSA). For calendar year 2023, the SSI program pays a maximum monthly Federal Benefit Rate (FBR) of $914. At their option, 46 states pay an additional SSI State Supplement.
In 41 states and the District of Columbia, an individual who receives SSI is automatically eligible for Medicaid. The remaining nine states—known as section 209(b) states— have state-specific Medicaid eligibility criteria for SSI recipients. (For more about SSI and Medicaid, see Tool 6.)
Who Is Eligible for SSI?
For a person to be eligible for SSI eligibility, the person must meet two broad requirements: a disability requirement and a financial requirement. Both children and adults can be eligible.
SSI Disability Requirement
An adult SSI applicant, age 18 or older, must show medical evidence that they are unable to earn at a Substantial Gainful Activity (SGA) level. Evidence from Vocational Rehabilitation (VR) agencies, evidence of how well the individual performs in employment settings, and even the applicant’s ability to do a range of daily living activities may be relevant to meeting the SSI disability standard.
The SSI program has a separate disability standard for children under age 18. The child applicant must show, through medical evidence and educational records, several substantial deficits in the ability to function in both school and non-school settings compared to their non-disabled peers. Statements from parents, other family members, and even neighbors could be relevant.
The SSI applicant and those helping with the application must make sure that medical and other relevant evidence is submitted to SSA.
SSI Financial Eligibility
The SSI applicant must also establish that their Countable Income and Countable Resources are within the program’s limits.
Countable Income includes both unearned and earned income. If a child or adult receives other unearned income besides SSI, $20 of that income will be excluded and what remains will be subtracted from the maximum SSI payment otherwise due to them.
For a child under age 18, part of their parent(s)’ income could be counted as income to the child and thus reduce the SSI payment. If that deemed income is high enough, it could even eliminate the child’s eligibility for an SSI payment. At age 18, the SSI program no longer counts parental income or resources no matter how high it is. Middle class families of youth with severe disabilities should be prepared to have the child apply for SSI at age 17 and 9 months, though they will not be eligible until they turn 18 years old. Parental income and resources will no longer count against the child at age 18.
Countable Resources must not exceed $2,000. For example, $2,200 in a bank account would make either an adult or a child ineligible for SSI. In some cases, the resources of the parent(s) could count toward a child’s $2,000 resource limit.
For more about SSI’s income and resource rules, see Tool 3.
SSI and Medical Reviews
All SSI recipients—children and adults—are subject to a medical Continuing Disability Review (CDR) from time-to-time. For most recipients, this occurs every 3–5 years. The purpose of the medical review is to determine if the person’s condition has medically improved, and if it has, to determine if that improvement makes them no longer disabled under SSI criteria:
- If there is no medical improvement, or if there has been medical improvement but the person still meets the SSI disability criteria, SSI benefits will continue.
- If there has been medical improvement and the person’s disability no longer meets the SSI disability criteria, SSI benefits will be terminated subject to the right to appeal that decision.
The Age-18 Redetermination
All children who receive SSI based on the childhood disability criteria will be subject to an Age-18 Redetermination when they reach age 18. The purpose of this medical review will be to determine whether the recipient meets the separate SSI disability standard for adults. Unlike the medical CDR, which looks for evidence of medical improvement, the Age 18-Redetermination is a new, initial determination and follows the same review process used for any new adult application for SSI:
- If SSA determines that the recipient’s condition meets the SSI disability standard for adults, benefits will continue.
- If SSA determines that the condition does not meet the disability standard for adults, SSI benefits will be terminated subject to the right to appeal the decision.
For more about this topic, see Tool 2.
Appealing SSI Decisions
The SSI program allows an applicant or beneficiary to appeal any decision concerning SSI eligibility or the SSI payment amount. This website focuses on appealing SSA decisions based on a finding that the individual does not meet the disability criteria.
If SSA decides to terminate benefits following a medical CDR or an Age-18 Redetermination, it must send a written notice to the beneficiary and their representative payee, if any. That notice must explain all the following:
- That SSI benefits are being terminated based on a determination that the beneficiary no longer meets the SSI disability criteria (following a medical CDR) or is not considered disabled under adult criteria (following an Age-18 Redetermination)
- The effective date of the termination
- Steps that can be taken to request an appeal and the time limit for doing so
- That the right to request that SSI benefits continue during the appeal and the time limit for doing so
How to Appeal an SSI Decision
An appeal can be filed online or by sending a letter to the address referenced in the notice. It can also be appealed or by going to an SSA office with the notice in hand and explaining you want to appeal that decision.
Read the notice carefully, as it will include the method for appealing and the time limit for doing so (generally 60 days from receipt of the notice). Also, the notice will explain how to request that SSI continue during the appeal and the time limit for requesting that (generally 10 days from receipt of the notice).
Getting an Attorney or Advocate to Assist with Your Appeal
When appealing, you would be wise to find an attorney or advocate who has experience with SSI appeals to represent you.
If you are a professional assisting an SSI applicant or beneficiary, you should always refer the individual to an attorney or advocate for representation as soon as you are aware that they have received a notice denying their SSI application or terminating their right to continue receiving SSI.
Here are some tips for locating an attorney or advocate:
- Try the Legal Services or Legal Aid program for your state or region. To find one, see the Our Grantees page on the federal Legal Services Corporation website.
- Ask the Protection and Advocacy Program for your state (many have the “Disability Rights” in their program name). To find your program, visit the National Disability Rights Network website.
- Seek a private attorney in your area who may—for a fee paid through back benefits—agree to handle the appeal. A search for the bar association in your county or region of the state may be the best way to find one.