Example

Angelica’s Story

When Angelica was first hospitalized with schizophrenia at 17, she was covered by her mother’s employer-sponsored health coverage. But when Angelica turned 26, she couldn’t stay on her mother’s insurance anymore, even as her mental state got worse — she could no longer hold down a job, was running out of money and ideas, and had no health coverage.

Angelica’s aunt helped out by paying for Angelica’s trips to a psychologist, who helped her understand what was going on. “You have a medical condition, a mental health issue, which keeps you from working. The government calls that a disability. Why don’t you go to the local County Department of Job and Family Services (CDJFS) office and see if they can help? I think you should be able to get some cash assistance and medical coverage.”

Applying for Help

Angelica went to her County Department of Job and Family Services (CDJFS) office and talked to Lauretta, a social worker. They sat down together, while Angelica told Lauretta about her medical history and her inability to work. She’d had no work for three months and was down to the last $500 in her bank account.

Lauretta explained that with her medical and work history, Angelica should be eligible for Social Security disability benefits, either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Social Security would check their records to see if Angelica had worked enough in the past to qualify for SSDI; otherwise, she’d probably get SSI instead. “You haven’t been able to work at the Substantial Gainful Activity (SGA) level — $1,550/month — for some time now. And with just $500 in resources, you’re below SSI’s $2,000 resource limit. So you’ll probably qualify.”

When Lauretta mentioned that the application process could take several months, Angelica was unhappy. She was out of money right now. Lauretta said, "While you are waiting for SSI, you can try applying for some other programs, like Medicaid and Food Assistance. Here's a list of the documents you should bring in so that I can help you fill out their applications." Together, they also called the local Social Security office to make an appointment for Angelica to turn in her SSI application later in the week.

Angelica came back the next day with bank statements, tax records, paystubs, and contact information for all the doctors and hospitals she’d dealt with. Then Angelica and Lauretta sat down together and filled out the Food Assistance and Medicaid application form. "Now that you're 26, your mother's employer-sponsored health plan won't cover you anymore, but now you'll qualify for Medicaid, because your income is below 138% of the Federal Poverty Guidelines (FPG)." This was a huge relief for Angelica, who didn't know that she could have been on Medicaid instead of being uninsured.

Then, Lauretta helped Angelica prepare the SSI application. Lauretta explained that there was not a complete online SSI application, but they could get things started online. Lauretta said, “That will help a lot when you go to the Social Security office to finish the application. A lot of what they need will already be in the system.”

“We want to get your application into their files as quickly as possible, because if it turns out you qualify for SSI,” Lauretta went on, “they’ll pay your SSI benefits all the way back to your application date.”

Waiting

In early January, Lauretta called Angelica. Angelica was approved for Medicaid and Food Assistance. “I’m breathing easier, now that I've got health coverage and some money for food,” she said.

On February 22, Angelica called Lauretta, clearly upset. She’d gotten a denial letter from Social Security. Lauretta asked Angelica to read the letterhead carefully. It turned out that Social Security Disability Insurance (SSDI) had denied Angelica because she didn’t have enough work credits to qualify. “That’s fine,” Lauretta explained. “We didn’t expect you to get SSDI anyway, given your work record. We’re really looking for SSI. Social Security has to check to see if you’re eligible for SSDI first, before they can consider you for SSI, that’s all. You’ve just got some more waiting to do.”

Award

On April 12, Angelica got her SSI award letter. She qualified for $943/month in SSI benefits. She called up Lauretta to ask what would happen next.

Lauretta explained, “First, SSI will pay you retroactive benefits. Since you applied back in December, SSI will give you benefits for each month you’ve been waiting since then.”

“When you’re feeling up to it,” Lauretta added, “you can start thinking about going back to work a few hours a week. You’ll have to report any changes in your income both to this office and to Social Security. But it’s worth it, because your SSI benefits amount will go down by less than your earnings, so you should always end up better off if you can work. For example, if you were earning $300/month, your SSI benefits amount would only go down by $107.50."

"Try out DB101’s Benefits and Work Estimator to get a feel for how earnings and SSI work together. When you are seriously considering going back to work, you should contact a benefits planner for more help.”

“Thanks for everything,” said Angelica.