Benefits & Insurance

Presumptive Disability

Table of Contents

• Presumptive Disability for SSI
• The Application Process
• What to Take with You
• Presumptive Medi-Cal

Presumptive Disability for SSI

Under Social Security's Supplemental Security Income (SSI) program, you may qualify for "presumptive" eligibility and collect immediate benefits. You must meet SSI's income and assets limitations, and provide a physician's statement testifying to a severe HIV symptomatic or AIDS diagnosis based on infections, not T-cell counts. SSI can "presume" that you are disabled by their definition (unable to do any kind of work for up to 12 months), and may pay benefits for up to six months while your claim is being processed. Presumptive SSI is for disabled people with little or no income or low benefits from State Disability Insurance (SDI) or Social Security Disability Insurance (SSDI). SSI pays up to $750 (2002) a month for single individuals (up to $770 2002 if collected together with SSDI or SDI). Income must be under the maximum level and assets under $2000 (bank accounts, stocks, IRA's, pensions, cash value of life insurance policies, etc.). One vehicle and your residence are excluded.

You will be asked about income and expenses. If your expenses exceed the SSI payment level, SSI will want to know how you are meeting your expenses. If someone is giving you money to get by on, for rent or food, SSI may deduct a set amount from your benefit. However, loans that have to be paid back do not count as income. SSI may ask people who loaned you money to sign a loan statement.

SSI can make the first payment, called an "emergency advance payment," the day you apply if you present a case of dire need. District offices can write these checks, but some prefer not to. Check with the office where you plan to apply. Otherwise payment could take weeks. Emergency advances require extra work for claims representatives; ask for, do not demand, this payment. If you are disabled and collecting SDI at more than $750 (2002) a month, you may be eligible for presumptive when your SDI ends. Take your notice of exhaustion of benefits, received with your last SDI check, into Social Security to apply.

While you collect presumptive, SSI will process your claim and examine your medical records. If your charts, hospital records, etc., do not support your doctor's statement testifying to your disability, payment will stop. You would not have to pay back any of the presumptive payments you received. Otherwise, payment may continue until your claim is decided or up to a maximium of six months. Social Security generally processes HIV claims in less than six months, but not always. Follow through with your claim to keep it moving along.

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The Application Process

Call Social Security (800.772.1213) for an appointment or go into your local office. Tell the office you are applying for "presumptive SSI" and that you may need "emergency advance payment." SSI claims cannot be backdated prior to the day you contact Social Security. If you apply at the Hollywood office, call 323.965.3943. You will complete the SSI form in the office. You may be given other forms that must be completed then, or returned to Social Security.

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What to Take with You

1. Physician's diagnosis of symptomatic HIV or AIDS. The required form is SSI's "Medical Report on Adult with Allegation of HIV Infection," available from Social Security and APLA's Benefits office 213.201.1472. At Hollywood only, your physician must fax the completed form to .323.965.3854 before your appointment. Taking the form in yourself may hold up immediate payment until SSI gets the required form.
2. Identification (driver's license, picture ID) and your Social Security card or number.

3. Proof of any income you may be receiving, including SDI, unemployment receipts, pay stubs, tax returns or W-2 statements from the past two years.
4. Proof of financial resources (three months of past bank statements, stocks, bonds, property deeds, car registration, etc.).
5. Proof of monthly expenses: lease, rent receipts, utility bills, estimates of other household expenses (groceries, etc.). If you share a house or apartment, SSI requires that you pay your fair share of the rent (rent amount divided by adult occupants). If your rent is less than fair share, because of help from landlords, roommates, friends, etc., SSI could consider this "income in kind" and deduct from your benefit. Loans from landlords, roomates or friends would not count as income.
6. A certified or original copy of your birth certificate may be required and proof of legal residency status.
7. If you are awarded presumptive SSI, you can also ask for a referral letter to Medi-Cal (which comes automatically with SSI). You can take this letter to Medi-Cal and within a few days receive a temporary Medi-Cal number.

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Presumptive Medi-Cal

Presumptive Medi-Cal works much the same as presumptive SSI. With a severe HIV symptomatic or AIDS diagnosis, based on infections, you can receive presumptive Medi-Cal within 5 to 10 days, and use it while your application is being processed. Income and assets restrictions are similar but not identical to SSI's. If your income is over $946 for a single person (unless you receive SSI), you may still get Medi-Cal with a monthly "share of cost." You can apply through APLA’s Benefits office. Or you can apply at your local Department of Public Social Services office (DPSS). Check your phone book for listings or call DPSS's 24-hour InfoLine at 800.339.6993. These offices do not take appointments. Go early, and plan to spend several hours waiting. You will have to fill out an application first, then meet with an eligibility worker to review your answers. Documentation is the same as for SSI. If your Medi-Cal worker is not familiar with presumptive, ask to speak to a supervisor. Do not leave without proof that you will be receiving a Medi-Cal card soon. Regular Medi-Cal applications take one to three months or longer.

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If you have questions about APLA, becoming a client or about any of the services we offer, call us at 213.201.1600 during normal business hours or send an e-mail. We are happy to help.

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