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 contact the nearest Division of Public Assistance (DPA) office and see if they can help? I think you should be able to get some cash assistance and medical coverage.”

So Angelica went to her Division of Public Assistance (DPA) office and talked to Lauretta, an eligibility technician there. 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 benefits from two agencies: the Division of Public Assistance (DPA) and the Social Security Administration (SSA). “I can give you some information about the benefits we offer at DPA and I can tell you how to contact Social Security and make an appointment to talk with someone there.”

Applying for DPA Benefits

Lauretta started telling Angelica about DPA benefits. First, she mentioned Adult Public Assistance (APA): “APA is a state program that gives a monthly payment and provides Medicaid coverage to people with disabilities and seniors who have low income and low resources. You can apply for APA right here at the DPA office using our combined application for services. The combined application lets you apply for APA, Medicaid health coverage, and SNAP all at the same time.”

Then Lauretta told Angelica that Medicaid covered a lot more people than it used to cover, and that she’d probably qualify for Medicaid even if she didn’t qualify for APA. “Most adults who have income that’s below 138% of the Federal Poverty Guidelines (FPG) can now get Medicaid coverage.” This was a huge relief for Angelica, who didn't know that she could have been on Medicaid instead of being uninsured.

Lauretta warned Angelica that it could take several months for DPA to review her application for APA, but let her know that Medicaid and SNAP (formerly Food Stamps) might get approved faster. She also mentioned that there was a chance Angelica could get some Interim Assistance (IA) before APA was fully approved, which would help out until the APA benefits began. Finally, she handed a couple of printouts to Angelica: “Here’s a copy of the combined application for services and a list of the supporting documentation you should give us when you turn in your application. We need the supporting documentation to make sure that you have a disability and that your income and resources meet the requirements for our programs.”

Angelica came back the next week with her completed application, along with copies of bank statements, tax records, pay stubs, medical records, and contact information for all the doctors and hospitals she’d dealt with. She gave all of that information to the receptionist at the Division of Public Assistance (DPA) office and then went ahead and called the local Social Security office to make an appointment to apply for the benefits that Social Security offered.

Applying for Social Security Benefits

When Angelica went in to Social Security, she met with Simone, a claims representative. Simone told her that there were two benefits that Social Security offered that helped people with disabilities: Social Security Disability Insurance (SSDI) and 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 per 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 for SSI.”

Then, Simone helped Angelica prepare the SSI application. Simone explained that there was no full online SSI application, but they could get things started online.

Simone explained, “Now you’ve got your SSI application officially started. It was good to get your application filed as quickly as possible, because if it turns out you qualify for SSI, you’ll get retroactive payments for SSI all the way back to your application date.” Simone then gave Angelica a list of the other documents she needed to bring in to finish her SSI application. Angelica was relieved to see that it was basically the same things that she had needed for the APA application. That made things easy, since she already had an extra set of all of those documents on hand.

Waiting

In early January, Lauretta, the DPA eligibility technician, called Angelica. Angelica was approved for Medicaid, SNAP, and $280 per month in Interim Assistance. “I’m breathing easier, now that I've got health coverage and some money,” she said.

On February 22, Angelica called Simone, the Social Security claims representative. She’d gotten a denial letter from Social Security. Simone 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,” Simone explained. “It wasn’t likely you’d get SSDI, given your work record. What you might get is SSI. Social Security has to check to see if you’re eligible for SSDI first, before you can be considered 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 per month in SSI benefits. She called up Simone to ask what would happen next. Simone 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. Some of the retroactive benefits will automatically be used to pay back the benefits you got from Interim Assistance while you were waiting for your SSI application to be approved. Now that you are getting SSI, your Interim Assistance benefits will end. You’ll probably start getting APA benefits instead of Interim Assistance, but for more about that, you need to contact your Division of Public Assistance (DPA) office.”

Angelica thanked Simone and visited the Division of Public Assistance (DPA) office to talk with Lauretta about APA. Lauretta explained, “The month after you start getting SSI, you’ll also start getting APA. You will get $362 per month in APA and as long as you continue to get APA, you will automatically continue to qualify for Medicaid.”

“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 DPA and to Social Security, but it’s worth it, because your SSI and APA benefits 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 per month, your SSI benefits amount would only go down by $107.50 and your APA benefits would remain unchanged."

"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.