Primer on Disability Benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)

Primer on Disability Benefits:
Social Security Disability Insurance (SSDI)
and Supplemental Security Income (SSI)
Updated January 8, 2008
Scott Szymendera
Analyst in Disability Policy
Domestic Social Policy Division



Primer on Disability Benefits:
Social Security Disability Insurance (SSDI) and
Supplemental Security Income (SSI)
Summary
Generally, the goal of disability insurance is to replace a portion of a worker’s
income should illness or disability prevent him or her from working. Individuals may
receive disability benefits from either federal or state governments, or from private
insurers. This report presents information on two components of federal disability
benefits, those provided through the Social Security Disability Insurance (SSDI) and
the Supplemental Security Income (SSI) programs. The SSDI program is an insured
program that provides benefits to individuals who have paid into the system and meet
certain minimum work requirements. The SSI program, in contrast, is a means-tested
program that does not have work or contribution requirements, but restricts benefits
to those who meet asset and resource limitations.
The SSDI program was enacted in 1956 and provides benefits to insured
disabled workers under the full retirement age (and to their spouses, surviving
disabled spouses, and children) in amounts related to the disabled worker’s former
earnings in covered employment. The SSI program, which went into effect in 1974,
is a needs-based program that provides a flat cash benefit assuring a minimum cash
income to aged, blind and disabled individuals who have very limited income and
assets.
To receive disability benefits under either program, individuals must meet strict
medical requirements. For both SSDI and SSI disability benefits, “disability” is
defined as the inability to engage in substantial gainful activity (SGA) by reason of
a medically determinable physical or mental impairment expected to result in death
or last at least 12 months. Generally, the worker must be unable to do any kind of
work that exists in the national economy, taking into account age, education, and
work experience.
Both programs are administered through the Social Security Administration
(SSA) and therefore have similar application and disability determination processes.
Although SSDI and SSI are federal programs, both federal and state offices are used
to determine eligibility for disability benefits. SSA determines whether someone is
disabled according to a five-step process, called the sequential evaluation process,
where SSA is required to look at all the pertinent facts of a particular case. Current
work activity, severity of impairment, and vocational factors are assessed in that
order. An applicant may be denied benefits at any step in the sequential process even
if the applicant may meet a later criterion.
The SSDI program is funded through the Social Security payroll tax and
revenues generated by the taxation of Social Security benefits, portions of which are
credited to a separate Disability Insurance (DI) trust fund. In contrast, the SSI
program is funded through appropriations from general revenues. This report will
be updated as warranted.



Contents
Social Security Disability Insurance...................................1
Supplemental Security Income.......................................2
Type of Benefits and Average Benefit Levels............................2
SSDI ........................................................2
SSI .........................................................3
Eligibility Requirements............................................4
Definition of Disability.........................................4
SSDI ........................................................5
SSI .........................................................6
Disability Determination Process......................................8
Program Financing Information.......................................9
SSDI ........................................................9
SSI ........................................................10
List of Figures
Figure 1. Adults (Age 18-64) Receiving Social Security Benefits, SSI,
or Both on the Basis of Disability .................................4
List of Tables
Table 1. Reasons for SSDI Worker Benefit Termination, 2005..............5
Table 2. SSI Recipients with Benefits Terminated by Age and Reason, 2003...8



Primer on Disability Benefits:
Social Security Disability Insurance (SSDI)
and Supplemental Security Income (SSI)
Generally, the goal of disability insurance is to replace a portion of a worker’s
income should illness or disability prevent him or her from working. Individuals may
receive disability benefits from either federal or state governments, or from private
insurers.
This report presents information on two components of federal disability
benefits, those provided through the Social Security Disability Insurance (SSDI) and1
the Supplemental Security Income (SSI) programs. The SSDI program is an insured
program that provides benefits to individuals who have paid into the system and meet
certain minimum work requirements. The SSI program, in contrast, is a means-tested
program that does not have work or contribution requirements, but individuals must
meet the asset and resource limitations. To receive disability benefits under either
program, individuals must meet strict medical requirements.
Social Security Disability Insurance
The SSDI program is a part of the Old Age, Survivors, and Disability Insurance
(OASDI) program administered by the Social Security Administration (SSA). The
disability insurance portion of OASDI was enacted in 1956 and provides benefits to
disabled workers under age 65 (and to their spouses, surviving disabled spouses, and
children) in amounts related to the disabled worker’s former earnings in covered
employment. The SSDI benefits, like those of the Old Age and Survivors Insurance
(OASI), are meant to replace income from work that is lost by incurring one of the
risks the social program insures against. Funding for the SSDI and OASI programs
is primarily through a payroll tax levied on workers in jobs covered by Social
Security, and the benefits are based on an individual’s career earnings. At the end
of October 2007, nearly 8.9 million disabled workers and their dependents were
receiving SSDI benefits.2


1 This paper was originally written by Laura Haltzel and updated by April Grady and Julie
M. Whittaker.
2 Social Security Administration, OASDI Monthly Statistics, October 2007, (Washington:
GPO 2007), Table 1, available on the website of the Social Security Administration at
[ ht t p: / / www.ssa.gov/ pol i c y/ docs/ st at comps/ oasdi _mont hl y/ 2007-10/ i ndex.ht ml ] .

Supplemental Security Income
The SSI program, which went into effect in 1974, is a means-tested program that
provides cash payments assuring a minimum income for aged, blind or disabled
individuals who have very limited income and assets.3 This program is often referred
to as a “program of last resort” since individuals who apply for benefits also are
required to apply for all other benefits to which they may be entitled, such as Social
Security retirement or disability benefits, pensions, or unemployment benefits.
Although the SSI program is administered by SSA, it is funded through general
revenues — not payroll taxes. The federal benefit provided through this program,
unlike through the SSDI program, is a flat amount (adjusted for other income the
individual may have), and is not related to prior earnings. In addition to the federal
SSI payment, many states provide additional supplements to certain groups or
categories of people. At the end of October 2007, nearly 7.4 million individuals
received federally administered SSI payments.4 Of these, nearly 6.2 million were5
entitled to benefits on the basis of disability or blindness.
Type of Benefits and Average Benefit Levels
SSDI
SSDI benefits are based on the worker’s past average monthly earnings, indexed
to reflect changes in national wage levels (up to five years of the worker’s low
earnings are excluded).6 The benefits are adjusted annually for inflation, as measured
by the consumer price index for workers (CPI-W). Benefits are also provided to
dependents (such as spouses or children), subject to certain maximum family benefit
limits. Disability benefits may be offset if the disabled worker is simultaneously
receiving workers’ compensation or other public disability benefits. In addition,
individuals who receive SSDI benefits also receive Medicare benefits after a 24-
month waiting period.
At the end of November 2006, the average monthly SSDI benefit was $980.20
for disabled workers; $260.90 for spouses of disabled workers; and $291.41 for


3 See CRS Report 94-486, Supplemental Security Income (SSI): A Fact Sheet, by Scott
Szymendera, and CRS Report RS20294, SSI Income and Resource Limits: A Fact Sheet, by
Scott Szymendera.
4 Includes federally administered state supplementation. Ten states provide supplemental
payments that are federally administered (other states that provide supplemental payments
administer them at the state level).
5 Social Security Administration, SSI Monthly Statistics, October 2007, (Washington: GPO
2007), Tables 1 and 2, available on the website of the Social Security Administration at
[ ht t p: / / www.ssa.gov/ pol i c y/ docs/ st at comps/ ssi _mont hl y/ 2007-10/ i ndex.ht ml ] .
6 The basic benefit formula for SSDI benefits is similar to the benefit formula for Social
Security Old Age and Survivors benefits. The worker’s past annual covered earnings are
indexed to reflect changes in national earnings levels. A formula which provides a higher
replacement rate for low earners is then applied to these averaged earnings.

children of disabled workers.7 The average age of a disabled worker beneficiary in

2006 was 52.1 years.8


SSI
The basic federal SSI benefit is the same for all beneficiaries. In 2008, the
maximum SSI payment (also called the federal benefit rate), regardless of age, is
$637 per month for an individual living independently or $956 per month for a
couple living independently. Federal SSI benefits are increased each year to keep
pace with inflation (as measured by the CPI-W). The monthly SSI benefit may be
reduced if an individual has other income or receives in-kind (non-cash) support or
maintenance. However, states may voluntarily supplement this payment to provide
a higher benefit level than that specified in federal law.
SSI recipients living alone or in a household where all members receive SSI
benefits are also automatically eligible for food stamps. States have three options for
determining Medicaid eligibility for SSI recipients. In 32 states and the District of
Columbia, individuals who are eligible for SSI are automatically eligible for
Medicaid. SSI recipients in seven states and the Northern Mariana Islands are
eligible but must complete a separate application for Medicaid. Eleven other states
have the option to impose Medicaid eligibility requirements that are more restrictive
than SSI criteria.
Individuals may receive SSDI, SSI based on disability (or blindness or age), or
both (some may also receive other benefits). The amount of the SSI benefit may be
adjusted based on receipt of other income, such as SSDI benefits (the SSDI benefit
is not reduced if the recipient also receives SSI benefits, because SSDI is not means-
tested). As Figure 1 shows, over the past several years, the number of adults (age
18-64) receiving disability-related Social Security benefits has increased faster than
those receiving disability-related SSI benefits or those receiving both types of
benefits. 9
At the end of November 2006, the average monthly federally administered SSI
payment amount was $465.80 for all recipients; $551.70 for children under age 18;
$481.60 for adults age 18-64; and $385.30 for adults age 65 and older.10


7 Social Security Administration, OASDI Monthly Statistics, October 2007, (Washington:
GPO 2007), Table 5, available on the website of the Social Security Administration at
[ ht t p: / / www.ssa.gov/ pol i c y/ docs/ st at comps/ oasdi _mont hl y/ 2007-10/ i ndex.ht ml ] .
8 Social Security Administration, Annual Statistical Report on the Social Security Disability
Insurance Program, 2006, (Washington: GPO 2007), Table 19, available on the website of
the Social Security Administration at [http://www.ssa.gov/policy/docs/statcomps/di_asr/

2006/].


9 Although the majority of disability-related Social Security benefits are paid under SSDI,
some individuals receive disability-related OASI benefits (e.g., disabled adult children of
retirees, disabled widow(er)s and disabled adult children of deceased retirees).
10 Social Security Administration, SSI Monthly Statistics, October 2007, (Washington: GPO
(continued...)

Figure 1. Adults (Age 18-64) Receiving Social Security Benefits, SSI,
or Both on the Basis of Disability


6,500,000
6,000,000
5,500,000
5,000,000
4,500,000entsSocial Security only
4,000,000cipiSSI only
3,500,000 re
3,000,000er ofBoth Social Security
2,500,000mband SSI
2,000,000Nu
1,500,000
1,000,000
500,000
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Source: Social Security Administration, SSI Annual Statistical Report, 2006, (Washington: GPO
2005), Table 14.
Note: The number of individuals receiving Social Security benefits includes disabled workers,
disabled widow(er)s, and disabled adult children. The SSI number includes those receiving federal
SSI benefits, federally administered state supplements, or both.
Eligibility Requirements
Definition of Disability
For both SSDI and SSI disability benefits, “disability” is defined as the inability
to engage in substantial gainful activity (SGA) by reason of a medically determinable
physical or mental impairment expected to result in death or last at least 12 months.
Generally, the worker must be unable to do any kind of work that exists in the
national economy, taking into account age, education, and work experience.
The definition of disability for disabled children receiving SSI benefits is
slightly different from adults. Instead of demonstrating work limitations, children are
required to demonstrate that they have “marked or severe functional limitation,” and
in addition, they are subject to slightly different criteria for the medical listings.
10 (...continued)
2007), Table 7, available on the website of the Social Security Administration at
[ ht t p: / / www.ssa.gov/ pol i c y/ docs/ st at comps/ ssi _mont hl y/ 2007-10/ i ndex.ht ml ] .

SSDI
To be eligible for SSDI benefits, a worker must be (1) insured, and (2) disabled
according to the definition of disability. To be insured, they must have worked a
minimum amount of time in employment covered by Social Security (similar to
eligibility for OASI benefits). However, for disability benefits, if an individual does
not have 40 quarters of coverage (generally about 10 years), they must have one
quarter of coverage (one quarter of coverage is equal to $1,050 in 2008 and indexed
to the annual increase in wages) for each year after 1950 or from age 21 up to the
onset of disability. In addition, a recency of work test requires the worker to have 20
quarters of coverage in the 40 quarters preceding the onset of disability (generally
five years of work in the last 10). Workers under age 31 need to have credit in one-
half of the quarters during the period between when they attained age 21 and when
they became disabled (a minimum of six quarters is required).
Once an individual’s application for SSDI benefits has been approved, he or she
will receive benefits after a five-month waiting period from the time the disability
began, and will receive Medicare coverage 24 months after SSDI benefits begin.
Disability benefits will continue as long as the individual remains disabled, or until
he or she reaches the full retirement age (currently age 65 and six months for workers
born in 1940) when the benefits automatically convert to retired worker benefits.
According to law, SSA periodically conducts continuing disability reviews, or CDRs,
to determine whether the individual is still disabled. How often the beneficiary’s
medical condition is reviewed depends on how severe it is and the likelihood it will
improve. The SSDI award notice explains when the first review is expected.. If
medical improvement is expected, the first review will be six to 18 months after first
receiving disability benefits. If medical improvement possible the case will be
reviewed about every three years. If medical improvement is unlikely, the case will
be reviewed only about once every five to seven years. If the beneficiary has
received SSDI benefits for at least 24 months, a medical review will not be initiated
solely on account of work activity.
Of the individuals whose SSDI benefits are terminated, the majority are due to
factors other than medical recovery. In 2006, of the nearly 500,000 disabled workers’
benefits that were terminated, 44.4% were because of conversion to retirement
benefits and 39.5% were due to the individual’s death. Another 5.2% of those
terminated had a medical improvement, while 7.1% had earnings from work above
the substantial gainful activity earnings limit.
Table 1. Reasons for SSDI Worker Benefit Termination, 2005
Number ofPercent of
Workers Terminations
Total terminations/ suspensions511,128100.0%
Attainment of normal retirement age226,85844.4%
Death of beneficiary201,77439.5%
Medical improvement26,5265.2%
Work above SGA36,2427.1%
Other19,7283.9%
Source: Social Security Administration, Annual Statistical Report on the Social Security Disability
Insurance Program, 2006, (Washington: GPO 2006), Table 50.



SSI
To receive SSI aged benefits, an individual must be at least 65 years old. To
receive SSI disability benefits, an individual must meet the same definition of
disability that applies under the SSDI program (see the section below on the
“Disability Determination Process”). To qualify for SSI benefits because of
blindness, an individual must have visual acuity of 20/200 or less with the use of a
correcting lens in the person’s better eye, or tunnel vision of 20 degrees or less. In
addition to age, disability, or blindness, an individual must meet income and resource
tests to qualify for SSI benefits. They must also (1) be a citizen of the United States,
or if not a citizen, (a) be a refugee or asylee who has been in the country for less than
seven years, or (b) be a “qualified alien” who was receiving SSI as of August 22,
1996, or who was living in the United States on August 22, 1996, and subsequently
became disabled; (2) be a resident of the United States or the Northern Mariana
Islands, or a child of a person in the military stationed outside the United States;11 (3)
apply for all other benefits to which they are entitled; and (4) if they are disabled,
accept the vocational rehabilitation services that they are offered. There is no recency
of work test for SSI benefits as there is for SSDI benefits.
The countable resource limit for SSI eligibility is $2,000 for individuals and
$3,000 for couples. These amounts are not indexed for inflation and have remained
at their current levels since 1989. Some resources are not counted in determining
eligibility for SSI. Among the excluded resources are: an individual’s home; a car
used for essential transportation (or, if not essential, up to $4,500 of its current
value); property essential to income-producing activity; household goods and
personal effects totaling $2,000 or less; burial funds of $1,500 or less; and life
insurance policies with total face value of $1,500 or less.
Two types of income are considered for purposes of determining SSI eligibility
and payment amounts: earned and unearned. Earned income includes wages, net
earnings from self-employment, and earnings from services performed. Most other
income not derived from current work (including Social Security benefits, other
government and private pensions, veterans’ benefits, workers’ compensation, and
in-kind support and maintenance) is considered “unearned.” In-kind support and
maintenance includes food, clothing, or shelter that is given to an individual. If an
individual (or a couple) meets all other SSI eligibility requirements, their monthly
SSI payment equals the maximum SSI benefit minus countable income.
Not all income is counted for SSI purposes, and different exclusions apply to
earned and unearned income. Monthly unearned income exclusions include a general
income exclusion of $20 per month that applies to non needs-based income. Food
stamps, housing and energy assistance, state and local needs-based assistance, in-kind
support and maintenance from non-profit organizations, student grants and


11 SSI benefits are not available to residents of Puerto Rico, Guam, or the United States
Virgin Islands. Residents of these jurisdictions are eligible to receive federal benefits from
their commonwealth or territorial government under provisions of Title XIV and Title XVI
of the Social Security Act. These benefits are administered by the Department of Health and
Human Services.

scholarships used for educational expenses, and income used to fulfill a plan for
achieving self-support (PASS) are also excluded from unearned income. Once the
$20 exclusion (and any other applicable exclusion) is applied to unearned income,
there is a each dollar for dollar reduction in SSI benefits (each dollar of countable
unearned income reduces the SSI benefit by one dollar).
Monthly earned income exclusions include any unused portion of the $20
general income exclusion, the first $65 of earnings, one-half of earnings over $65,
impairment-related expenses for blind and disabled workers, and income used to
fulfill a PASS. As a result of the one-half exclusion for earnings, once the $65
exclusion (and any other applicable exclusion) is applied to earned income, SSI
benefits are reduced by $1 for every $2 of earned income. In 2008, the monthly
earned income amount at which an individual with no unearned income and no
special earned income exclusions no longer qualifies for a federal SSI payment (not
including any state supplement) is $1,359 (also called the earned income “breakeven”
amount); the monthly earned income amount at which a couple no longer qualifies
is $1,997. The earned income breakeven amount may be lower for SSI recipients
with unearned income and those who do not live independently; it may be higher for
those who receive special earned income exclusions related to a PASS or to work.
In some cases, the income and resources of non-recipients are counted in
determining SSI eligibility and payment amounts. This process is called “deeming”
and is applied in cases where an SSI-eligible child lives with an ineligible parent, an
eligible individual lives with an ineligible spouse, or an eligible non-citizen has a
sponsor.
In contrast to SSDI, the majority of adults who have their SSI disability benefits
terminated are terminated because of having too much income. Unlike SSDI
benefits, SSI benefits may be suspended for one month, and paid in the next
depending on an individual’s income or resources.12 Table 2 shows SSI recipients
who had their benefits terminated. For both SSDI and SSI recipients age 18-64, less
than 10% of suspensions are due to recovering from disability.


12 Benefits are terminated if benefits have been suspended for at least 12 consecutive
months.

Table 2. SSI Recipients with Benefits Terminated
by Age and Reason, 2003
Number of RecipientsPercent of Recipients
Under Age 18Age 18-64Under Age 18Age 18-64
Total Terminations62,676470,025100.0100.0
Excess Income24,551290,00639.261.7
Excess Resources4,79610,8047.72.3
Death of Recipient5,05185,4288.118.2
No longer disabled16,74727,66326.75.9
Other 11,531 56,124 18.4 11.9
Source: Social Security Administration, SSI Annual Statistical Report, 2004, (Washington: GPO
2005), Table 61.
Disability Determination Process
The application process for SSDI and SSI disability benefits is very much the13
same. Although SSDI and SSI are federal programs, both federal and state offices
are used to determine eligibility for benefits. An individual applies for benefits at a
local Social Security Administration office where they are interviewed to obtain
relevant medical and work history and to see that required forms are completed. The
case may be denied at that point because the applicant does not have SSDI insured
status or is earning too much money from work (work above the SGA earnings limit)
in the case of Social Security disability cases, or is above the income and resource
limits in the case of SSI disability cases — otherwise it is forwarded to the state
disability determination service (DDS) for a medical determination.
The medical determination for both types of disability benefits is made on the
basis of evidence gathered in the individual’s case file. Ordinarily there is no
personal interview with the applicant on the part of the state personnel who decide
the claim.
SSA determines whether someone is disabled according to a five-step process,
called the sequential evaluation process, where SSA is required to look at all the
pertinent facts of a particular case. Current work activity, severity of impairment,
and vocational factors are assessed in that order. An applicant may be denied
benefits at any step in the sequential process even if the applicant may meet a later
criterion. For example, a worker that meets the medical listings for disability but
earns an amount exceeding the SGA earnings limit would be denied benefits at Step

1. The five steps are as follows.


13 For additional information see CRS Report RL33374, Social Security Disability Insurance
(SSDI) and Supplemental Security Income (SSI): The Disability Determination and Appeals
Process, by Scott Szymendera.

!Step 1. Work test. Is the individual working and earning over SGA
($940 per month for a non-blind individual or $1,570 per month for
a blind individual in 2008)? If yes, the application is denied. If no,
the application moves to Step 2.
!Step 2. Severity test. Is the applicant’s condition severe enough to
limit basic life activities for at least one year? If yes, the application
moves to Step 3. If not, the application is denied.
!Step 3. Medical listings test. Does the condition meet SSA’s
medical listings, or is the condition equal in severity to one found on
the medical listings?14 If yes, the application is accepted and
benefits are awarded. If no, the application moves to Step 4.
! Step 4. Previous work test. Can the applicant do the work he or she
had done in the past? If yes, the application is denied. If not, the
application moves to Step 5.15
!Step 5. Any work test. Does the applicant’s condition prevent him
or her from performing any other work that exists in the national
economy? If yes, the application is accepted and benefits are
awarded. If no, the application is denied.
Program Financing Information
The SSDI program is primarily funded through the Social Security payroll tax,
a portion of which is credited to a separate Disability Insurance (DI) trust fund. By
contrast, the SSI program is funded through appropriations from general revenues.
SSDI
The payroll tax is a 15.3% tax on earnings that is split equally between
employees and employers. Payroll tax revenues are used to pay benefits under the
Social Security OASDI program and the Medicare Hospital Insurance (HI) program.
The Social Security portion of the payroll tax is 12.4% (6.2% each per employee and
employer) on earnings up to the taxable maximum ($102,000 in 2008). Of the

12.4%, 10.6% is paid to the OASI trust fund and 1.8% is paid to the DI trust fund.


In addition to these payroll tax contributions, the DI trust fund receives some revenue
from the taxation of Social Security benefit payments. These combined revenues are


14 The medical listings can be found in the Social Security Administration publication
Disability Evaluation Under Social Security, available at [http://www.ssa.gov/disability/
professionals/bluebook/Entire-Publication1-2005.pdf]. This publication is commonly
referred to as the SSA Blue Book. (Hereafter cited as SSA Blue Book.)
15 Cases of children applying for SSI benefits are not subject to the work test but instead to
a test of functional capacity.

invested in non-marketable government bonds, which earned an effective annual
interest rate of 5.3% in 2007.16
The resources in the DI trust fund are used to pay SSDI benefits. Currently, the
DI trust fund is running a surplus as revenues coming into the trust fund exceed
benefits paid out. Under current projections, this trend will continue for the next nine
years, but after that the program expenditures are projected to exceed its revenues,
leading to the exhaustion of the DI trust fund in 2026. In contrast, the OASI trust
fund will be depleted in 2042, and taken together the OASDI trust fund will be
depleted in 2041.17 Among other things, the rapid rise in expenditures will be a
reflection of the aging of the baby boom, as more of them are projected to apply for
SSDI benefits when they reach ages 50-65, at which higher rates of disability
incidents occur.
SSI
The SSI program is financed through the general revenue of the United States.
Each year, Congress appropriates money to pay both SSI benefits and administrative
costs. The SSI Appropriation for FY2006 was $40.203 million, with $37.340 million
going to pay SSI benefits and $2.863 million going to pay for program
administration, vocational rehabilitation, and research.18


16 Data taken from the Social Security Administration Office of the Chief Actuary and is
available at [http://www.ssa.gov/OACT/ProgData/effectiveRates.html].
17 Data is taken from the “intermediate” assumptions of the Board of Trustees of the Federal
Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds as published
in Table IV.B.3 of their 2007 Annual Report, available at [http://www.ssa.gov/OACT/
T R/T R07/index.html ].
18 Social Security Administration, Fiscal Year 2008 Budget, p. 6, available online at
[ h t t p : / / www.ssa.gov/ budget / 2008bud.pdf ] .