When we do an SNT for a claimant on SSI and SSI-related Medicaid, the receipt of the personal injury award funds is countable unearned income in the month received.  If we transfer out the funds to an SNT, the funds do not become a disqualifying resource if completed before the first of the following month.

But what do we do about the income in the month of receipt?  It is counted as disqualifying income and causes a potential overpayment.  To be eligible in any particular month, the SSI claimant must have resources of less than $2,000 on the first of the month, and income of less than $963 for any one of the days in the month. ($943 + $20 “general  income disregard”).

EXAMPLE:  William receives a personal injury settlement check of $300,000 on March 11th.  It is counted as “unearned income” for the March SSI check already received that month, that was based on his not having this unanticipated income.  We move the $300,000 into a Special Needs Trust before April 1st, so there is no problem with ongoing ineligibility for having too many resources in months May, June, July, etc..  But what about the excess income received in March, counted as income received March 11th?   It is  legally an overpayment, and SSA will generate a notice to William that he had excess income in March, and he owes the entire SSI check back, as an income overpayment, in the sum of $943.  What’s the legal answer?

The answer is requesting an SSA “administrative waiver” of the overpayment amount.  The rule effective for many years past was that if the amount of the overpayment was less than $1,000 that SSA could waive it, IF REQUESTED TO DO SO, because it was administratively not worth pursuing.  Now that number jumps to $2,000 that can be “administratively waived.”

If the person requests a reconsideration on the amount of the overpayment and the person is liable for an overpayment of $2,000 or less, the reconsideration is treated as a request for waiver after the processing center (PC) makes a formal reconsideration determination or dismissal, if there will be no effect on current or future benefits per GN 02201.013E.1.

In a few years, the current SSI payment amount would exceed the $1,000 authority to waive it.  So SSA has just announced that they are waiving the administrative waiver from $1,000 to $2,000.

GN 02250 TN 56 and SI 02260 TN 47 – Waiver Provisions for Overpayments

  • The administrative waiver tolerance has been increased from $1,000 to $2,000 in both Title II and SSI cases;
  • When a liable person requests waiver and the total amount of that person’s liability is $2,000 or less, recovery will be waived (unless there is some indication that the person may be at fault);
  • Application of the $2,000 administrative waiver tolerance depends on the total amount of a person’s liability;
  •  Example: a person who is liable for several overpayments, which total more than $2,000, even though each is $2,000 or less, cannot be considered for waiver under this tolerance;
  • If an overpayment of more than $2,000 has been reduced to $2,000 or less by repayment or collection, the waiver tolerance does not apply;
  • If the person requests a reconsideration on the amount of the overpayment and the person is liable for an overpayment of $2,000 or less, the reconsideration is treated as a request for waiver after the processing center (PC) makes a formal reconsideration determination or dismissal, if there will be no effect on current or future benefits per GN 02201.013E.1;
  • Neither full development nor an SSA-632-BK (Request for Waiver of Overpayment Recovery or Change in Repayment Rate) is required for waivers which will be processed under this provision.

Also, SSA has made another claimant-friendly update.  Because SSA is so bogged down in workload with the reduction in staff of almost 10,000 workers, but an increase in numbers of baby-boomer retirees and others seeking benefits, they are suspending Continuing Disability Reviews (CDRs) for the remainder of the year to give Disability Determination Servicesin the 50 states and SSA personnel a breather.

EM-24021 – 2024 Full Medical CDR Workload – One-Time-Only Instructions

  • For the remainder of FY 2024, the field offices will not send additional full medical CDRs to DDS;
  • If unassigned full medical CDRs are currently pending, DDS will take no action for the remainder of FY 2024;
  • For pending full medical CDRs that require a consultative evaluation, all CEs scheduled on or after June 21, 2024 will be canceled (unless the case is for a low birth weight baby, expedited reinstatement, pre-hearing, disability hearing, or fraud or similar fault);
  • If there is currently insufficient evidence in the file to make an age-18 redetermination, DDS will not initiate additional development, schedule a CE, or assign a medical or psychological consultant for review.