Wednesday, September 29, 2010

A Social Security PASS for Medicaid Benefits and Much More

One of the rewarding elements of a Social Security practice is the idea that when one a practitioner succeed on behalf of a Claimant, that Claimant’s life is improved in perpetuity, or at least until they are well enough to work again. Unfortunately in some cases, even a grant of benefits is not enough to ensure that the Claimant has access to proper health care. SSDI requires a two year wait before Medicare benefits kick in, and those two years can bring serious health events that require treatment. SSI will frequently open the door to Medicaid benefits immediately, which are worth more to many Claimants than the monthly payment that Social Security makes. Medicaid generally requires smaller patient outlays, and has comparable benefit levels to other government plans. The question is, when an RSDI Claimant earns too much to qualify for SSI (and consequentially Medicaid), and can find no other way onto the Medicaid registry despite being indigent by all other measures, what are the options for healthcare, especially during the Medicare waiting period? Enter the PASS, otherwise known as the “Plan for Achieving Self-Support”.

In Georgia, and in other states where SSI grants Claimants access to Medicaid, SSDI recipients who are otherwise earning too much to qualify for Medicaid may be able to get coverage if they have minor children living with them, or if they earn an amount over the limit that may be “spent down” by medical bills, which would push them under the limits. These are not the only ways that a non-SSI recipient may unlock benefits, but it is safe to state that each gateway to Medicaid is narrowly tailored and does not serve every element of the disabled and poor population, especially those that are close to the line. To further restrict access to Medicaid, SSDI payments are generally made in greater amounts than the earnings limits set by SSI. As such, Claimants that would otherwise qualify for SSI, and thus Medicaid, are thereby precluded from tapping into these benefits. PASS can benefit those that are poor, but on SSDI, by carving off a portion of their SSDI earnings to be set aside in a pot of funds to be used to assist the Claimant in pursuit of a work goal.

The benefits of PASS are multi-fold. For the hypothetical “almost poor enough” SSDI recipient that I discussed above, the benefits are clear. If their PASS were crafted correctly and approved, this person would receive a larger monthly allotment of money since they would qualify for SSI benefits, Medicaid benefits would begin immediately since they are now under the earnings limit, and they would begin contributing to a growing a pool of funds that may be used for a variety of purposes, including starting a business, getting training, buying equipment, and other activities appurtenant to getting back on one’s feet. This is a great scenario for the Claimant, and can truly make their lives better.

So what are the requirements of participating in the PASS program? The primary requirement is an approved PASS plan. A PASS plan may be submitted on the SSA-545 form, which may be found at here. A PASS plan is not something that may be simply thrown together. There must be an actual plan including goals and time frames specific to the Claimant that must be met in furtherance of the work goal. This plan must designate what amount money will be used to reach the goal and how that money will be used. Finally the plan must set clear lines on the steps to be taken to avoid co-mingling the PASS funds with the Claimant’s other money, the SSA must approve the plan and reserves the right to conduct future reviews to assess compliance and progress. For information about the PASS program, one can find the appropriate telephone number by visiting Another helpful website with more written detail may be found at

To speak with an attorney about your Social Security claim, please contact Thomas O’Brien at Feiler & Associates.

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