PURPOSE: To clarify current policy related to determinations of eligibility for one member of an SSI couple previously suspended or terminated because of excess income.
CITATIONS (AUTHORITY): Sections 1611, 1612, and 1614 of the Social Security Act, as amended; Regulations No. 16, sections 416.120, 416.202, 416.300, 416.1001, 416.1101, 416.1185, 416.1321, 416.1323, and 416.1335.
PERTINENT HISTORY: Under section 416.1323 of the Regulations, SSI payments to a couple (eligible individual and eligible spouse) are suspended effective with the first month in which they lose their eligibility status due to excess income (i.e., when their combined countable income exceeds the amount of their SSI benefit). If payments remain continuously suspended for 12 calendar months, the couple is terminated. (Regulations No. 416.1335)
A number of inquiries from operating personnel have suggested the need for clarification of the policies affecting those persons who wish to reestablish eligibility for payment after having been suspended or terminated as described above. In particular, there has been some confusion as to the meaning of Regulations No. 416.1185(d). This section has been interpreted to preclude the deeming of an ineligible spouse's income to the spouse attempting to reestablish eligibility, where that same income was previously the cause of the determination of ineligibility for the couple. However, this is not the case. The section precludes the deeming of the same income to two different people simultaneously, but it does not prohibit deeming of the same income to the same person(s) at different times. That section is intended to address those situations where an ineligible person is living with both a spouse and a child who are filing as individuals.
POLICY DIRECTIVE STATEMENT: 1. When an SSI couple has ceased to be eligible because of excess income, either party may subsequently seek eligibility in his or her own right by filing either a request for reinstatement (if payments have been suspended), or a new application (if payments have been terminated).
2. Such subsequent eligibility will be determined on the basis of the circumstance existing at the time of filing the request(s) for reinstatement or the new application(s), without regard to the prior eligibility status of either member of the couple.
3. Thus, as is the case with initial applications, if only one of the parties files a request for reinstatement (or a new application) the claim is that of an eligible individual with an ineligible spouse, from whom income must be deemed if the couple is living in the same household. But if both parties file, their eligibility as a couple must be considered (and their incomes combined) before either party can be found eligible individually.
1. An eligible couple, living in the same household is placed in suspense because of the excess income of the husband. The wife, who has no income of her own, subsequently requests reinstatement as an individual. However, because she is still living in the same household with her husband, an ineligible spouse, his income must be deemed to her. Therefore, upon redetermination, she is found ineligible as an individual because of excess income.
2. Same facts as above except that the wife requests reinstatement after separating from her husband and living apart from him for a month. Because they no longer live in the same household, her husband's income cannot be deemed to her, and she qualifies as an eligible individual.
3. Same facts as above, except that the husband also files a request for reinstatement. Because the wife has not yet lived apart from her husband over 6 months, her eligibility must be judged as a member of a couple rather than as an individual. Assuming the husband still has excess income which would render them ineligible as a couple, the wife can be found eligible individually.
CROSS-REFERENCES: Claims Manual Sections A2450-A2462, 12100-12109, 12200-12204, 12206, 13145.1-13145.2 and 13400ff.
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