Do you have a child with a disability? You may have tangled with the alphabet soup of public benefits programs. We’d like to introduce you to some of the acronymic programs and help you distinguish among them.
Supplemental Security Income — SSI
One of the key elements of the alphabet soup of benefits is SSI. People who have a disability or are over age 65 may qualify — if they meet financial criteria. The program is run (and funded) by the federal government.
That’s the key for SSI: it is a means-tested benefit. If you have available resources over $2,000 or income over the SSI threshold (currently $943/month), you may not qualify for benefits. Of course that is a vastly oversimplified description. So for now let’s just say SSI is a federal, means-tested benefit program for people with disabilities.
Medicaid — or, in Arizona, AHCCCS
Medicaid is a federal program but run by the states. Arizona apparently worried that it did not have an acronym and wouldn’t fit in the alphabet soup mode — so we gave our version a catchy one: AHCCCS. It’s pronounced “access” (though it’s mostly about how to prevent access) and it stands for the Arizona Health Care Cost Containment System.
Not enough acronyms for you? We’ve got you covered. Arizona calls its long-term care Medicaid program ALTCS — or the Arizona Long Term Care System. And, like SSI, Medicaid/AHCCCS/ALTCS is means-tested. In fact, if you get SSI (in Arizona) you automatically qualify for AHCCCS.
You can qualify for Medicaid/AHCCCS/ALTCS even if you don’t receive SSI benefits. But the standards are similar — they look at income and assets. Oh, whoops — AHCCCS doesn’t consider assets, though ALTCS does. Confusing yet?
Social Security Disability Income — SSD
SSD sounds vaguely threatening. It’s also confusing, because sometimes people call it SSDI. That makes it even easier to confuse SSD and SSI.
But they’re very different programs — though both are based on disability (usually). In fact, the disability standard for SSD is identical to the one for SSI. But in order to qualify for SSD you have to have a Social Security work history.
Wait — not quite right. You can qualify for SSD benefits under the Disabled Adult Child (DAC) program. That is, you can if your parent is covered by Social Security and you were disabled before reaching age 22. Maybe.
Whether you are seeking SSD on your own work history or on someone else’s, there’s no financial test. Well, not quite. If you are able to work and earn more than a set amount, then you aren’t disabled. Yes, you might have a disability, but you don’t qualify as “disabled” and can’t get SSD under your own or a DAC standard.
At this point you might reasonably protest: “alphabet soup? this is alphabet spaghetti!” Wait. It gets worse.
Substantial Gainful Activity — SGA
We’re still in Social Security land here. In the discussion of SSD above, we mentioned that you do not qualify as disabled if you could earn more than a certain amount. Note that it is could earn, not did earn. So if you’re able to make more than the threshold amount, even if you didn’t, you may not be disabled.
But what it that threshold? It’s called Substantial Gainful Activity, or SGA. And in 2024 it’s $1,550/month (more — $2,590 — if you’re blind). Those numbers are indexed for inflation, so they’ll go up in 2025, and again in 2026, and … well, you know how that works.
Now please do understand that this standard is not a magic cliff. There are circumstances where you can earn more than the SGA amount for periods of time, and the methodology of calculating it can be adjusted to the benefit of the applicant. But it is an important measuring test for much of the alphabet soup.
Medicare — no acronym!
At this point we have to acknowledge that not every blessed thing in Public Benefits Land has an acronym. Medicare is the principal exception.
Medicare is available to people who have paid into the program (usually by withholding from wages) and who are either disabled or over age 65. And, like SSD, Medicare is not means-tested. So a very wealthy 66-year-old probably will qualify for Medicare — though she might have to pay significantly higher premiums for the coverage she gets. She’ll still pay less than the market rate, however.
One thing to note: people who get on Medicare by virtue of their disability have to wait 24 months after the SSD determination before Medicare kicks in. That can leave some Arizonans dependent on AHCCCS for two years after starting their SSD.
Qualified Medicare Beneficiaries — QMB
So you qualify for Medicare, but you are too poor to pay the premiums, co-payments and deductibles to stay on that health-care program? Good news for you — there’s the QMB program. If you qualify it will pick up those health-care related costs.
In fact, there might be more good acronymic news for you. Even if you don’t meet the QMB standard, you might qualify for SLMB or QI treatment.
SLMB (Specified Low-income Medicare Beneficiaries) have a little more income than their QMB compatriots. But they still get their Part B Medicare premiums paid through their (SLMB) program. And they probably also get their Part D (medication) premiums paid or subsidized, as well.
QI (Qualified Individual) beneficiaries have a little more income than either SLMB or QMB recipients. But they do get their Part B premiums paid.
It’s worth noting that the QMB, SLMB and QI programs, though set by federal law, are administered by states. And their financial eligibility rules vary by state.
Alphabet soup, indeed.
Dependent Adult Child — DAC
Let’s go back to the DAC program for a moment — because it’s key to understanding how public benefits programs work for many families. And let’s use an illustration.
Jenny has Down Syndrome. She meets the disability standards under both minor and adult disability tests (they are different — SGA doesn’t matter for minors). She is 16.
Jenny could qualify for SSI because she has no assets and no ability to earn income. But she doesn’t, because her parents are both working at good jobs and their assets and income are “deemed” available to Jenny. Not all of their assets and income, mind you, but enough to put her over the eligibility amounts.
When Jenny turns 18, her parents no longer have a legal obligation to support her — even though they do, in fact. So their assets and income are no longer relevant to Jenny’s eligibility, and she immediately qualifies for SSI.
When Jenny is 40, her mother begins taking her own Social Security retirement. Jenny suddenly transitions to the DAC program, and she gets 50% of the amount her mother gets. That does not reduce her mother’s Social Security — her mother’s Social Security insurance benefits included this dependent benefit all along.
Then, when Jenny is 45, her father becomes disabled and collects SSD on his own account. Because his Social Security check is larger than Jenny’s mother’s, Jenny’s benefit jumps up to 50% of the larger amount.
Ten years later, when Jenny is 55, her father dies. Now her benefit jumps again — this time to 75% of her father’s benefit amount. At the same time (depending on their marital status and the timing of each parent’s Social Security start), Jenny’s mother’s benefit might increase to equal her late husband’s benefit.
Have you enjoyed the alphabet soup?
Did you make it all the way to this point? We’re proud of you and hope this all helped make a complicated system more understandable. Of course there is more — much more — detail about each of these topics, but we wanted to give you some of the interrelationship. Now go reward yourself with — what else — a bowl of soup. Or some spaghetti.
