Department of Health Services Logo

 

Wisconsin Department of Health Services

Home

Applying For Benefits

How a Determination is Made

Frequently Asked Questions

Medical Consultant Opportunities

Other Resources

Contacts

Wisconsin Disability Determination Bureau

Frequently Asked Questions

Who can get disability benefits under Social Security or Supplemental Security Income?

Under the Social Security Disability Insurance Program (SSDI/Title II), there are three basic categories of individuals who can qualify for cash benefits on the basis of disability:

  1. A person under age 65 who worked long enough to be covered under Social Security and then had to stop working due to a disability.
  2. A person who has had a disability since childhood (before age 22) and is a dependent of a deceased parent, a parent with a disability, or a retired parent who worked long enough to be covered under Social Security.
  3. A widow or widower age 50-60 with a disability, if the deceased spouse worked long enough to be covered under Social Security.

Under the Supplemental Security Income program (SSI/Title XVI), there are two basic categories under which a financially needy person may get payments on the basis of disability:

  1. An adult age 18 or over who is disabled.
  2. A child (under age 18) who is disabled.

For adults, the Social Security Act defines disability as the presence of a physical and/or mental condition that is severe enough to prevent any substantial work activity and is expected to last 12 months or result in death. For children, disability is defined as a physical and/or mental condition that causes severe limitations in the ability to function like other children of the same age and is expected to last 12 months or result in death.

Can a person who is found to meet the definition of disability qualify for Medicare, Medicaid, Medicaid Purchase Plan, or Katie Beckett?

If an adult or child meets the federal definition of disability, as described above, as well as any other eligibility requirements, he or she may qualify for program benefits. 

  • Medicare. A person who is entitled to SSDI/Title II disability benefits can apply for Medicare coverage once 24 months of cash benefits have been received. Persons with chronic kidney disease or ALS (Lou Gehrig’s Disease) may be exempted from the 24 month waiting period. To learn more about Medicare benefits visit Social Security’s website.
  • Medicaid/Medicaid Purchase Plan/Katie Beckett. In addition to meeting the disability rules, an individual or family's income and other financial resources are factors considered in determining if someone is eligible. Individuals who receive SSI disability payments also qualify for Medicaid. To learn more about these benefits visit the ForwardHealth website.

Is it true that everyone's claim is denied the first time they apply?

No. All claims are fully considered, and if the evidence shows that you meet the disability determination criteria, your claim will be allowed.

What if my claim is denied?

If you wish to appeal your Social Security decision, you must make your request in writing within 60 days from the date that you receive the letter notifying you of the decision. It is assumed you receive the letter five days after the date on it, unless you can show that you received it later. The letter will explain how and where to file the appeal.

If you wish to appeal your Medicaid, Medicaid Purchase Plan or Katie Becket decision, you must file your appeal within 45 days of the date on the letter notifying you of the decision. The letter will explain how to file the appeal. Late requests for appeal cannot be honored.

How long does it take to get a disability decision?

The amount of time that it takes depends on current workloads and how quickly all the necessary evidence can be obtained. You can help by supplying information as quickly as possible whenever DDB asks for it. It will also help if you tell DDB right away about things like a change in your address or a change in the treatment for your condition.

How much will I get from Social Security?

Social Security Disability Insurance (SSDI). The amount of your monthly disability benefit is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, visit the Social Security website to view your Social Security Statement online or use the Benefit Calculator.

Supplemental Security Income (SSI). The amount of monthly SSI benefits varies depending on your living arrangement and other factors, such as receiving other benefits from Social Security. You will be advised by your Social Security office of your benefit amount at the time that you are determined to be eligible.

Can I work and still get disability benefits?

Yes. In many cases, persons with disabilities do work. The Social Security Administration (SSA) provides work incentives, such as cash benefits, help in covering extra work expenses related to your disability, Medicare, Medicaid, and training or education. SSA's publication "Working While Disabled — How We Can Help," provides additional information.

Can I work and still get Medicare or Medicaid coverage?

Many people with disabilities work and continue to receive healthcare coverage. Your Social Security office will be able to provide more information on continuing Medicare coverage while working. Your local agency has more information on continuing Medicaid coverage while working.

 

Last Revised: April 22, 2013