Disability Determination Bureau: Disability Determination Process FAQs

Under the Social Security Disability Insurance (SSDI) program, you may qualify for cash benefits on the basis of disability if any of the following applies:

• You are under age 65, have worked long enough to be covered under Social Security, and had to stop working due to a disability.
• You had a disability since before age 22, and you are a dependent of either a:

a. Deceased parent.
b. Parent with a disability.
c. A retired parent who worked long enough to be covered under Social Security.

• You are a widow or widower age 50-60 with a disability, if your deceased spouse worked long enough to be covered under Social Security.

Under Supplemental Security Income (SSI) program, you may qualify for payments on the basis of disability if you are in financial need, and either of the following applies:

• The person is age 18 or over with a disability.
• The person is under age 18 with a disability.

The Social Security Act defines disability as:

• For adults, 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, 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.

You may qualify for one of these programs if you meet the federal definition of disability, as described above. You must also meet the following requirements:

• Medicare—If you qualify for Social Security Disability Insurance benefits, you can apply for Medicare coverage once you receive 24 months of cash benefits. Those with a chronic kidney disease or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, may not have to wait 24 months. Learn more about Medicare benefits at the Social Security website.
• Medicaid and Medicaid Purchase Plan (MAPP)—If you meet the disability rules, you may be eligible depending on your individual or family income, as well as other financial considerations. Those who receive Supplemental Security Income disability payments also qualify for Medicaid. Learn more about these benefits at the ForwardHealth webpage.

We will look at your claim and the supporting materials. If you meet the disability determination criteria, your claim will be allowed.

You may appeal a decision. An appeal is a chance to say why you think a wrong decision was made.

• For a Social Security decision—You must ask for an appeal in writing within 60 days from the date you received the denial notice. The letter will explain how and where to file the appeal.
• For Medicaid or Medicaid Purchase Plan—You must file your appeal within 45 days of the date on the denial notice. The letter will explain how to file the appeal. Late requests cannot be honored.

It depends on our workload and how quickly we get the needed information. You can help by:

• Supplying requested information as quickly as possible.
• Reporting any changes—such as a change in address or a change in the treatment of your condition—as quickly as possible.

• Social Security Disability Insurance—The amount of your monthly disability benefit is based on your lifetime average earnings covered by Social Security. To estimate your disability benefit, visit the Social Security website to view your Social Security statement or use the benefit calculator.
• Supplemental Security Income—The amount of your monthly benefit varies depending on your living arrangement and other factors, such as receiving other benefits from Social Security. You will find out your benefit amount once you are found eligible.

Yes. In many cases, people with disabilities work. Social Security provides work incentives, such as cash benefits, help covering extra work expenses related to your disability, Medicare, Medicaid, and training or education. For more information, view Working While Disabled: How We Can Help (PDF).

Yes. Many people with disabilities work and continue to receive coverage.

• Continuing Medicare coverage—To learn more and find contact information, view Working While Disabled: How We Can Help (PDF).
• Continuing Medicaid coverage—To learn more, contact your local or tribal agency.