CBHCM Benefits and Entitlements Navigation — Questions and Answers
Question 1: The primary difference between SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance) is:
- SSI is for veterans only; SSDI is for the general population
- SSI is need-based and does not require work history; SSDI is based on work credits earned (Correct answer)
- SSI provides Medicare coverage; SSDI provides Medicaid coverage
- SSDI is only available to individuals under age 50
Correct answer: SSI is need-based and does not require work history; SSDI is based on work credits earned
SSI is a needs-based program funded by general tax revenues, available to low-income individuals regardless of work history. SSDI is an insurance program based on Social Security work credits. SSI recipients typically receive Medicaid; SSDI recipients receive Medicare after a 24-month waiting period.
Question 2: A client receiving SSI wants to return to work but worries about losing her benefits. Which SSI work incentive allows her to set aside income or resources for an approved vocational goal without those amounts counting against her SSI eligibility?
- Trial Work Period (TWP)
- Plan to Achieve Self-Support (PASS) (Correct answer)
- Extended Period of Eligibility (EPE)
- Substantial Gainful Activity (SGA) threshold increase
Correct answer: Plan to Achieve Self-Support (PASS)
The Plan to Achieve Self-Support (PASS) allows SSI recipients to set aside money or other resources for an approved goal — such as education, vocational training, or starting a business — without those funds counting as SSI income or resources. The Trial Work Period applies to SSDI, not SSI.
Question 3: When a client's SSI/SSDI application is denied, the case manager should advise the client to take which action FIRST?
- Accept the denial and apply for state-funded general assistance instead
- File a Request for Reconsideration within 60 days of receiving the denial notice (Correct answer)
- Wait 12 months and submit a new application with additional documentation
- Contact their state representative to request a waiver of the disability determination
Correct answer: File a Request for Reconsideration within 60 days of receiving the denial notice
The Social Security appeals process begins with a Request for Reconsideration, which must be filed within 60 days (plus a 5-day mailing grace period) of the denial notice. Missing this deadline typically requires restarting the entire application process.
Question 4: Which federal health insurance program automatically covers most individuals approved for SSI benefits?
- Medicare Part A
- CHIP (Children's Health Insurance Program)
- Medicaid (Correct answer)
- Medicare Part B
Correct answer: Medicaid
SSI recipients are typically automatically enrolled in Medicaid (administered by states), which provides comprehensive health coverage. SSDI recipients, by contrast, must wait 24 months after benefit approval before becoming eligible for Medicare.
Question 5: A client is at risk of losing Medicaid coverage due to a recent change in household income. The case manager's FIRST action should be to:
- Refer the client to a hospital social worker for emergency coverage
- Review the client's income and explore alternative Medicaid eligibility pathways or other coverage options before coverage lapses (Correct answer)
- Advise the client to delay reporting the income change to the Medicaid agency
- Discontinue non-essential services to reduce the client's financial burden
Correct answer: Review the client's income and explore alternative Medicaid eligibility pathways or other coverage options before coverage lapses
The case manager's first step is to assess the full picture — reviewing income, understanding applicable Medicaid categories (disability-based Medicaid, ACA expansion, etc.), and identifying whether the client may still qualify through another pathway before coverage is lost.
Question 6: A client with schizophrenia in a Medicaid expansion state has no work history and has never applied for disability benefits. The FASTEST coverage pathway the case manager should explore first is:
- Medicare based on his disability diagnosis
- SSDI based on his psychiatric history
- ACA Medicaid expansion based on income (Correct answer)
- VA benefits based on potential military service
Correct answer: ACA Medicaid expansion based on income
In Medicaid expansion states, adults with incomes up to 138% of the federal poverty level qualify for Medicaid regardless of disability status or work history. This is usually the fastest pathway. SSDI requires work credits this client does not have; Medicare requires either age 65+ or SSDI approval after a 24-month wait.
CBHCM Benefits and Entitlements Navigation
The primary difference between SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance) is: