Wisconsin Disability Determination

Disability Determination Bureau site links:

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 may also be covered by Medicare under the Chronic Renal Disease program.

• 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.

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, 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 received the letter five days after the date on it, unless you can show that you received it later.

When you are sent a letter about a decision on your claim, the letter will tell you how to appeal the decision.

How long does it take to get a disability decision?

The amount of time that it takes depends on how quickly all the necessary evidence can be obtained. The average time between the date of application and the final decision is just over 100 days, but this can vary greatly depending upon how many sources the Disability Determination Bureau (DDB) needs to contact and how quickly they respond. 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. 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, you may request a Social Security Statement that displays your earnings record and provides an estimate of your disability benefit. It will also include estimates of retirement and survivors benefits which you and your family may be eligible to receive now and in the future. The request form is available by calling or visiting Social Security.

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

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. The Social Security Administration'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 county or tribal human or social services department has more information on continuing Medicaid coverage while working.

Wisconsin Department of Health and Family Services
Division of Health Care Access and Accountability
Disability Determination Bureau