Social Security family maximum limits with DAC benefits - will my disabled son lose Medicaid?

Yes, DAC benefits absolutely count toward the family maximum even if your adult child lives separately. The family maximum is typically between 150%-180% of the worker's PIA, regardless of where beneficiaries live. For high earners like your husband ($3600), it's closer to 150%.You'll need to calculate the Family Maximum Benefit (FMB) using the formula on your husband's earnings. But very roughly, with his PIA of $3600, the family max might be around $5400 (150%). That would mean all auxiliary benefits (your spousal benefit if you're taking one + your son's DAC) would be proportionally reduced to fit within what's left after your husband's benefit.Very important: DAC beneficiaries CAN keep Medicaid eligibility even when switching from SSI through special protected status under Section 1634(c) of the Social Security Act. This is CRUCIAL for your decision.

Thank you for explaining this! So if I understand correctly, even if my son gets DAC instead of SSI, he could keep his Medicaid? That's a huge relief because his healthcare needs are significant.I'm still confused about the math though. I won't be taking a spousal benefit - I'll be getting retirement on my own record ($3000). Does that mean my son could get the full $1800 DAC amount (50% of my husband's $3600)? Or would he still be limited somehow by the family maximum even if I'm not taking a spousal benefit?

OMG I just went through this EXACT same thing with my daughter!!! The family max is SO confusing. Here's what I learned: If you're getting benefits on your OWN record (not as a spouse), then your benefit doesn't count toward your husband's family maximum. The family max only affects people drawing on HIS record.My daughter moved from SSI to DAC last year and it was the BEST DECISION EVER. She gets about $800 more per month now! But getting through to SSA was IMPOSSIBLE until I found this service called Claimyr (claimyr.com). They got me through to an actual human at SSA in like 20 minutes when I'd been trying for weeks. They have a video showing how it works: https://youtu.be/Z-BRbJw3puU AND YES, your son can keep Medicaid! There's a special protection called the

Thank you for sharing your experience! It's so helpful to hear from someone who's been through this. I'll definitely check out that Claimyr service - I've been dreading the phone calls to SSA. And I'm relieved to hear your daughter was able to keep her Medicaid coverage. I'll make sure to specifically ask about the Pickle Amendment protection when we apply.

Am I the only one furious about how deliberately confusing the SSA makes all this?! They hide these critical benefits behind mountains of incomprehensible jargon and expect disabled individuals and their aging parents to somehow figure it all out!? I spent YEARS not knowing my son could get DAC benefits instead of paltry SSI!Just be warned - when your son switches to DAC, they'll probably mess something up. They ALWAYS do. Document EVERYTHING. Record calls if legal in your state. They messed up my son's Medicaid continuation and it took SIX MONTHS to fix while we paid out-of-pocket for his medications. The system is BROKEN.

this happened to my brother too. ssa kept saying he would keep medicaid but then the state medicaid office said he was over income limits. total nightmare. took like 4 months to fix

EXACTLY! The left hand doesn't know what the right is doing! SSA says \

Your son definitely qualifies for DAC since he has a disability that began before 22. It's usually better than SSI. My sister gets DAC and its so much better than SSI was.

Thanks for confirming! Yes, he was diagnosed at age 3, so that requirement is definitely met.

I think everyone's missing something important here. If your son gets DAC, he'll lose SSI which means he'll also lose automatic Medicaid qualification. DAC benefits are considered Title II benefits which are different from SSI (Title XVI). In some states, this means he'll have to qualify for Medicaid through different criteria. The income might put him over the limit depending on Florida's specific rules.You need to contact your local Medicaid office specifically, not just rely on what SSA says about continued eligibility. Each state implements these protections differently.

This isn't entirely accurate. While DAC (Childhood Disability Benefits) are Title II benefits, there are specific Medicaid continuation provisions for people transitioning from SSI to DAC. It's called the

Thank you for this precise information! I'll definitely write down \

To answer your follow-up question about the math: Yes, since you're drawing on your own record ($3000), that won't affect your husband's family maximum calculation.Let's do some rough math:- Your husband receives $3600 (his full PIA)- Let's estimate the family maximum at around 150% of PIA for high earners = $5400- Available for other beneficiaries on his record: $5400-$3600 = $1800Since your son would be the only other person drawing on your husband's record, and his potential DAC benefit would be $1800 (50% of your husband's PIA), this works out perfectly within the family maximum in your situation.The DAC amount would be significantly higher than his current SSI ($943), plus he can maintain Medicaid eligibility with proper handling. This looks like a good move financially, but be prepared for administrative challenges during the transition period.

And be prepared for SSA to calculate this wrong the first time! They initially told me my son could only get $600 instead of the full 50% he was entitled to. I had to FIGHT them on this for months. Don't take their first answer as gospel!

Thanks for the warning. I'll double-check their calculations carefully and be prepared to advocate if needed.

my cousin gets SSI and medicaid but his dad never worked so he cant get DAC. ur son is lucky

I'm sorry to hear about your cousin's situation. We are fortunate that my husband worked consistently. I hope your cousin is getting all the support available to him.

One important detail: When your son switches to DAC benefits, he'll have a 5-month waiting period AND a 24-month Medicare waiting period. During these periods, it's crucial that the Medicaid continuation is properly processed.Also, the process works like this:1. Apply for DAC with SSA2. When approved, immediately contact Florida Medicaid (DCF) about 1634(c) continuation3. Provide DCF with the SSA award letter showing the transition from SSI to DAC4. Request written confirmation of Medicaid continuationThe timing is critical - this must be done during the month of the change or the following month to ensure no gap in coverage. Since your son has a roommate, also consider how increased income might affect any income-based housing subsidies if applicable.

Thank you for laying out these specific steps! I hadn't considered the waiting periods or the potential impact on housing. His current living arrangement isn't subsidized, but I'll make sure to follow these exact steps with both SSA and DCF to keep his Medicaid coverage intact.

after my mom died my disabled brother had to switch from her record to my dads record and it was a mess for like 8 months. but now hes getting more money and still has medicaid. just be ready for it to take forever and keep calling them

Thanks for the reality check. I'm starting to realize I need to be prepared for a lengthy process with possible complications. I'll definitely stay persistent with follow-up calls.

I'm dealing with a similar situation with my adult daughter who has autism. One thing I learned that might help - when you apply for DAC benefits, ask SSA to do a "protective filing" which basically holds your place in line while they process everything. This can help prevent any gaps in benefits during the transition. Also, I'd strongly recommend getting a written statement from your local Medicaid office BEFORE making the switch confirming they'll honor the Section 1634(c) continuation. Some offices are more familiar with this than others, and having it in writing ahead of time saved me a lot of headaches. The income difference really is significant - going from $943 to $1800 would be life-changing for your son's independence. Just document everything and don't let them rush you through the process. You've got this!

I went through this exact transition with my son last year, and I can confirm that the DAC benefits made a huge difference for him financially. One thing I'd add to all the great advice here is to make sure you understand how the DAC benefits will affect any state benefits your son might be receiving beyond Medicaid. In some states, things like food assistance or utility help have different income calculations for SSI vs DAC recipients. Also, when you call SSA, ask specifically about retroactive benefits. If your son has been eligible for DAC for a while but has been on SSI instead, he might be entitled to back payments for up to 12 months. This can be a substantial amount that could help with any transition costs or medical expenses. The process can be frustrating, but the outcome is usually worth it. Your son deserves the higher benefit amount, and with proper planning for the Medicaid continuation, this sounds like it will significantly improve his quality of life. Don't let the bureaucracy discourage you from pursuing what he's entitled to!

I'm going through something very similar with my 34-year-old son who has intellectual disabilities. He's been on SSI for over a decade, and I just found out about DAC benefits when my husband started collecting his retirement last month. One thing that really helped me was contacting our local disability advocacy organization - they had a benefits specialist who walked me through the entire process for free. They knew all the ins and outs of the Medicaid continuation rules and even helped me prepare the paperwork ahead of time. Also, when you do make the switch, keep paying close attention to his first few benefit statements. My friend's daughter had her DAC amount calculated incorrectly initially (they used an old PIA instead of the current one), and it took three months to get it corrected. The retroactive payment was significant once they fixed it though. The peace of mind knowing your son will have better financial security is worth navigating all this bureaucracy. I'm still in the middle of our transition, but already the difference in monthly income is going to be huge for his independence. Hang in there - you're doing the right thing by researching this thoroughly before making the change!

I'm a former SSA disability examiner and want to add a few technical points that might help with your decision. The family maximum formula is actually more complex than the rough 150% estimate - it uses bend points similar to PIA calculations. For someone with your husband's benefit amount, the actual family maximum could be closer to $6,300, which would give your son even more room for the full DAC amount. Regarding the Medicaid transition, make sure to ask SSA about filing a "Disabled Adult Child" application specifically, not just a general disability application. This distinction matters for processing and ensures the correct benefit type from the start. One critical timing issue: If your son's birthday falls in certain months, there might be strategic advantages to when you file. DAC benefits can be retroactive up to 12 months, but SSI stops the month before DAC begins. Planning the timing carefully can minimize any benefit gaps. Florida does honor the Section 1634(c) Medicaid continuation, but I'd recommend calling the Florida Department of Children and Families Medicaid office at 1-866-762-2237 ahead of time to confirm the specific documentation they'll need. Having everything ready prevents delays in coverage continuation. The income increase from $943 to potentially $1,800 monthly is substantial and could significantly improve your son's quality of life while maintaining his healthcare coverage. Just be prepared for the administrative marathon ahead!

I'm a disability benefits consultant and want to emphasize something crucial that hasn't been fully addressed - the potential impact on your son's other benefits and programs. When transitioning from SSI to DAC, it's not just Medicaid you need to worry about. If your son receives SNAP (food stamps), housing assistance, or participates in any state waiver programs, the income increase could affect his eligibility. DAC benefits are counted differently than SSI for many means-tested programs. Some states have "spend-down" provisions that can help, but you'll need to check each program individually. Also, consider opening an ABLE account before making the switch if your son doesn't already have one. The higher DAC income will give him more ability to save money without affecting benefit eligibility, and ABLE accounts can hold up to $100,000 without impacting most benefits. One more thing - document your son's current living situation thoroughly before applying. SSA sometimes questions whether adult children are truly "disabled" if they're living semi-independently, even though this shouldn't affect DAC eligibility. Having clear documentation of his disability and support needs can prevent unnecessary delays. The financial improvement will be significant, but planning for all these ancillary effects will make the transition much smoother. Good luck!

I'm a social worker who specializes in disability benefits, and I want to add some practical steps that might help streamline this process for you. First, request a Benefits Planning Query (BPQY) from SSA before making any changes. This report will show exactly what your son's DAC benefit would be and help you verify the family maximum calculations that others have mentioned. Second, contact your son's current doctors and request letters documenting his ongoing disability and need for medical care. Even though he qualified for SSI based on childhood disability, SSA sometimes requests updated medical evidence for DAC applications, especially if there's been a gap in their records. Third, consider timing the application strategically around his SSI payment date. If his SSI normally comes on the 1st of the month, applying right after he receives a payment can help minimize any potential gap between stopping SSI and starting DAC. The income jump from $943 to $1,800 could be truly life-changing for his independence, and with proper planning for the Medicaid continuation, this sounds like an excellent move. Just remember that persistence is key with SSA - don't get discouraged if the first representative you speak with isn't fully familiar with DAC benefits or the Medicaid protections. Ask to speak with a supervisor if needed. You're being a great advocate for your son by researching this thoroughly!

I'm a benefits coordinator who has helped hundreds of families navigate the SSI to DAC transition, and I wanted to share some additional insights that might be helpful for your situation. One thing I always tell families is to create a "transition binder" with copies of everything - your son's original disability determination, current medical records, proof of his living situation, and most importantly, documentation of when his disability began (before age 22). Having this organized upfront can speed up the process significantly. Also, while everyone's mentioned the Section 1634(c) Medicaid protection, I want to emphasize that in Florida specifically, you'll want to contact your local AHCA (Agency for Health Care Administration) office in addition to DCF. Sometimes there's confusion between these agencies about who handles what, and having both on the same page prevents coverage gaps. One practical tip: when your son's DAC benefits start, his new Medicare card will have a different number than any previous one. Make sure all his healthcare providers get updated information to prevent billing issues. The increased income will also affect his Medicare Part B premiums eventually (though probably not significantly at $1,800/month), but it's worth being aware of. The math definitely works in your son's favor here - going from $943 to potentially $1,800 monthly is transformative. With proper planning, he should be able to maintain all his healthcare coverage while gaining significant financial independence. You're absolutely making the right choice to pursue this!

I work as a disability advocate and wanted to add one more crucial piece of advice that could save you significant time and frustration. Before you start the DAC application process, I highly recommend getting a written statement from SSA confirming your son's exact disability onset date in their system. Sometimes there are discrepancies between what families remember and what's actually in SSA's records, and if they have his disability onset listed as after age 22 (even incorrectly), it can delay or complicate the DAC application. Getting this verified upfront and corrected if necessary can prevent major headaches later. Also, when you do apply, ask specifically about "expedited processing" for DAC applications. While not always available, SSA sometimes has procedures to fast-track these applications when someone is transitioning from SSI, especially if there are clear financial hardships that could result from benefit gaps. The income increase your son could see is substantial - from $943 to $1,800 is life-changing money that could significantly improve his independence and quality of life. With all the excellent advice you've received here about Medicaid continuation and proper documentation, you're well-prepared to advocate effectively for your son. Don't let the bureaucratic complexity discourage you from pursuing benefits he's rightfully entitled to!

I've been working in disability law for over 15 years and want to emphasize something that could be crucial for your son's case. When you apply for DAC benefits, make sure to specifically request that SSA conduct what's called a "Title II disability determination" rather than relying solely on his existing SSI disability finding. While both programs use similar criteria, Title II sometimes has slightly different medical review processes, and having a fresh determination on his record can actually strengthen his case for ongoing benefits. Also, I'd strongly recommend documenting not just his current medical needs, but also his work history (or lack thereof) and any vocational rehabilitation attempts. This creates a complete picture of why he requires DAC benefits and can be helpful if there are ever any future reviews of his disability status. One practical tip: when the DAC benefits begin, your son will eventually become eligible for Medicare after the 24-month waiting period. Start planning now for how to coordinate Medicare with his continued Medicaid coverage - this is called "dual eligibility" and can actually provide better overall healthcare coverage than Medicaid alone. The financial improvement from $943 to $1800 monthly is significant, but the long-term security of having Title II benefits rather than means-tested SSI could be even more valuable for your son's future independence. You're making an excellent decision for him!

I'm a retired SSA field office manager and want to address a few operational details that could help your transition go more smoothly. First, when you call SSA, ask to speak with a "Technical Expert" or "Claims Specialist" rather than a general service representative - they're much more knowledgeable about DAC benefit calculations and family maximum rules. Also, be aware that SSA's computer systems sometimes automatically deny DAC applications if there's an active SSI case, even when the person is clearly eligible. If this happens, don't panic - it's a system glitch that can be corrected, but you'll need to be persistent about getting it reviewed by someone who understands the override procedures. One thing that might help: when you apply, bring a copy of your husband's Social Security statement showing his exact PIA amount. This helps the claims rep calculate the correct DAC benefit amount (50% of his PIA) and family maximum from the start, reducing the chance of errors. The transition from $943 SSI to approximately $1800 DAC is definitely worth pursuing, especially since your son can maintain Medicaid through the Section 1634(c) protections everyone has mentioned. Just be prepared for potentially 3-6 months of back-and-forth with various offices to get everything coordinated properly. The end result will be much better financial security for your son!