When does DAC benefit amount make child ineligible for SSI and Medicaid?

For 2025, the SSI Federal Benefit Rate is $967 for an individual (with some states adding a supplement). When your brother starts receiving DAC benefits on your father's record, that's considered unearned income for SSI purposes. SSI will reduce $1 for each $1 of unearned income after the first $20 general income exclusion. So the math would be: If DAC benefit is $1200, minus $20 exclusion = $1180 countable income. Since that's more than the $967 SSI rate, he would no longer be eligible for SSI payments. Regarding Medicaid - this is important - when someone loses SSI due to receiving DAC benefits, they qualify for continued Medicaid coverage under what's called the "Pickle Amendment" or Special DAC provisions. Your brother should NOT lose Medicaid when transitioning from SSI to DAC. The local Medicaid office needs to be notified about this change, but there's specific protection for this scenario.

My daughter went through this exact situation last year when I started getting my retirement!!! Her SSI was about $900 and then she got DAC of like $1100 and SSI completely stopped. we were TERRIFIED about losing her Medicaid because she has expensive medications and treatments!!! I called SSA like 20 times and nobody could give me a straight answer. FINALLY got a rep who knew what they were talking about and told us about the special Medicaid continuation. BUT we still had to fight with the county Medicaid office because they didn't understand the rules!!! Make sure you get documentation from SSA explaining why the SSI stopped (because of DAC benefits) to show Medicaid!!!!

just checking...when u say dac that means disabled adult child right? my nephew gets that i think. he got ssi as a kid then switched when my sister claimed ss

I went through this exact transition with my son. Here's what you need to know: 1. The 2025 SSI Federal Benefit Rate is $967. SSI reduces $1 for every $1 of unearned income after a $20 exclusion. 2. If your brother receives DAC of $1200, only $1180 counts against SSI ($1200-$20). Since $1180 > $967, he would lose SSI completely. 3. The good news: Section 1634(c) of the Social Security Act protects people who lose SSI due to receiving DAC benefits. This is NOT the Pickle Amendment (that's different) but a special DAC provision. 4. There is NO 2-year waiting period for Medicare. That waiting period applies only to SSDI recipients. For DAC beneficiaries, Medicare eligibility starts 24 months after DAC entitlement begins, but Medicaid should continue during this time. 5. IMPORTANT: You MUST notify your state Medicaid office about this change. Request continued Medicaid under the Section 1634(c) protected status for DAC beneficiaries. Get a letter from SSA explaining why SSI stopped. Don't trust random SSA or Medicaid workers to know these rules - many don't. Ask to speak with a supervisor who understands the DAC Medicaid continuation provisions.

When I was trying to help my brother with a similar situation, I spent WEEKS trying to get through to someone at SSA who could actually explain how the DAC and SSI interaction works. I'd call, wait on hold for hours, and then get disconnected. Finally tried a service called Claimyr (claimyr.com) that got me connected to an SSA agent in about 20 minutes instead of the usual hours-long wait. They have a video showing how it works: https://youtu.be/Z-BRbJw3puU The agent I spoke with was able to calculate exactly how much DAC my brother would receive and confirmed he would keep Medicaid under the special provision. Definitely worth it to get accurate information directly from SSA instead of guessing.

your brother is going to lose ssi and then medicaid too probably. happened to my cousins kid. system is broken!!!! they make these rules complicated on purpose so people lose benefits they deserve.

My son has been on DAC benefits for 3 years now. One thing nobody mentioned yet is that if your brother ever receives an inheritance or other resources over the $2000 SSI limit, he could lose the special Medicaid protection. Be very careful with any family financial planning and consider a special needs trust if needed.

Have u talked to your brothers doctors about this??? Our neurologist actually wrote a letter saying my daughter NEEDED continuous medicaid coverage for her treatment plan and that helped when we had to fight with the county medicaid office!!! Bring ALL the documentation you can!!

One more thing to be aware of: the DAC benefit amount will be 50% of your father's Primary Insurance Amount (PIA) while your father is alive. If you have multiple family members drawing on your father's record, the Family Maximum Benefit rules might apply, potentially reducing the amount your brother receives. After calculating the expected DAC amount, I'd recommend contacting your state's Medicaid office BEFORE the transition occurs to discuss the DAC Medicaid continuation provision. Some offices have special coordinators who handle these complex cases. Getting ahead of the situation can prevent a gap in coverage.

This is such a complex situation, and I really appreciate everyone sharing their experiences! As someone who works with disability benefits, I want to add a few practical tips: 1. Document EVERYTHING - keep records of all calls to SSA and Medicaid, including dates, names of representatives you spoke with, and what they told you. 2. When your dad applies for retirement benefits, make sure SSA knows about your brother's disability so they can process the DAC application simultaneously. This helps avoid delays. 3. Consider reaching out to your local disability advocacy organization or legal aid - many have staff who specialize in these benefit transitions and can help navigate the Medicaid continuation process. 4. If your brother has any other sources of income (even small amounts), make sure to factor those into the SSI calculation as well. The Section 1634(c) protection for DAC beneficiaries is real and legally required, but sadly many local offices don't understand it. Having an advocate who knows the rules can make a huge difference in ensuring your brother maintains his healthcare coverage during this transition.

This thread has been incredibly helpful! I work as a benefits counselor and want to emphasize something that several people touched on but is worth repeating: the timing of notifications is crucial. When your dad files for retirement benefits, SSA should automatically identify your brother as a potential DAC beneficiary if they have his disability information on file. However, I always recommend being proactive. Contact your local SSA office about 60-90 days before your dad plans to file to discuss the DAC application process. For the Medicaid piece, each state handles this slightly differently, but the federal protection under Section 1634(c) applies everywhere. Some states call it "DAC Medicaid continuation" or "protected DAC status." When you contact your state Medicaid office, use these terms and reference Section 1634(c) of the Social Security Act. One thing I didn't see mentioned: if your brother currently receives state supplemental payments in addition to federal SSI, those would also stop when DAC benefits begin. Make sure to factor that into your calculations when determining his total income change. The Medicare piece is also important to understand - your brother will become eligible for Medicare 24 months after his DAC entitlement date (not when benefits actually start being paid). During those 24 months, the continued Medicaid coverage is what protects him. Best of luck with this transition! It sounds like you're being very thorough in your planning, which will serve your brother well.

I'm new to this community but have been following this thread because I'm in a similar situation with my adult daughter. She's been on SSI for years and my husband is planning to retire next year. One thing I wanted to add that might be helpful - when we started researching this transition, our local Independent Living Center had a benefits specialist who was incredibly knowledgeable about DAC/SSI interactions. They actually helped us run the numbers ahead of time and even offered to attend meetings with us at the Medicaid office if needed. Many people don't know these centers exist, but they often have staff who specialize in exactly these types of benefit transitions. Also, I learned that some states have what's called a "Medicaid Buy-In" program that can provide additional protection for people with disabilities who have income above certain thresholds. It might be worth asking about that as a backup option, though hopefully the Section 1634(c) protection will work as intended. The anxiety around potentially losing healthcare coverage is so real - I completely understand the stress you're feeling. But reading all these responses gives me hope that there ARE protections in place, we just need to be our own advocates to make sure they're applied correctly.

I'm a disability attorney and want to add some important procedural details that can help ensure a smooth transition: 1. **Retroactive Benefits**: When your dad files for retirement, your brother's DAC benefits will be retroactive to your dad's entitlement date. This could create a large lump sum payment that might temporarily affect other benefit calculations. 2. **Representative Payee**: If your brother currently has a representative payee for his SSI, that same person can serve as rep payee for DAC benefits, but SSA will need to update their records. 3. **State Medicaid Verification**: Each state has different procedures for verifying continued Medicaid eligibility. Some require annual redeterminations even under the Section 1634(c) protection. Mark your calendar to proactively submit any required documentation. 4. **Food Stamps/SNAP**: This transition may also affect SNAP benefits since the income calculation changes. Contact your local SNAP office to understand how DAC benefits will impact food assistance. 5. **Housing Assistance**: If your brother receives any housing vouchers or subsidized housing, notify them about the income change as well. The key is treating this as a coordinated transition across ALL benefits, not just SSI/DAC. Create a checklist of every agency that needs to be notified and tackle them systematically. Having legal representation during complex transitions like this can be invaluable if you run into resistance from any agency.

I've been helping families navigate DAC transitions for several years and wanted to add a few more practical considerations that haven't been mentioned yet: **Banking and Financial Accounts**: When your brother transitions from SSI to DAC, his resource limits change significantly. SSI has a strict $2,000 asset limit, but DAC recipients don't have resource limits. This means any money he's been keeping under $2,000 can now grow without affecting his benefits. However, as mentioned earlier, this could impact his protected Medicaid status if resources get too high. **Work Incentives**: If your brother has any capacity for part-time work now or in the future, the work incentive rules are different for DAC vs SSI. DAC has more generous work incentives, including the ability to have a trial work period and extended period of eligibility. This might open up employment opportunities that weren't feasible under SSI rules. **Direct Deposit Updates**: Make sure to coordinate the timing of when SSI stops and DAC begins for direct deposit purposes. There can sometimes be a gap of a month or two, so having some emergency funds set aside for that transition period is wise. **Annual Reporting**: Unlike SSI which requires frequent reporting of changes, DAC benefits are generally more stable. However, you'll still need to report any work activity or significant life changes to SSA. The most important thing is starting this process early and staying organized. I always tell families to create a "transition binder" with copies of all documentation, contact information for every agency, and a timeline of key dates. Good luck with your brother's transition!

I've been working in disability advocacy for over 15 years and this thread is absolutely incredible - so much accurate, detailed information! I just wanted to add one more resource that many families don't know about: the Work Incentives Planning and Assistance (WIPA) program. These are federally funded programs that provide free benefits counseling specifically for people with disabilities who are transitioning between different benefit programs. Your local WIPA provider can help model exactly how your brother's benefits will change with different DAC amounts, and they often have direct relationships with state Medicaid offices to help facilitate the Section 1634(c) continuation. They can also help with the SNAP and housing assistance notifications that were mentioned earlier. To find your local WIPA program, you can search on the Social Security Administration's "Ticket to Work" website or call 1-866-968-7842. Having a benefits counselor who specializes in these transitions can be invaluable, especially since they're typically more up-to-date on the complex rules than general SSA staff. Also, I want to emphasize what others have said about documentation - when you do speak with SSA about the DAC application, ask them to send you a written summary of what benefits your brother will receive and when they'll start. Having that documentation will be crucial when working with the Medicaid office to ensure continuous coverage. You're doing such a great job advocating for your brother! The fact that you're researching all of this ahead of time puts you way ahead of most families who don't discover these protections until after problems arise.

I'm a social worker who specializes in disability benefits and wanted to share one more crucial timing consideration that could save your family a lot of stress. When your dad files for Social Security retirement, there's often a 2-3 month processing delay before your brother's DAC benefits actually start being paid, even though he'll be entitled from your dad's benefit start date. During this gap period, your brother should continue receiving his full SSI payments since his DAC hasn't actually started yet. However, once the DAC benefits begin and SSI stops, there can be another delay before the Medicaid office processes the Section 1634(c) continuation. I've seen families go weeks or even months with Medicaid showing as "terminated" in the system while the continuation gets sorted out. During this time, pharmacies and doctors might show your brother as having no coverage. My recommendation: Contact your brother's pharmacy and key medical providers BEFORE this transition begins. Explain the situation and ask about their policies for covering prescriptions/services during benefit transitions. Many have hardship programs or will work with you if they know a Medicaid continuation is pending. Some will even accept a letter from you explaining the Section 1634(c) protection while the official Medicaid update is being processed. Also, if your brother takes expensive medications, ask his doctor about getting a 90-day supply filled right before the transition to avoid any gaps in medication access. Being proactive with healthcare providers has saved many families from dangerous interruptions in medical care during these transitions.