Criteria to recommend improvements to the HIV Infection Listings (see Box S-1 for the statement of work).

Throughout its discussions, the committee acknowledged that listings cannot be viewed in a vacuum. The committee recognized that HIV/AIDS outcomes are improved by adhering to potent antiretroviral regimens. Adherence requires timely diagnosis of HIV infection, linkage and retention in HIV care, as well as continuous access and adherence to these drugs and to expert medical care. Recognition of this connection is critical because Social Security benefits have a great impact on access to care and treatment for people living with HIV/AIDS. Qualifying for Social Security disability benefits in many states is seen as an entrée to other public programs, such as Medicare and Medicaid and housing programs. The 2010 Patient Protection and Affordable Care Act will undoubtedly affect these social programs and others, but it is too early to determine how the Social Security disability program will be affected. While the issues of adherence and access to care are critical in the discussion of Social Security disability benefits, in-depth discussion about the means by which people receive treatment and medications are outside the committee’s scope.

SOCIAL SECURITY DISABILITY EVALUATION PROCESS

SSA pays disability benefits through two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). To qualify, individuals must meet SSA’s definition of disability, which differs for adults and children,1 defined as follows:

  • Adults: “an inability to engage in any substantial gainful activity2 by reason of any medically determinable physical or mental

1

Social Security considers children to be those under the age of 18.

2

The term substantial gainful activity (SGA) is used to describe a level of work activity and earnings. Work is “substantial” if it involves doing significant physical or mental activities or a combination of both. For work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be substantial gainful activity. “Gainful” work activity is work performed for pay or profit; work of a nature generally performed for pay or profit; or work intended for profit, whether or not a profit is realized. The amount of monthly earnings considered as SGA depends on the nature of the person’s disability. The Social Security Act specifies a higher SGA amount for statutorily blind persons. If a person’s impairment is anything other than blindness, earnings averaging over $1,000 a month (for the year 2010) generally demonstrate SGA. For a statutorily blind person, earnings averaging over $1,640 a month (for the year 2010) generally demonstrate SGA for SSDI.



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