Supplemental Security Income for People with Disabilities: Implications for Medicaid

Issue Brief
  1. Social Security Administration (SSA), Annual Report of the Supplemental Security Income Program at 6 (May 29, 2020), https://www.ssa.gov/oact/ssir/SSI20/ssi2020.pdf; 20 C.F.R. § 416.110.

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  2. See generally 42 U.S.C. § § 1381-1383f; 20 C.F.R. Part 416.

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  3. Cf. 42 U.S.C. § § 401-434; 20 C.F.R. Part 404.

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  4. 42 U.S.C. § 1396a (a)(10)(A)(i)(II); but see 42 U.S.C. § 1396a (f). For more information, see KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey (June 2019), https://www.kff.org/medicaid/issue-brief/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey/.

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  5. 42 U.S.C. § 426 (b).

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  6. SSA, SSI Federal Payment Amounts for 2021 (last accessed 4/22/21), https://www.ssa.gov/oact/cola/SSI.html. Prior to 1975, SSI benefit amounts were set by statute. Since 1975, the maximum SSI benefit has been subject to an annual cost-of-living adjustment (COLA) based on the increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of the prior year to the third quarter of the current year. SSA, Cost-of-Living Adjustments (last accessed 4/20/21), https://www.ssa.gov/oact/cola/colaseries.html; see also 20 C.F.R. § 416.205. The most recent COLA, effective for benefits payable beginning in January 2021, was 1.3 percent. SSA, Latest Cost-of-Living Adjustment (last accessed 4/20/21), https://www.ssa.gov/oact/cola/latestCOLA.html.

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  7. SSA, SSI Federal Payment Amounts for 2021 (last accessed 4/22/21), https://www.ssa.gov/oact/cola/SSI.html.

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  8. SSA, Monthly Statistics, April 2021, Table 1 (released May 2021), https://www.ssa.gov/policy/docs/statcomps/ssi_monthly/2021-04/table01.htmlsee generally 20 C.F.R. Part 416, Subpart K.

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  9. SSA, Understanding Supplemental Security Income SSI Benefits – 2021 Edition (last accessed 4/22/21), https://www.ssa.gov/ssi/text-benefits-ussi.htm.

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  10. 20 C.F.R. § 416.110.

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  11. 42 U.S.C. § § 1382 (b); 1382f.

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  12. The other two types of Social Security benefits are retirement insurance and survivors benefits. Eligibility for Social Security retirement benefits is triggered when a person with a qualifying work history reaches retirement age. Social Security survivors benefits are paid to a worker’s spouse, dependent child(ren), and/or dependent parent(s) after a person with a qualifying work history dies. 42 U.S.C. § 402.

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  13. 42 U.S.C. § 423.

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  14. 20 C.F.R. § 416.925; 20 C.F.R. Part 404, Subpart P, Appendix 1, Part A.

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  15. 42 U.S.C. § 402 (d)(1)(G). For other examples of people who may qualify based on a relative’s work history, see SSA, Types of Beneficiaries (last accessed June 23, 2021) https://www.ssa.gov/oact/progdata/types.html.

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  16. 42 U.S.C. § 423 (a)(2).

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  17. 20 C.F.R. § 416.1102.

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  18. 20 C.F.R. § § 416.1112, 416.1124.

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  19. 20 C.F.R. § § 416.1130-416.1145.

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  20. 20 C.F.R. § § 416.1160-416.1169.

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  21. 20 C.F.R. § 416.420.

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  22. 20 C.F.R. § 416.1205 (c).

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  23. 20 C.F.R. § 416.1202.

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  24. 20 C.F.R. § 416.1210.

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  25. Noncitizens may be eligible for SSI only in very limited circumstances. See, e.g., SSA, Supplemental Security Income for Non-Citizens (last accessed June 23, 2021), https://www.ssa.gov/pubs/EN-05-11051.pdf.

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  26. 20 C.F.R. § § 416.905, 416.920.

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  27. 20 C.F.R. § 416.920 (a)(4)(ii).

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  28. 20 C.F.R. § § 416.906; 416.924.

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  29. The number of nonelderly adult SSI enrollees in Figure 5 differs from Figure 1 due to differences in the two data sources. For example, Figure 5 subsets the number of nonelderly adults who report a disability and receive SSI, and the functional disability questions may not identify all SSI enrollees, such as people with mental health disabilities.

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  30. The ACS questions used to classify an individual as having a disability include: (1) Is this person deaf, or does he/she have serious difficulty hearing? (2) Is this person blind, or does he/she have serious difficulty seeing, even when wearing glasses? (3) Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions? (4) Does this person have serious difficulty walking or climbing stairs? (5) Does this person have difficulty dressing or bathing? (6) Because of a physical, mental, or emotional condition, does this person have difficulty doing errands alone, such as visiting a doctor’s office or shopping? The ACS definition of disability is intended to capture whether a person has a functional limitation that results in a participation limitation. U.S. Census Bureau, American Community Survey, Why We Ask Questions About… Disability, (last accessed April 21, 2021), https://www.census.gov/acs/www/about/why-we-ask-each-question/disability/.

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  31. KFF, People with Disabilities Are At Risk of Losing Medicaid Coverage Without the ACA Expansion (Nov. 2020), https://www.kff.org/medicaid/issue-brief/people-with-disabilities-are-at-risk-of-losing-medicaid-coverage-without-the-aca-expansion/.

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  32. SSA, SSI Annual Statistical Report 2019, Outcomes of Applications for Disability Benefits at Table 69 (Aug. 2020), https://www.ssa.gov/policy/docs/statcomps/ssi_asr/2019/sect10.html.

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  33. Id. at Table 70.

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  34. Id. at Table 71.

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  35. Id. at Table 72.

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  36. SSA, Hearings and Appeals, Average Wait Time Until Hearing Held Report (For the Month of March 2021), (last accessed 4/22/21), https://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html.

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  37. 20 C.F.R. § 416.990 (b).

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  38. 20 C.F.R. § 416.987.

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  39. See, e.g., H. Stephen Kaye, “The impact of the 2007-09 recession on workers with disabilities,” Monthly Labor Review, 19-30 (Oct. 2010), https://www.bls.gov/opub/mlr/2010/10/art2full.pdf (finding a nearly 10 percent decline in the presence of workers with disabilities in the employed labor force during the Great Recession, from October 2008 through June 2010, more than twice the proportional decline for workers without disabilities during this period); Onur Altindag, Lucie Schmidt, and Purvi Sevak, The Great Recession, Older Workers with Disabilities, and Implications for Retirement Security, Univ. of Mich. Retirement Research Center Working Paper No. 2012-277 (Nov. 2012), https://deepblue.lib.umich.edu/bitstream/handle/2027.42/95904/wp277.pdf?sequence=1&isAllowed=y (finding a 30 percent greater increase in involuntary job loss during the Great Recession for workers age 50 and older with an underlying risk of disability compared to the general population).

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  40. Austin Nichols, Lucie Schmidt, and Purvi Sevak, “Economic Conditions and Supplemental Security Income Application,” 77 Social Security Bulletin (2017), https://www.ssa.gov/policy/docs/ssb/v77n4/v77n4p27.html. Additionally, from 2007 to 2010, the 17 percent increase in SSI expenditures 2010 has been described as “modest,” with spending for other means-tested programs experiencing greater increases during that period. Robert A. Moffitt, The Social Safety Net and the Great Recession, The Russell Sage Foundation and The Stanford Center on Poverty and Inequality (Oct. 2012), https://web.stanford.edu/group/recessiontrends-dev/cgi-bin/web/sites/all/themes/barron/pdf/SocialSafety_fact_sheet.pdf.

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  41. Austin Nichols, Lucie Schmidt, and Purvi Sevak, “Economic Conditions and Supplemental Security Income Application,” 77 Social Security Bulletin (2017), https://www.ssa.gov/policy/docs/ssb/v77n4/v77n4p27.html

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  42. Id.

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  43. This finding is despite that people who lose their job during a period of high unemployment generally are less likely to apply for SSI compared to those who lose their job during a period of low unemployment. Id. Another study found that an increase in the state unemployment rate tends to be associated with a decrease in initial approvals of SSI applications for both adults and children, particularly for mental health disabilities. Kalman Rupp, “Factors Affecting Initial Disability Allowance Rates for the Disability Insurance and Supplemental Security Income Programs: The Role of the Demographic and Diagnostic Composition of Applicants and Local Labor Market Conditions,” 72 Social Security Bulletin (2012), https://www.ssa.gov/policy/docs/ssb/v72n4/v72n4p11.html.

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  44. SSA, FY 2022 Congressional Justification at p. 13-14 (May 28, 2021), https://www.ssa.gov/budget/FY22Files/2022BO.pdf.

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  45. Id.

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  46. Id. at 13.

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  47. SSA, Committee on Finance, United States Senate, Statement for the Record, Grace Kim, Deputy Commissioner for Operations at 6-7 (April 29, 2021), https://www.finance.senate.gov/imo/media/doc/SSA%20Testimony%20Service%20Delivery
    %20COVID%20FINAL%20to%20SFC.pdf
    .

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  48. Id. at 8.

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  49. Id. at 4, 8.

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  50. Id. at 8-9.

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  51. Id. at 9.

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  52. SSA, FY 2022 Congressional Justification at p. 13 (May 28, 2021), https://www.ssa.gov/budget/FY22Files/2022BO.pdf.

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  53. KFF analysis of Census Bureau Household Pulse Survey, March 17 to March 29, 2021.

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  54. Id.

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  55. Id.

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  56. SSA, Monthly Statistics, April 2021 at Table 2 (released May 2021), https://www.ssa.gov/policy/docs/statcomps/ssi_monthly/index.html.

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  57. SSA, Committee on Finance, United States Senate, Statement for the Record, Grace Kim, Deputy Commissioner for Operations at 4-5 (April 29, 2021), https://www.finance.senate.gov/imo/media/doc/SSA%20Testimony%20Service%20Delivery
    %20COVID%20FINAL%20to%20SFC.pdf
    .

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  58. Id. at 5.

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  59. SSA, Monthly Statistics, April 2021 at Table 2 (released May 2021), https://www.ssa.gov/policy/docs/statcomps/ssi_monthly/index.html.

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  60. KFF, Analysis of Recent National Trends in Medicaid and CHIP Enrollment (April 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/.

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  61. Id.

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  62. Id.

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  63. Id.; see also KFF, Medicaid Maintenance of Eligibility Requirements:  Issues to Watch (Dec. 2020), https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/.

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  64. Executive Office, of the President, Office of Management and Budget, Office of Information and Regulatory Affairs, OIRA Conclusion of EO 12866 Regulatory Review, Rules Regarding the Frequency and Notice of Continuing Disability Reviews, Withdrawn (Jan. 22, 2021), https://www.reginfo.gov/public/do/eoDetails?rrid=131391; 84 Fed. Reg. 63588-63601 (Nov. 19, 2019), https://www.federalregister.gov/documents/2019/11/18/2019-24700/rules-regarding-the-frequency-and-notice-of-continuing-disability-reviews.

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  65. See, e.g., KFF, Medicaid and CHIP Eligibility, Enrollment and Cost sharing Policies as of January 2019:  Findings from a 50-State Survey (March 2019), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey//

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  66. 42 C.F.R. § 435.916 (f).

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  67. The Biden Plan for Full Participation and Equality for People with Disabilities, (last accessed 4/22/21), https://joebiden.com/disabilities/. This document refers to 1984 as the last time that SSI asset limits were increased. The increase adopted in 1984 raised asset limits incrementally over several years, with the last increment taking effect in 1989. 20 C.F.R. § 416.1205 (c).

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  68. Letter to Hon. Joseph R. Biden and Hon. Kamala Harris (April 16, 2021), https://www.brown.senate.gov/imo/media/doc/ssi_letter_41921.pdf.

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  69. KFF, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (March 2020) (see studies cited at endnotes 862-876), https://www.kff.org/report-section/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-report/.

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  70. KFF, People with Disabilities Are At Risk of Losing Medicaid Coverage Without the ACA Expansion (Nov. 2020), https://www.kff.org/medicaid/issue-brief/people-with-disabilities-are-at-risk-of-losing-medicaid-coverage-without-the-aca-expansion/.

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  71. KFF, Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021:  Findings from a 50-State Survey (March 2021), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-and-enrollment-policies-as-of-january-2021-findings-from-a-50-state-survey/.

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  72. KFF, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey (June 2019), https://www.kff.org/medicaid/issue-brief/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey/.

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  73. 20 C.F.R. § § 416.260, 416.264, 416.265, 416.268, 416.269.

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Appendix
  1. 20 C.F.R. § § 416.905, 416.920.

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  2. 20 C.F.R. § § 416.920 (a)(4)(i); 416.972.

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  3. SSA, Substantial Gainful Activity (last accessed 4/22/21), https://www.ssa.gov/oact/cola/sga.html.

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  4. 20 C.F.R. § 416.920 (b).

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  5. 20 C.F.R. § 416.920 (a)(4)(ii).

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  6. 20 C.F.R. § 416.909.

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  7. 20 C.F.R. § 416.920 (a)(4)(iii).

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  8. 20 C.F.R. § 416.925; 20 C.F.R. Part 404, Subpart P, Appendix 1, Part A.

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  9. 20 C.F.R. § 416.925 (d).

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  10. 20 C.F.R. § 416.926.

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  11. 20 C.F.R. § § 416.214; 416.935.

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  12. 20 C.F.R. § 416.935 (b)(1).

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  13. 20 C.F.R. § 416.920 (a)(4)(iii), (d).

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  14. 20 C.F.R. § § 416.920 (a)(4)(iv); 416.945.

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  15. 20 C.F.R. § 416.960 (b).

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  16. 20 C.F.R. § 416.920 (a)(4)(iv).

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  17. 20 C.F.R. § § 416.920 (a)(4)(v), (g); 416.960 (c).

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  18. 20 C.F.R. § 416.966 (a).

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  19. 20 C.F.R. § 416.920 (a)(4)(v).

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  20. 20 C.F.R. § § 416.906; 416.924.

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  21. 20 C.F.R. § 416.924 (b), (c).

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  22. 20 C.F.R. § § 416.924 (d); 416.925 (b)(2)(i); 20 C.F.R. Part 404, Subpart P, Appendix 1, Part B.

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  23. 20 C.F.R. § 416.924 (d).

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  24. 20 C.F.R. § 416.926a.

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  25. 20 C.F.R. § 416.926a (b), (d), (e).

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  26. 20 C.F.R. § 416.926a (b), (g)-(l).

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  27. 20 C.F.R. § § 416.1003; 416.1010-416.1013; 416.1015.

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  28. 20 C.F.R. § § 416.1407; 416.1413; 416.1413a.

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  29. 20 C.F.R. § 416.1429.

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  30. 20 C.F.R. § § 416.1467; 416.1476.

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  31. 20 C.F.R. § 416.1481.

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  32. SSA, Hearings and Appeals, Average Wait Time Until Hearing Held Report (For the Month of March 2021), (last accessed 4/22/21), https://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html.

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  33. 20 C.F.R. § 416.990 (d).

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  34. Id.

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  35. Id.

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