Transcript Overview of Social Security Disability Insurance (SSDI)

Overview of the Social Security
Disability Insurance (SSDI) program
Hosted/Facilitated by: Miranda Kennedy with the NDI Technical Assistance Team
Presented by: Kevin Nickerson and Mary Lynn ReVoir with the NDI Technical
Assistance Team
U.S. Department of Labor
2013 Ticket/EN Series
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Disability Employment Initiative
(DEI)
• DEI Projects at the state level and/or local level participating
LWIBs are required to become Employment Networks under
Social Security Administration’s Ticket to Work Program.
• Training and Technical Assistance to DEI Projects in attaining
Employment Network status and implementing effective EN
operations is provided under U.S. DOLETA contract with NDI
Consulting, Inc. and the National Disability Institute (NDI).
• Evaluation of the impact of the DEI Projects implementation
and outcomes as Employment Network will be provided under
U.S. DOL ODEP contract with Social Dynamics.
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Learning Objectives
Upon completion of this training webinar, DEI grantees
and participants and partners from the public
workforce system will have the following:
• Examine the role of the DRC & Benefits Planning services
• Understand the basics of the Social Security Disability
Insurance (SSDI) program
• Basic knowledge of key Work Incentives specific to the SSDI
program
• Understand the value of Work Incentives, and how they can
apply to the work of an EN
• Next Steps
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Ticket/EN Subject Matter Expert
Mary Lynn ReVoir
P: (515) 975-2344
E: [email protected]
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Agenda
• The role of the DRC & Benefits Planning
• Overview of SSA disability programs, and
eligibility requirements
• Review of Work Incentives associated with
the SSDI program
• Options for returning to disability benefits, if
needed
• Time for Q & A
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Understanding the Role of the
DRC and Coordinating Benefits
Planning Services
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Why Benefits Planning is Important
to the Success of any EN
• SSA disability benefits & Work Incentives are complex, and
are often misunderstood by beneficiaries
• In order to help Ticket holders move forward in achieving
gainful employment once again, having someone that can
help navigate the complex world of SSA disability benefits is
critical
• When used wisely, Work Incentives can be a powerful tool in
assisting Ticket holders in the return to work
• Every EN should have basic knowledge of how SSA disability
benefits work, if these systems confuse us as professionals,
its easy to imagine why Ticket holders are hesitant to try
working again
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Resource Model – DRC with expertise in TtW ONLY &
Partnering with Benefits Planner

DRCs have expertise in TtW program, but rely on
other avenues to assist SSA beneficiaries in accessing
benefits planning services, and information about
Work Incentives

DRCs maximize existing remote opportunities to
provide information to Ticket holders through Work
Incentive Seminar Events (WISE), with assistance
from the Beneficiary Access and Support Services
(BASS) contractor

For more information about WISE webinars, see:
https://www.chooseworkttw.net/wise/jsp/wise.jsp
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Resource Model – DRC with expertise in TtW ONLY &
Partnering with Benefits Planner

Due to the flexible nature of TtW funds, it is possible to
use these funds to purchase needed items, or, in this
case, benefits planning services

Example: Develop contract with a private certified
benefits planner, whereby payment is provided if
and when the Ticket holder returns to work at a
level which would qualify the EN for payment

The payment to the private provider could be a
percentage of EN payment(s), or a set amount
provided after the first payment is achieved by the
EN, or fee for service
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Expert Model – DRC with expertise in BOTH TtW &
Benefits Planning

DRC has understanding of how the TtW Program operates AND
has training in SSA disability benefits (SSI/SSDI) and work
incentives

Example: NY, Maine, and NJ have DRC’s that are trained in
understanding SSA disability benefits

DRC’s will be involved in EN operations AND are required to
utilize disability benefits training available through Cornell
University or VCU

For more information about VCU Work Incentives Counseling
Training, see: http://www.vcu-ntc.org/training/initial.cfm

For more information about Cornell Universities online
benefits planning training series, see:
https://www.ilr.cornell.edu/edi/edionline/ediONLINE_catalog.cfm
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Ticket/EN Subject Matter Expert
Kevin Nickerson
E: [email protected]
P: (607) 272-7570 Ext. 136
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Overview of SSA disability
programs, and eligibility
requirements
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Overview
• The Social Security Administration offers two programs that
support individuals with disabilities with an inability to work at
a substantial level.
– Social Security Disability Insurance (SSDI)
– Supplemental Security Income (SSI)
• Many people with disabilities who receive SSDI and/or SSI,
want to work or return to work but are unsure what will
happen to their benefits when they do
• SSA has special work incentives available that make it
possible for individuals to test their ability to work and
continue to receive some or all of their cash and health
benefits
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SSA disability benefit eligibility
Individuals must prove 2 things to be eligible for
SSDI or SSI:
1.
Prove that they have a documented medical disability that has, or will
last 12 months or longer or result in death
2.
Meet SSA’s definition of disability:
The inability to engage in Substantial Gainful Activity (SGA, which is
paid work) by reason of any documented medical impairment
(physical or mental) that will lasts 12 months or longer and/or result
in death
NOTE: Individuals who are blind do not have to prove that they are
unable to work. They only have to prove that they meet SSA’s level of blindness
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Substantial Gainful Activity
(SGA)
SGA is a basic test used by SSA to establish disability status

SGA is the performance of significant mental and/or physical duties
for profit

It is usually determined to be gross earnings (before taxes) of an
amount of money that is set January 1 of each calendar year based
on the National Average Wage Index

To meet this test a person must not be working, or if working,
earning less than the SGA level amount:
2013 SGA for non-blind individuals = $1040/month
2013 SGA for blind individuals = $1740/month
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Review of Work Incentives
associated with the
SSDI program
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Social Security Disability
Insurance (SSDI)
SSDI is a Title II Benefit
•
SSDI benefits are based on a person’s work history
looking at length of time and amount of money earned,
based on F.I.C.A. contributions, which is why SSDI
check amounts will vary from person to person
•
Disabled Adult Children (DAC)
•
•
•
•
•
Disability Prior to Age 22 & Never Legally Married
Insufficient FICA or higher parent amount
Parent is deceased, disabled or retired
Possible continuation of Medicaid
Medical Insurance - MEDICARE
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Important Notes on SSDI
•
5 Month Waiting Period for cash benefits
•
24 month waiting period for Medicare (beginning
with the first month of eligibility for cash benefits)
•
No Asset limit (not a needs based program)
•
Individual must have 12 months consecutive-initial
eligibility
•
SSDI is obsessed with SGA – this remains important
both before, and after eligibility, although Work
Incentives help to overcome this rule in some cases
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SSDI Work Incentives & Wages
Work Incentives that apply to the
SSDI program:






Trial Work Period = $750/Month for 2013
Extended Period of Eligibility
Extended Medicare Coverage
Impairment Related Work Expenses
Special Condition/Subsidies
Expedited Reinstatement of benefits
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Trial Work Period (TWP)
•
A 9-month period, within 60 months, in which a
person on SSDI can work and earn any amount of
money without earnings affecting their SSDI eligibility,
or cash benefits
•
Each month an SSDI recipient earns more than $750
counts as one month of the TWP (2013 amount)
•
These months do NOT need to be consecutive
•
For Ticket holders, this represents an opportunity to
attempt working again, and evaluate their abilities
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Extended Period of Eligibility
(EPE)
•
A period of extended eligibility that starts the month after the
TWP ends and continues for the next 36 months (whether
working or not)
•
For months that countable earned income is less than the SGA
level, beneficiaries receive their full SSDI check
•
For months that countable earned income is more than the
SGA level, SSDI cash benefits may not be received
•
When countable wages first exceed the SGA level (cessation
month), Social Security will plan to stop the benefits - but will
allow the person to receive a check for that month and for 2
more months as a “Grace Period” before cash benefits cease
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SSDI Timeline
3 Month Grace Period – Can
occur anytime AFTER the TWP
is completed
TWP
9 Months of
Trial Work
available
Count when earnings
are over $750/month
EPE
36 Months for Extended Period of
Eligibility
[SSA looking at determining when
“Countable Earnings” are over
SGA, during this period of time]
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Impairment Related Work
Expenses (IRWE)
An IRWE exists when:

The individual with a disability pays for the item or service

The item or service is related to the person’s condition

The person would not be able to work if s/he did not spend
the money and receive the item or service

IRWE amount may be reduced from Gross wages, the
remaining Countable Wages are evaluated based on the
SGA test, to determine whether the beneficiary remains in
pay that month
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Subsidies
A Subsidy Exists When the Employer:

Willingly pays more in wages than the value of
services performed (Employer Subsidy); or

Receives full value (of services from employee) only
because additional supports are provided to the
employee (sometimes called Special
Considerations)
 For use with SSDI beneficiaries
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Subsidy: For Self-Employed
•
Unpaid help – for example, a relative that helps you in
your business but is not paid for these services
•
Unincurred business expense – for example, vocational
rehabilitation program (ACCES-VR) pays for a computer
for your business operation
•
In either case, subsidies assist a beneficiary by reducing
the amount of Gross wages SSA examines when
determining whether someone is “gainfully employed”
NOTE: Additional rules apply to Self-Employment, and how SSA counts wages
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Extended Medicare Eligibility
(effective October 1, 2000)

An SSDI beneficiary is entitled to continued Medicare
coverage after the Trial Work Period and for at least an
additional 93 months following the ninth trial work month.

During this entire period, hospital insurance (Part A) is
automatic and cost-free. Part B (Medical Insurance)
continues to be optional and subject to premium
payment ($104.90/month in 2013 for all enrollees)
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Options for returning to
disability benefits, if needed
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Options for Returning to
Disability Benefits
• Re-Application
• Expedited Reinstatement (EXR)
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Expedited Reinstatement of Benefits
(EXR)
SSDI benefits shall be reinstated without a new
application if the person:
–
–
–
–
–
–
Was eligible for SSDI; and
Lost SSDI due to performance of SGA
Requests EXR within the consecutive 60-month period
beginning with the month of entitlement termination
Is disabled by the same as (or related to) the physical or
mental disability that was the basis for their original claim
Is under a disability based on the application of the medical
improvement review standards (MIRS)
Is unable to perform SGA due to his or her medical condition
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EXR (cont.)
•
SSDI dependent’s benefits may be reinstated if the
dependent satisfies all of the requirements for entitlement
to the benefits
•
Provisional benefits may be received up to 6 months
pending the reinstatement application
•
Once the individual receives EXR benefits for 24 months
(called the Initial Reinstatement Period, or IRP), he or she
will be eligible for a new Trial Work Period, Extended
Period of Eligibility and Expedited Reinstatement period
(This is a new period of disability), and also becomes
Ticket eligible again
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Summary
Next Steps
Q&A
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Summary
In today’s presentation we covered the
following:
• Methods for DRC to coordinate, or provide, benefits
planning services for Ticket holders
• Basics of SSDI benefits eligibility
• SSDI Work Incentives, and how they can assist
beneficiaries in the return to work
• Options for returning to benefits rolls if needed
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Next Steps
Register to Attend the next training in this series:
Monday, February 11th (3:00pm – 4:00pm EST)
Part 4: Ticket to work and Benefits Planning,
Overview of Supplemental Security Income (SSI)
This webinar will:
• Increase your understanding of the basics of the
Supplemental Security Income (SSI) program
• Provide basic knowledge of key Work Incentives specific to
the SSI program
• Increase your understanding of the value of Work Incentives
and how they can apply to the work of the Employment
Network
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Questions/Comments
If you have a comment or
question you can:
A: Submit it to the host in writing
via the Chat or Q&A Box to the
right, or…
B: Click on the “raise hand” icon
to have your line un-muted and
ask your question/make your
comment.
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Contact Information
Kevin Nickerson
NDI Technical Assistance Team
[email protected]
Phone: (607) 272-7570 Ext. 136
Mary Lynn ReVoir
NDI Technical Assistance Team
P: (515) 975-2344
E: [email protected]
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