Transcript Slide 1

Overview of the Work Incentives
for Social Security Disability
Benefits
Ambassador Orientation
April 9, 2010
Presented by:
Karla Bell
California Health Incentives Improvement Project
San Diego State University Interwork Institute
Reasons to Work
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More income
Independence
Learn New Skills
Meet New People
Build Assets
Increase
Retirement
Tax Credits
Social Security Administration
(SSA)
 1300
local Field Offices
 10 Regional Offices
 OESP (Office of Employment
Support Programs)
Oversees Ticket to Work and
WIPA projects
 Over 60,000 employees
Local SSA Field Office
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Hierarchy and Individuality of Field Offices (aka District Offices)
 Service Representative (SR)
 Usually first point of contact when an individual visits SSA
 Assesses situation, answer questions, investigates &
resolves problems
 Claims Representative (CR)
 Help to establish entitlement to Social Security benefits.
 CR's can also be assigned as WIL's (not separate
positions)
 Work Incentive Liaisons (WILs)
 Primary contact on work incentive issues for CR's and
SR's.
 Area Work Incentive Coordinator (AWIC)
 Coordinate with WIL's, Public outreach
Disability Benefit Programs
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Social Security Disability Insurance
(SSDI)
Supplemental Security Income
(SSI)
Both SSDI and SSI = Concurrent
benefits
How do I find out what benefits I
receive?
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Benefits Planning Query (BPQY)
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Request from your local Social Security
Office
Call the Social Security Administration
(SSA) at: 800-772-1213 (voice); 800325-0778 (TTY)
A Community Work Incentives
Coordinator (WIPA projects) will
request a BPQY for you as part of
benefits counseling
Social Security Disability Insurance
(SSDI)
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AKA: DI, SSA, Social Security or Title II
Based on work, not financial need
Must have worked long enough & recently enough
(FICA contributions) to become insured
Disabled or blind under Social Security rules
5 month waiting period
Medicare eligible after entitled for 24 months
Not affected by resources
3 Different Forms: SSDI, Childhood Disability
Benefits (CDB), Disabled Widow(er)s Benefits (DWB)
Social Security Disability Insurance
(SSDI)
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Must have insured status on own work record
At least 20 credits in the 10 years prior to onset of
disability
Those disabled prior to age 31 need fewer credits to
qualify
Possible to earn up to four credits per year -one
credit = $1,120 in 2010
The amount of disability benefits payable under title
II is determined by the number holder’s work
record. The maximum monthly payment for 2010 is
$2,346
Childhood Disability Benefits
(CDB)
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To be eligible for Social Security as an adult
child with a disability, individuals must be:
1. 18 years of age or older
2. Disabled by SSA’s definition before age
22; and,
3. Child of an insured worker who is either
disabled, retired or deceased.
No 5-month waiting period required
Benefits not payable prior to the month in
which the individual turns 18
Medicare
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Federally run program that has the same
eligibility standards and coverage rules
across all 50 states
Medicare Part A:
 Hospital Insurance (HI)
 Helps pay for care in a hospital and
skilled nursing facility, home health care
and hospice care
Medicare Part B:
 Helps pay for doctors, outpatient hospital
care and other medical services
Medicare Part D:
 Prescription Drug Program
 Participants choose a drug plan
Supplemental Security Income
(SSI)
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Federal income program funded by general tax
revenues (not Social Security taxes)
Aged, blind or disabled people with limited
income and limited resources
U.S. Citizen or qualified alien
Income/resources of family members or living
arrangements may affect eligibility
No waiting period
Automatic Medi-Cal eligibility in CA
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Medi-Cal is a state-run program designed primarily
to help those with low income and little or no
resources
2010 California SSI payment rates
SSI Payment= $674 Federal Benefit Rate +
State Supplement Payment
 $845.00 (Individual-own household)
 $639.66 (Individual-household of
another)
 $929.00 (Individual-no cooking facilities)
 $908.00 (Blind individual)
 $1407.00 (Couple)
 $1554.20 (Blind Couple)
SSI Resource Limit:
 $2000 (individual)
 $3000 (couple)
SSDI Work Incentives
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Trial Work
Period
Extended Period
of Eligibility
Expedited
Reinstatement
Continuation of
Medicare
Trial Work Period (TWP)
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Allows you to test work for
at least 9 months while
receiving full SSDI benefits
No limit to earnings during
TWP
2010: $720 gross
earnings or 80 hours in
self-employment = TWP
month
Trial Work Period (TWP)
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Lasts until you complete 9 months (not
necessarily consecutive) of work within a
rolling 60-consecutive month period
After TWP, there is a 3 month grace period
with full SSDI benefits in addition to earned
income (may occur during Extended Period
of Eligibility (EPE) or after EPE has ended)
No other work incentives apply during the
TWP
Only one TWP per period of entitlement
What happens after I use my Trial
Work Period (TWP)?
 Your Extended Period of Eligibility
(EPE) starts the month after TWP ends
 36 consecutive months
 Once EPE starts, it cannot be stopped
 Key concept:
Substantial Gainful Activity (SGA)
 2010: SGA is $1000 in countable earnings
($1640 for a Blind individual)
Extended Period of Eligibility
(EPE)
 First 36 months are Reinstatement Period
 If monthly countable earnings are over
$1000 not entitled to cash benefits
 If monthly countable earnings are less
than $1000 then entitled to cash benefits
 Benefits automatically reinstated without
need for new application or disability
determination
 During the EPE, work activity over $1000
may not cause termination of benefits only
suspension
Extended Period of Eligibility
(EPE)
There are work incentives that you can use during the
EPE to lower your countable earnings:
 Impairment Related Work Expenses (IRWE)
 Subsidy or Special Conditions
 You require more supervision or help from
coworkers
 Your performance is at a lower standard
 You are provided with special equipment for your
job
 Your have irregular work hours and/or take
frequent rest breaks
 You have a job coach
What happens once my 36 month Extended
Period of Eligibility ends?
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Your benefits will continue if you are not
working or earning above SGA
Your benefits will end if you work above
SGA after the 36-month reinstatement
period
Expedited Reinstatement provides an
additional 5 years of reinstatement if work
stops and there is no medical improvement
Expedited Reinstatement (EXR)
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Previous entitlement to
benefits terminated due
to SGA
Unable to work or perform
SGA due to a disabling
impairment
Eligible within 60 months
of benefit termination
date
Up to 6 months
provisional benefits
payable during EXR
decision making process
Medical decision needed
Example of TWP & EPE: (2010 Amounts)
*Trial Work Amount = $720 total gross monthly earnings
*SGA = $1000 total countable monthly earnings ($1,640 if Blind)
(These amounts are likely to increase each year in January, but for this example the amounts
remain the same each year for simplicity.)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov.
Dec
$800
$600
$800
$900
$700
$1500
$800
$0
$800
$550
T2
T3
T4
T5
$950
$825
$1200
$1100
$1200
$1200
$1050
$950
*Grace
& Cessation
Grace
Grace
Not
Eligible
Not
Eligible
Eligible
T1
T6
*Start
TWP
$825
$1000
$1000
T7
T8
T9
$900
*Start
*End
TWP
EPE
$875
$1200
$1500
$1075
$850
$1200
$2000
$875
$1250
$980
$1025
$850
Eligible
Not
Eligible
Not
Eligible
Not
Eligible
Eligible
Not
Eligible
Not
Eligible
Eligible
Not
Eligible
Eligible
Not
Eligible
Eligible
$120
$450
$1500
$1600
$865
$995
$1300
$1500
$1700
$875
$1400
$1250
Eligible
Eligible
Not
Eligible
Not
Eligible
Eligible
Eligible
Not
Eligible
Not
Eligible
Not
Eligible
Eligible
Not
Eligible
Not
Eligible
$0
$1250
$800
$850
$875
$1200
Eligible
Not
Eligible
*End
EPE
Eligible
Eligible
*Termi
nation
Due to the complexity of the SSDI work incentives
it is helpful to see a WIPA Community Work
Incentives Coordinator for benefits counseling
What happens to Medicare if
SSDI benefits stop?
 Medicare coverage
uninterrupted
during Trial Work
Period
 Continues for at
least 93 months
after the 9 month
Trial Work Period
 After that you may
be able to purchase
Medicare coverage
SSI and Work
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Going to work
can increase
overall income
Medi-Cal can
continue even if
working
Reinstatement
How earnings affect SSI payments
SSA counts less than half of your
earned income
For example:
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$885 in wages
$400 counts against SSI
Certain Impairment Related Work
Expenses and Blind Work Expenses
can also be deducted from your gross
wages
SSI Calculation Example-IRWE
$885 Gross Wages
-$20 General Income Exclusion
$865 Remainder
-$65 Earned Income Exclusion
$800 Remainder
-$100 Impairment Related Work Expense
$700
÷2
$350.00 Total Countable Earned Income
$845.00 Maximum SSI Rate
-$350.00 Total Countable Income
$495.00 Adjusted SSI Payment
$885.00 Gross Wages
+$495.00 SSI
-$100 IRWE
$1280.00 Total Financial Outcome
Blind Work Expenses (BWE)
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For SSI beneficiaries whose primary diagnosis is
blindness
Allows the exclusion of any work related items that
are paid out of pocket and not reimbursed
BWEs do not need to be related to blindness or any
impairment
Examples: Service animal expenses, fees, State,
Federal & local taxes, visual & sensory aids, driver
services, transportation to and from work, childcare,
meals consumed at work, union dues, uniforms,
reader services, vehicle modification, mandatory
pension contributions, training to use an
impairment-related item, translation of materials
into Braille
SSI Calculation Example-BWE
$885 Gross Wages
-$20 General Income Exclusion
$865 Remainder
-$65 Earned Income Exclusion
$800 Remainder
÷2
$400 Remainder
-$100 Blind Work Expense
$300.00 Total Countable Earned Income
$908.00 Maximum SSI Rate
-$300.00 Total Countable Income
$608.00 Adjusted SSI Payment
$885.00 Gross Wages
+$608.00 SSI
-$100 BWE
$1393.00 Total Financial Outcome
IRWE & BWE
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All Blind and Impairment Related Work
Expenses must be verified by your local
Social Security field office
Provide them with original receipts or
canceled checks of the expenses
SSA will determine if the expense may be
deducted
Request in writing in order to use appeal
rights (if necessary)
SSI Calculation Example-SSDI &
SSI Benefits
$520 Unearned Income (SSDI payment)
-$20 General Income Exclusion
$500 Countable Unearned Income
$885 Gross Wages
-$65 Earned Income Exclusion
$820 Remainder
÷2
$410.00 Countable Earned Income
$500.00 Countable Unearned Income
+$410.00 Countable Earned Income
$910.00 Total Countable Income
$845.00 Maximum SSI Rate
-$910.00 Total Countable Income
$0.00 Adjusted SSI Payment
What happens if my earnings are so
high that my SSI stops?
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1619(b) is a work incentive that allows working SSI recipients
to keep FREE Medi-Cal (No Share-of-Cost)
Medi-Cal retained when SSI payment is reduced to $0.00 per
month due to earned income
Medi-Cal continues until you earn above a Threshold
2010 California 1619(b) Threshold Amounts:
 Disabled = $34,324.00
 Blind = $37,252.00
People with high medical costs can earn even more
(Individualized Threshold)
Benefits can start again if you stop working or your earnings
decrease (Reinstatement)
1619(b)
To qualify:
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Have been eligible for an SSI cash payment for at least 1
month;
Would be eligible for cash payment except for earnings;
Still be disabled or blind;
Still meet all other eligibility rules, including the resources
test;
Need Medi-Cal in order to work;
Have gross earned income that is insufficient to replace
SSI, Medi-Cal, and any publicly funded attendant care.
1619(b)
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Individualized Threshold: threshold can be adjusted
on a case-by-case basis
Higher Individualized Threshold if:
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Blind Work Expenses (BWE)
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Impairment Related Work Expenses (IRWE)
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Plan to Achieve Self-Support (PASS Plan)
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Publicly Funded Personal Attendant
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(i.e. In-Home Supportive Services)
Medical Expenses above State Average
1619(b)
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Blind and Impairment Related
Work Expenses must be verified
by your local Social Security field
office
 Provide
them with original
receipts or canceled checks of
the expenses
Section 301
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SSI/SSDI benefits may continue in spite of
determination that medical improvement has
occurred if enrolled in an appropriate program that
increases likelihood of not returning to disability
benefit rolls:
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Department of Rehabilitation (using an IPE)
Individualized Education Plan (IEP) if under age 22
PASS Plan
Ticket to Work
Support Services using an individualized written
employment plan
Benefits continue until you complete the program,
stop participation in the program or if your
continued participation in the program no longer
increases likelihood that you remain off the rolls
Ticket to Work
A ticket all SSI and SSDI recipients, ages 1864, can use to get free employment services
866-968-7842 (voice), 866-833-2967 (TTY)
http://www.yourtickettowork.com/
Ticket to Work
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Help you access vocational rehabilitation
services, training, education and placement
services
Ticket can be used with:
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Department of Rehabilitation or
Employment Network
Your choice to use your Ticket or not and
who you take it to
Protection from continuing disability review
when Ticket is assigned and in use
Work Incentives Seminar Events
(WISE)
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Community Events
FREE information about Ticket to Work and
other work incentives for SSDI and SSI
recipients
Meet local Employment Networks and Work
Incentives Planning and Assistance (WIPA)
representatives
Upcoming San Diego WISE (see flier):
May 25, 2010, 10 am – 2:00 pm
Goodwill Industries
Medi-Cal Working Disabled
Program
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An individual with a disability who is working
full or part time may qualify
Individuals can earn up to $55,188
($73,884 for a couple) gross per year and
still qualify for Medi-Cal
 Higher gross wages possible when there are
Impairment Related Work Expenses
(IRWEs)
Affordable premiums:
 $20 - $250 (Single Person)
 $30 - $375 (Couples)
Medi-Cal Working Disabled
Program
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Asset Limit ($2000 individual, $3000 couple)
Retirement Plans allowed and not counted
towards asset limit
All disability income is exempt in determining
eligibility and premium (Social Security
Disability Insurance-SSDI, State Disability
Insurance, Workers Comp., Childhood
Disability Benefits, private disability insurance,
etc.)
Maintain In-Home Supportive Services at
home and in the workplace
Local Resources
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Area Work Incentives Coordinator
(AWIC)
Public outreach on work incentives
Norma Richey
Covers California South Coast
(714) 966-2410 ext. 246
17075 Newhope St., Ste. B
Fountain Valley, CA 92708
Local Resources
Work Incentives Planning and
Assistance (WIPA)-San Diego
County
 One on one benefits planning
 Steve Stover, Community Work
Incentives Coordinator
 619-840-6616
 Email:
[email protected]
Local Resources
Disability Rights California
 advocacy, appeal rights & assistance
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PABSS: Protection & Advocacy for
Beneficiaries of Social Security
http://www.disabilityrightsca.org/
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800-776-5746
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TTY 800-719-5798
Resources
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Talent Knows No Limits
http://www.talentknowsnolimits.info/
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Disability Benefits 101
http://www.disabilitybenefits101.org/
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SSA Red Book-Guide to Work Incentives
http://www.ssa.gov/redbook/
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WISE Events
http://www.cessi.net/WISE/
Resources
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Area Work Incentives Coordinators (AWIC)
http://www.ssa.gov/sf/awic.htm
Ticket to Work
http://www.yourtickettowork.org/
Ticket to Work FAQS
http://www.cessi.net/ttw/faqs/beneficiaries.html
Questions
You are welcome to contact
Karla Bell at
619-594-5381 (office)
760-579-3474 (cell)
[email protected]