Transcript Slide 1

SOCIAL SECURITY BENEFITS
SSDI and SSI
Social Security Administration
Overview of
Disability Programs
SSDI & SSI
SOCIAL SECURITY DISABILITY--SSDI
• Insurance program based on quarters of
coverage-paid by FICA taxes
• Not based on financial need
• Earned quarters--$1090=One quarter
• Disabled or blind under Social Security rules
• 5 month waiting period
• Medicare eligible after entitled for 24 months
Spouse Benefits
• Age 62 and married to worker
• Any age mothers-worker’s child under age
16
• Divorced spouse-married 10 years, age 62
unmarried
• Surviving divorced spouse-age 60 married
10yrs can be remarried after age 60
• Widow (er) married 9 months age 60
• Disabled widow (er) age 50
Child Disability Benefits
• As a child (under 18) auxiliary beneficiary
on the record of a parent receiving SSA
benefits or deceased-disability not a factor
• As a Disabled Adult Child (over age 18) on
the account of a parent
• SSI-as a child whose parents meet the
income/resource limits-disability is a factor
SUPPLEMENTAL SECURITY INCOME SSI
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Federal welfare program based on need
Aged, disabled or blind
Be a U.S. citizen or qualified alien
Income/resources of spouse or parents (if
under 18) may affect eligibility
• No waiting period
• Automatic Medi-cal eligibility in CA
• Paid by general taxes not FICA taxes
Disability Definition
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The same for both programs
Inability to work is key for adults
Inability to function is key for kids
Disability must be severe enough to keep
adult from doing any substantial work
• Disability must be expected to last 12
months
• ….or result in death
Who decides if you’re disabled?
Non-Disability Factors
Disability Factors
•Social Security caseworker
•SSI caseworker
•Appeals and RepPayee
paperwork handled by SSA
Office
Medical folder sent to
California Department of
Social Services: Disability
and Adult Services (DDS)
Representative Payees
Who needs one?
•Children
•Drug addicts
•Alcoholics
•Adults who are
legally incompetent
•Psychological
disorders
Who can be one?
•Parent or family
member
•Legal guardian
•A close friend
•Custodian of the
person
•Social Service
agency
If Your Claim is Approved
• Generally takes 3-5 months to get decision
• SSDI benefits begin with the 6th full month
of your disability (waiting period)
• Ex: Disability begins 01/09 and file 02/09
First payment month 07/09 payable in
08/09
• SSI benefits payable month after you file
• SSI review done before first payment
Appeal Process
• Initial claims 32% approval rate
• 1st-Reconsideration: Claim sent back to
DDS for another review 8%
• 2nd- Hearing: Administrative Law Judge
69% 2007 SSA Statistical Report
• 3rd-Appeals Council Review: Judge
reviews ALJ decision
• 4th Federal Courts: Civil court action
• All have time periods
SSA Medical Benefits
Medicare
•Part A-D
•Federal program tied to
SSDI and age 65
•Entitled age 65 or 25th
month after disability
benefits
•Monthly premiums
Medi-Cal
•State program Medicaid
•California Dept. of
Social Services
•Tied to SSI
•Hawaii separate
application
•Medi-Cal pays
Medicare premiums
SSA WORK INCENTIVES
• Most people with disabilities want to work
• SSA offers a package of work incentives to
help them
• Work incentives allow beneficiaries to:
--Test ability to work and
--Gradually become self-supporting
FEARS, MYTHS, AND TRUTHS ABOUT
WORK AND DISABILITY BENEFITS
• If I start working my benefits will stop or my
income will go down-Fear
• Work incentives allow for continuation of
cash benefits for a period of time-Truth
• I can make more money not working-Myth
• Going to work will generally increase overall
income-Truth
• I can’t work because I’ll lose my Medical
Insurance-Fear
• Healthcare (Medicare and Medi-cal) can
continue even if claimant is working-Truth
FEARS, MYTHS, AND TRUTHS ABOUT
WORK AND DISABILITY BENEFITS
• I’m afraid that if I go to work and my benefits
stop, I’ll get sick again and have a hard time
getting back on benefits-Fear
• Expedited Reinstatement can pay up to six
months while you wait for decision-Truth
• I can’t get a good paying job-Myth
• PASS Program, Ticket to Work and
Community Partners can help you-Truth
• I get and SSA check-Myth
• SSA benefits are SSDI-Truth
SSDI PRIMARY WORK INCENTIVES
• Trial Work Period
• Extended Period of Eligibility-SGA
$980/1640
• Expedited Reinstatement
• Continuation of Medicare
• 301 VR payment
• Ticket to Work
TRIAL WORK PERIOD (TWP)
• Allows claimant to
test work ability
while still receiving
full SSDI for 9
months
TWP
• 2009-$700 constitutes a TWP month
• We give you a rolling 5 year period to earn
the nine months
• If earning at or above the current SGA
level we pay for the tenth month and two
additional “grace” months
• Gives beneficiary a trial run on working
LET’S REVIEW THE NUMBERS…
• 9 Trial work months
• 3 Grace months
• During these
months claimant
receives full SSDI
check and their
wages
EXTENDED PERIOD OF ELIGIBILITY
Starts at end of TWP
and extends for 36
months
Claimant whose
earnings drop below
SGA in any month
can get full SSDI
payment for that
month
Automatic
reinstatement if work
stops
IRWE
LET’S REVIEW THE NUMBERS…
• 9 Trial work months
• 3 Grace months
• During these months claimant receives full
SSDI check and their wages
• 36 Extended period of eligibility—During
these months claimant is entitled to the full
SSDI check any month wages fall below
SGA
EXPEDITED REINSTATEMENT
• Starts at end of EPE
and runs for the
following 60 months
• Claimant who
stopped work due to
same disability can
be paid while we
make a medical
decision
• Pay up to six
months
LET’S REVIEW THE NUMBERS..
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9 Trial work months
3 Grace months
36 months Extended period of eligibility
60 months Expedited reinstatement
105 months = Almost 9 years that claimant
stays connected to SSDI for the cash
benefits
• 301 Pmts
CONTINUATION OF MEDICARE
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Starts at end of TWP
93 months starting the month after TWP
9 month TWP
93 months after TWP
102 Months of Medicare = 8 ½ years
TICKET TO WORK ACT OF 1999
• Ticket is a voucher to receive rehabilitation
or training services from Employment
Networks (EN)
• Almost anyone receiving SSDI or SSI
disability 18-64
• Does not mean SSA believes claimant is
no longer disabled
TICKET PROCESS OVERVIEW
• Ticket received by an SSDI/SSI claimant
• Claimant decides if they want to attempt to
return to work and use the ticket
• Claimant contacts MAXIMUS 1-866-9687842 for information on EN’s
• Claimant selects EN and they agree on an
IWP (Individual Work Plan)
MORE TTW ENHANCEMENTS
• The Continuing Disability Review (CDR)
process has changed
• Beneficiaries using Ticket will not be
selected for a medical CDR
• SSDI/SSI beneficiaries who have received
benefits for 24 months No Med CDR
Section 111 Protection
• Regularly scheduled CDR’s will continue
SSI Payment Computation
$ 500.00 Social Security
- 20.00 General Exclusion
$ 480.00 Countable income
$ 500.00 Wages
- 65.00 Earned Income Exclusion
$ 435.00 ÷ 2 = $217.50 Countable income
Total C/I $217.50 + $480.00 = $697.50
$870.00 - $697.50 = $172.50 SSI
SSI WORK INCENTIVES
• Impairment related
work expenses-IRWE
• Blind work expenses
BWE
• Earned Income
Exclusion
• Plan to Achieve Self
Support-PASS
• Property Essential to
Self support-PESS
• EXR
• Continued Medi-cal
eligibility-1619b
$2899 month
• Reinstatement
eligibility without new
application
• Student Earned
income Exclusion
• 301 pmts
SSI WORK INCENTIVE EXAMPLE
• Tom goes back to work at Petco Park
SSI rate CA $935 no countable income
$2500 gross wages
-$1640 Student Earned Income Exclusion
-$85 General & Earned Income Exclusion
$775 countable income
-$50 IRWE for Drugs
-$725 countable income
SSI WORK INCENTIVES
$725 countable income
-$362.50 ½ remaining earnings
=$362.50 countable income
-$100 BWE taxes and lunches at work
=$262.50 countable income
-$162.50 PASS for books and computer
=$100 countable income
$935-$100 = $835 SSI + $2500 wages
=$3335 Total monthly income
Dealing with Social Security
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Online www.socialsecurity.gov
Telephone: 1-800-772-1213
In person
8 Branch offices in San Diego County
Servicing areas
SAN DIEGO SSA OFFICES
Toll Free 1-800-772-1213
• 1333 Front St
San Diego CA 92101
Tel: 619.557.5257
• 626 L St.
Chula Vista CA 91911
Tel: 619.427.7414
• 846 Arnel St
El Cajon CA 92020
Tel: 619.440.2943
• 2160 S El Camino Real
Oceanside CA 92054
Tel: 760.439.8025
• 8505 Aero Drive
San Diego CA 92123
Tel: 858.278.1099
• 2530 E Plaza Blvd
National City CA 91950
Tel: 619.267.1175
• 7961 University Ave
La Mesa CA 91941
Tel: 619.464.8533
• 367 Via Vera Cruz
San Marcos CA 92078
Tel: 760.471.2155
QUESTIONS
E-Services
www.socialsecurity.gov
• Apply for retirement
• Apply for SSDI
• Apply for Medicare
Part D
• Request a Social
Security statement
• COA, telephone #
• Replace Medicare
card
• Check status of
online application
• Request a proof of
income letter
• Get a form
1099/1042S
• Apply for direct
deposit
• Retirement
Estimator
HOW TO CONTACT THE PASS CADRE
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Toll Free 1.888.674.6250
Local 619.557.6605
Fax 619.557.5722
Mailing Address:
1333 Front Street
San Diego CA 92101
♦ PASS Specialist:
Patrick Mattis & Peter Prather