Transcript Medicaid and Persons with Disabilities
Plan for Achieving Self-Support (PASS): Using the PASS to Fund AT to Support a Work Goal October 22, 2014
1
Today’s Presenters
James R. Sheldon, Jr.,
Supervising Attorney National Assistive Technology (AT) Advocacy Project Neighborhood Legal Services, Buffalo, NY [email protected]
* 716-847-0650 ext. 262
Ronald M. Hager,
Senior Staff Attorney National Disability Rights Network Washington, D.C.
* 202-253-5252 2
CEUs
The RESNA Catalyst Project offers CEUs for this webinar session. The RESNA Catalyst Project is an approved authorized provider for CEU credits by the International Association for Continuing Education and Training (IACET). You can receive 0.1 CEUs for a sixty to ninety minute webinar. There is a $16 fee to receive credits for each webinar. To learn more about CEUs or to apply for CEUs from an archived webinar, contact Paul Galonsky, [email protected]
.
3
Funding of AT to Support Work Six-Part Webinar Series
Upcoming Sessions 5 and 6:
• November 19, 2014 -
A Review of Lesser Known Funding Sources and Funding Strategies for Work Related AT
• December 10, 2014-
Using Traditional Medicaid and Medicaid Waivers to Fund Assistive Technology to Support Work
All sessions 2:00 to 3:15p.m. Eastern & sessions will be archived at http://www.resnaprojects.org/statewide/webedarchive.html
4
Services of the National AT Advocacy Project
A Technical Assistance and Training Project
• Call or email speakers for technical assistance • Any topic covered in the webinars • Any issue related to funding of AT • We can assist you in thinking through funding issues and appeals
Additional materials available on most topics
• Contact us for copies and/or links.
5
Purpose of Webinar Series
Barriers to Funding AT to Support Work
• It can be expensive.
• Individuals and service providers may not be familiar with funding sources and funding criteria.
Will discuss funding sources, funding criteria:
• Most common funders – Medicaid, special education, vocational rehabilitation • Less common funding sources • Special rules within programs that support funding for work, education, training.
6
Format for Today’s Session
• Walk through power point (on screen, received via email) • Participants can post questions in question or chat box.
• Will attempt to address questions during presentation.
• Follow up questions can be emailed to presenters.
• Contact presenters for more resources on today’s content.
• Additional resources-This ppt, additional documents, and a link to the recorded presentation will be posted at http://www.resnaprojects.org/statewide/webedarchive.html
– See
AT Advocate
newsletter and
NY Makes Work Pay
policy-to practice brief, focusing on PASS, sent to you with power point.
7
Purpose of this Session
• The Plan for Achieving Self Support (PASS) can be a key AT funding source • Will explain the criteria for obtaining approval for use of a PASS • Will explain how can a PASS be used – to fund a range of items, including AT, to support a work goal – to supplement or compliment other funding, such as state vocational rehabilitation agency funding 8
What is a PASS?
A special SSI rule for not counting income or resources that support a work goal.
If approved, the PASS can result in funding for items to support a work goal and: • Retained SSI eligibility • A larger SSI check • SSI eligibility where none existed before • New Medicaid eligibility or retained Medicaid (in 39 states where Medicaid automatic for SSI beneficiaries) 9
Why PASS is Special
•
Self-directed plan –
individual, with or without assistance, can write up own plan •
Creates a funding stream –
can use SSI “countable income” to pay for items to support a work goal – Even when no other funder can or will pay for item, it might be something to fund through a PASS.
•
SSI increases dollar-for-dollar in most cases –
when countable income approved to purchase items, SSI payment increases.
10
Background: SSI’s Income and Resource Rules
SSI payments based on federal benefit rate (FBR):
• $721 – monthly FBR for 2014 • Optional state supplement – E.g., Idaho supplements FBR by $53, Minnesota supplements by $81.
– Many states, including New Mexico and North Carolina, do not supplement the FBR.
If individual has income, other than SSI, part of income is subtracted from base rate to determine SSI payment.
11
Hypothetical
12
The Case of Mario
Mario is 17 years old and a high school senior.
• He has cerebral palsy, uses a 7-year old power wheelchair for all mobility, and relies on accessible transportation to go to school.
• He will turn 18 in February 2015.
• He will graduate from high school in June 2015.
• He plans to go to college and study to become an English teacher at the high school level.
13
Mario’s Current Education
Mainstreamed with some special education services:
• Special transportation to get to and from school in wheelchair • A note taker in classes where extensive notes are taken • Laptop with adapted keyboard, voice dictation software 14
Mario’s Social Security and SSI Benefits
Social Security Benefits - $520 per month
• Dependent’s benefits (Dad gets SS retirement, Mom works).
• In February 2015, at age 18, dependent’s benefits will convert to Social Security Disability Insurance (SSDI).
• SSDI will come as Childhood Disability Benefits, also known as Disabled Adult Child’s benefits (same monthly amount).
SSI Eligibility
• No current SSI as parental income too high.
• Parental income will count until age 18.
15
Mario’s SSI Check Calculation
Mario becomes eligible for SSI at age 18.
• In February 2015, will qualify for $221 SSI check (based on 2014 rate) (parental income no longer counts at age 18).
• SSI disregards $20 ($520 – 20) and remaining $500 is subtracted from the $721 SSI base rate ($721 – 500), giving Mario a $221 monthly SSI check.
• With SSI Mario qualifies for automatic Medicaid in his state.
$500 in countable Income could be used in a PASS!
16
Mario’s Eligibility for Vocational Rehabilitation (VR) Agency Services
We assume VR will sponsor English teacher goal.
• Will cover college expenses, including tuition, books, and special transportation to get him to college in his wheelchair.
• Will not cover van purchase, but will pay for van modifications to allow Mario to drive the van in his wheelchair.
• Mario may face a challenge to have VR agency cover range of other expenses (see next slide).
17
AT Needed by Mario
•
A ramp
at the home, to leave home and travel to college and work •
Accessible van transportation
, to attend college (until he gets a modified van) •
A modified van
, with hydraulic lift, hand controls, etc.
•
A power standing wheelchair
, to replace old wheelchair, allow him to benefit from standing therapy throughout the day, to do work-related activities best done in standing position.
•
A new laptop
, with modified keyboard, voice input software 18
Always Look First to Funding Other than PASS
•
Medicaid
should be able to fund standing wheelchair and possibly ramp.
•
VR agency
should be able to fund van transportation, van modifications, and possibly laptop and ramp.
•
PASS
could fund any item on list deemed necessary to move toward the work goal, but PASS funding limited by amount of countable income and/or resources.
• In Mario’s case will
look to PASS
to fund the van purchase, ramp, and laptop with accessories.
19
Mario’s Need for a PASS
SSI Rule:
Income/resources used in an approved PASS to support a work goal not counted when determining SSI eligibility.
Example:
Mario plans to attend a five-year college program to attain a BA and Masters to become an English teacher. • VR agency will pay for tuition, transportation to college, and books.
• Will still need $28,000 including: $700 for laptop; $24,900 for a new van to travel to student teaching sites and later work; $1,300 for one year of van insurance; and $1,100 for a modular ramp.
Mario proposes to set aside $500 of his SSDI check each month, for 56 months, to save for these items to meet his work goal.
20
Mario’s Approved PASS
With PASS approval, SSI no longer counts $500 of SSDI
• Countable income is now $0. SSI check increased to $721.
• PASS savings = $28,000 (56 months x $500) • Savings will pay for computer, ramp, van, and insurance.
PASS starts July 2015, continues through February 2019:
• Can purchase van and insure it in February 2019.
• Until then, VR agency covers special transportation to college.
• Will attain BA in May 2019, Masters in May 2020.
21
Mario’s SSI Budget Using PASS
Step 1 Unearned income General income exclusion PASS exclusion Counted $520 - 20 - 500 $ 0 Step 2 Base SSI rate Counted income SSI benefit $721 0 $721
Note:
Net value of PASS is $1 increase in SSI for every $1 in PASS expenses. After setting aside $500 of SSDI in the PASS, Mario still has $741 for living expenses ($721 SSI, $20 SSDI).
22
Criteria for PASS Approval
Must be in writing using Form SSA-545 Must contain:
• Specific work goal • A feasible work goal • A savings and spending plan • A list of items and services needed and their cost • A timetable for achieving the goal • Work goal must increase prospect for self support 23
Will PASS Increase Prospect for Self Support?
PASS policy requires:
• If SSI received before PASS approval, work goal must significantly reduce the SSI payment amount.
• If only SSDI received before PASS approved, work goal must be expected to eliminate SSDI check, i.e., through work at the substantial gainful activity (SGA) level - $1,070 in 2014.
24
Mario’s PASS Will Increase His Prospect for Self Support
Mario’s goal is a job making $32,000 per year ($2,667 per month) upon graduation.
• First criteria met as this would eliminate his SSI eligibility.
• If SSDI were his only income before PASS approval, he would meet the criteria, as he will earn more than $1,070 per month (or more as SGA level increases in future years).
25
The Feasible Work Goal
• Must specify a job or profession. • Must have reasonable chance of attaining the goal, in light of disability.
• Goal could be for full-time or part-time work, sufficient to reduce SSI or eliminate SSDI. • Goal could be to move from part-time to full-time work.
26
Mario Has Identified a Feasible Work Goal
• Teaching English at the high school level is a “job or profession.” • Mario should obtain a letter of support, from his guidance counselor and/or a teacher, to support his ability to achieve this goal.
• If his state VR agency has already decided to sponsor him, a letter of support from a VR counselor would also be good.
27
What Money Goes Into a PASS?
Unearned income
• E.g., Social Security Disability Insurance (SSDI) or VA pension
Earned income
• Wages from a job • Income from a business
Resources
• Savings • Personal injury award, Inheritance, lump sum SSDI or SSI award 28
Allowable PASS Expenses
All reasonable and necessary expenses, such as:
• College or training costs • Transportation, including vehicle lease or purchase • Vehicle insurance, maintenance, repairs, warranty costs • Computer, software and Internet costs • Work clothes, professional clothing • Business start-up costs • Dues, fees, licenses, child care • A wide range of AT
Anything reasonably tied to the work goal!
29
Connecting Mario’s Needed AT to His College Studies and Work
•
Getting ready to leave the home for college or work
– a lifting device, like Hoyer lift, to meet hygiene needs. (Assume this will be funded through Medicaid.) •
Leaving the home for college or work -
a ramp.
•
Traveling to college or work -
a modified vehicle.
•
Performing activity in college or tasks at a job –
the laptop computer with adapted keyboard and specialty software.
30
PASS Time Limits
General Rule:
A PASS can be approved for whatever period of time is needed to achieve the goal.
Application to Mario’s PASS:
• His PASS should go for 56 months, through February 2019, to allow him to save for the laptop, ramp, van, and van insurance, and potentially find a student teaching placement.
SSI’s PASS Specialist will do periodic review.
• Usually at least once per year.
• Will make sure deposits are going into dedicated account and that Mario has proof of expenses paid.
31
PASS Amendments
A PASS Can Be Amended as Necessary
• To add things that were not anticipated in the original PASS • To address personal changes -- a job loss, a change in income • Could be needed to allow extra time to reach milestones – For example, Mario may realize it will take six years, rather than five years, to complete a Master’s program.
32
Mario’s Need to Amend His PASS
Additional Items Needed to Achieve Goal:
Several months into his PASS Mario realizes he will have $2,200 of additional expenses.
• Professional clothing for student teaching, job search - $500 • Computer software - $200 • Internet services for schoolwork and job search - $1,000 • Van maintenance costs until he finds employment - $500 33
Mario’s Amended PASS
Amendment adds $2,200 in additional costs.
• Adds 5 months to PASS period, setting aside $500 from SSDI for months 57 to 60, and setting aside $200 from SSDI in month 61.
• If approved, PASS will extend through July 2019.
• Will continue to receive SSI at full federal benefit rate ($721 in 2014) through month 60.
• For month 61, SSI payment will be $421 based on countable SSDI of $300 ($520 – 20 – 200).
Note:
In all years we continue to assume SSI and SSDI are paid at 2014 rates. In reality both rates will be adjusted yearly.
34
Mario has Used VR Agency and the PASS to Fund the Modified Van
• Most VR agencies will pay for modifications but not a van purchase.
• With an approved PASS Mario will save nearly $25,000 to purchase a new van.
• The VR agency will pay for van modifications, which in many cases can exceed $20,000. 35
Mario Could Use VR Agency, PASS, and AT Loan Program* to Fund Accessible Van
• Over five years of college to obtain teaching credentials, Mario can save enough to purchase a van.
• Wants to get van much sooner, through a down payment and loan, to travel to internships and student teaching sites.
• He has a low credit score and no co-signer for a loan.
• Mario obtains a low-interest loan through an “alternative financing program” in his state.
• He can then use money deposited into PASS to pay off loan.
*See http://www.resnaprojects.org/allcontacts/allafpcontacts.html
for links to alternative financing programs in more than 40 states.
36
PASS Assistance Available
Work Incentives Planning and Assistance (WIPA) Projects (every state)
– Work incentives counselors may be able to prepare the written PASS proposal.
State VR Agency
– In many states they support work incentives counseling through trained staff or fee-for-service agreements.
National AT Advocacy Project
– Can provide technical assistance if AT-related.
Cornell’s PASS Website:
Can develop PASS, online, using SSA Form 545, www.ilr.cornell.edu/edi/pass/default.html
.
37
Thank you!
Please use your chat box to ask questions
James R. Sheldon, Jr., Supervising Attorney [email protected]
* 716-847-0650 ext. 262 Ronald M. Hager, Senior Staff Attorney National Disability Rights Network [email protected]
* 202-253-5252 38