Transcript Document

Florida Benefits Information Referral Network
Presents
“Changing Face of Benefits”:
Knowledge for Successful Employment
Sponsored Through
Agency For Persons With Disabilities
Medicaid Infrastructure Grant
Developed By
Sharon Brent, Director
Training and Technical Assistance
National Disability Institute
Principles of Project Training
Information provided in the training
is one tool for decision making about
employment
2. Good decisions are the result of good
planning
3. The training is based on the
philosophy of self-determination and
person centered planning.
1.
Building Blocks for
Self-Determination
1.
2.
3.
4.
A person has the FREEDOM to dream, make his or her
own decisions and plan their own life.
A person has the AUTHORITY to control how money is
spent for supports
A person has the SUPPORT needed from people they
choose, i.e. family, friends, employees.
A person is required to take RESPONSIBILITY to do
what he or she says they will do
Overview of Eligibility
SSI and SSDI






Call Social Security at 1-800-772-1213; 0r Apply On-Line
www.socialsecurtiy.gov; or visit local SSA Field Office
Collect information about the disability and about work
history
Complete Forms from SSA—Make copy
Keep appointment with SSA
SSA moves file to DDS (Disability Determination Service)
for medical review, returning decision to SSA
SSA sends letter of eligibility determination
Approved; Denied (reconsideration); 2nd denial (Appeal)
CHECKLIST FOR SUCCESS
 Make copies of all documents you give to SSA: both
forms you fill out and evidence you want them to have
that are in your possession. Do not LOSE your copies!!
 When you call SSA (1-800-772-1213) keep a record:
 Date
 Name of person you spoke to
 What you asked
 What they told you
Checklist-continued

Promptly open and read ALL mail sent by SSA. When
SSA gives a deadline response date, compliance within
that date is required. Seek help immediately for help.
Keep ALL paperwork, letters, and mailing envelopes in
your file. Do Note Lose!!!!

You must report pay stubs each month to SSA. Be sure
to report to correct field office (Zip Code of the payee is
the key). Report by mail, and/or walk into the office.
Keep wage records in your file. If on SSI & SSDI report
to each program separately.
Checklist-continued

If a person receives SSI and/or Medicaid,
remember to keep all resources/assets below
$2,000/individual $3,000/couple in any month to
maintain eligibility. Medicaid eligibility may vary
from State to State.

When a major life change occurs (address,
marriage, employment, lose of job, divorce,
children) report to SSA immediately, both to 1800-772-1213 and to local SSA field office.
DEFINITION OF DISABILITY
The SSA defines disability for both SSI and
SSDI programs as the inability to engage in
Substantial Gainful Activity (SGA) by
reason of any medical (physical and/or
mental or blind) impairment.
Disability must have lasted or be expected to
last for a continuous period of not less than
12 months or result in death.
Definition
Substantial Gainful Activity
SGA=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 annual SGA level
amount.
Eligibility of Benefits
Supplemental Security Income-SSI





Unearned Income (Not Wages)
• SSDI, VA, Annuities
Income (Earned Wages)
• 12 months no SGA income
• SGA factor during initial eligibility
• Once eligible SGA non-issue
Resources (NOT Wages or Unearned
Income
• $2,000/month/Individual
• $3,000/month/Couple

Social Security Disability Insurance-SSDI
Required Work Credits in F.I.C.A

5 Month Waiting Period

SGA
•
•

Medical Eligibility
• Medical Eligibility Defined

DAC –Disabled Adult Children
• Disability Prior to Age 22
• Never Legally Married-NOT On Title II
Benefits
• Insufficient FICA-or Higher Parent Amout
• Parent FICA Opens(Dies;Retires;Disabled)
• Possible continuation of Medicaid-Pickle
Amendment
Medicare (Medical Insurance)
• 24 months upon eligibility
• Part A-Free-Part B/D-Premium
Medical Eligibility
• Medical Eligibility Defined
Medical Insurance-MEDICAID
• SSI connected, State Administered
12 months consecutive-initial eligibility
Factor During EPE and Beyond

SSI and Medicaid
Resource Example
The SSI/Medicaid programs have specific resource
limitations in order to be eligible to receive and/or
maintain benefits. The monthly maximum amount for
SSI (Federal) is $2,000/individual $3,000/couple.
Medicaid (State) may vary the allowed amount for
eligible status based on State rules. (Neither must not
exceed the specific amount at the beginning of each
month).
The Resource limitation is set by statute and is countable
real or personal property including cash.
SSI Resources
Counted-Maybe

Countable by SSA (maybe):
• Cash, Savings Accounts, Stocks, Bonds, CD’s,
IRA’s etc.
• Land (Owned but not lived on)
• Anything owned which could be converted to
cash and used for Food and Shelter (including
utilities)
• Resources of a spouse. Resources of parent if
beneficiary is under 18 (minor).
SSI Resources
(Maybe) Excluded












An owned home you live in and the land it sits on.
Household goods and personal property in total (as of March, 2005)
Clothing someone might give or gift to a beneficiary (as of March 2005)
Burial Space for beneficiary and immediate family
Burial funds up to $1500 for individual and spouse
Life Insurance with a combined face value of not more that $1500
Retroactive SSI or SSDI amount for up to 9 months (Keep receipts on how money is
spent)
Property in Specific Trust
A bank account for Plan for Achieving Self-Support (PASS)
An Individual Development Account (IDA)
Property Essential for Self-Support (PESS)
One automobile, regardless of value (as of March 2005)
1. Employment or medical treatment
2. Modified for use by an individual with a disability
3. Geographic climate, terrain, distance, or similar factors impeding the
performance of essential daily activities.
SSI Wage Calculation Formula
SSI and Earned Income (No Unearned Income/No Work Incentives)
Step 1
$________
Earned Income (Gross Wages)
- $ 20.00 General Exclusion
- $ 65.00 Earned Income Exclusion
$_________ Countable Earned Income
Step 2
$_________Countable Earned Income from Step 1
 by 2
Division Answer $________
- $_________Subtract division answer from Countable Earned Income
$_________Final Revised Countable Earned Income
Step 3
$_________Maximum SSI Benefit (Federal Benefit Rate + State
Supplement)
- $________ Final Revised Countable Earned Income (Step 2)
$_________New Monthly SSI Benefit
SSI Wage CALCULATION Formula
Step 4
$_______ Gross Earned Income (Step 1)
+ $_______ New Monthly SSI Benefit (Step 3)
$________Total Monthly Gross Income
Step 5
$_____Gross Earned Income (Step 1)
x 15% = FICA, Medicare, State &
Federal Income Tax, SDI, etc.
- $_____Estimated Tax from Gross Income
$_____Net Income After Taxes
+ $_____New SSI Amount (Step 3)
$_____Total Monthly Cash In Hand
TRIAL WORK PERIOD-TWP
SSDI WORK INCENTIVE
Unless medical recovery is determined, (SSDI) beneficiaries are entitled to a 9
month Trial Work Period (TWP) for testing work skills while maintaining
the monthly cash benefits. During this TWP full benefit checks will continue
regardless of the amount of money earned. The 9 months of TWP do not
need to be earned in a row.

TWP months are counted when an individual earns a specific amount of income.
(Determined January 1 each year by SSA)

The TWP ends only when an individual has 9 months of TWP within a 60 month
consecutive period of time (5 years).

Once all 9 months of TWP have been earned within the 60 month window a
person then enters Extended Period of Eligibility (EPE).
EXTENDED PERIOD OF ELIGIBIITY (EPE)
SSDI WORK INCENTIVE

At the conclusion of the 9 month TWP beneficiaries will immediately enter into the 36 month
EPE as long as the medical eligibility continues.

The 36 month period begins in the month following the 9 month TWP whether a person is
determined to be earning SGA or not.

During EPE cash benefits continue only for months SGA is not earned. Any month SGA is
earned the individual is not eligible for the cash benefit. The first month of SGA (grace
months) benefits continue. Next two months are considered grace months and if SGA is
earned benefits continue.

When EPE is complete, a person earning gross wages below SGA will continue to receive a
benefit check as long as medical eligibility continues. If a person is earning SGA or above
and the EPE is completed, a person is no longer eligible for a cash benefit.

For self-employment, an individual determination of SGA will be established during EPE.
An SSDI claims representative will look at hours and income when making SGA
determination.
If a person needs support in order to earn income document and record the time
and activity of support in order to determine if earnings are actually SGA.
(See Work Incentive Subsidies and Impairment Related Work Expenses).
WORK INCENTIVES
COMPARISON CHART
Social Security Disability Insurance
SSDI
Supplemental Security Income
SSI
Trial Work Period
Continuation of SSI
Extended Period of Eligibility
Student Earned Income Exclusion
Continuation of Medicare
1619 A and 1619 B
Impairment Related Work Expense
Impairment Related Work Expense
Section 301
Section 301
Special Rules for the Blind
Blind Work Expense
Subsidies
Subsidies
Ticket To Work
Property Essential for Self-Support
Expedited Reinstatement
Plan for Achieving Self-Support
Ticket To Work
Expedited Reinstatement
WORK INCENTIVES PLANNING
AND ASSISTANCE

Work Incentives Planning and Assistance (WIPA) Program
http://www.socialsecurity.gov/work/ServiceProviders/wipafactshee
t.html


The goal of the WIPA program is to better enable SSA beneficiaries
with disabilities to make informed decisions about work. Each
WIPA project has Benefits Specialists called Community Work
Incentives Coordinators (CWIC) who will:
1. Provide work incentives planning and assistance to beneficiaries
of SSI an/or SSDI with disabilities; and
2. Conduct outreach efforts to those beneficiaries who are
potentially eligible to participate in federal or state work
incentives programs.
WIPA Agencies by State For more specific information, visit the
state-by-state contact list AT ABOVE ADDRESS.
DISABILITY PROGRAM
NAVIGATOR INITIATIVE






Disability Program Navigator (DPN)
http://www.doleta.gov/disability/onepagers/dpn_factsheet_aug
ust2006.pdf
The Department of Labor (DOL) and the Social Security
Administration (SSA) have jointly established a new position, the
Disability Program Navigator, within DOL’s One-Stop Career
Centers.
The Disability Program Navigator helps people with disabilities
“navigate” through enormous challenges of seeking work,
complex rules surrounding entitlement programs, and provides
work support programs now available at DOL funded One-Stop
Career Centers.
Disability Program Navigators by State
For more specific information, visit the state-by-state contact list.
Area Work Incentives Coordinator
SSA-AWIC

Area Work Incentives Coordinator (AWIC)
http://www.ssa.gov/work/Beneficiaries/awic.html
 AWICs provide assistance to personnel in field offices on
employment supports & outreach by:
 Coordinating and/or conducting local public outreach on
work incentives;
 Providing, coordinating, and/or overseeing training for all
personnel on SSA’s employment support programs;
 Handling some sensitive or high profile disability work-issue
cases, and;
 Monitoring the disability work-related issues in their
respective areas.
SSI and Earned Income Tax Credit
NOTE: On July 18, 2005, SSA issued Final Rules amending the
SSI regulations by making technical revisions to rules on
income and resources based on the Social Security
Protection Act (SSPA) of 2004 and several other statutory
changes. These revisions, among other things, clarify that
certain types of income are excluded when determining SSI
income and resources. Any unspent portion of Federal
income taxes related to an Earned Income Tax Credit (EITC)
is excluded from resources for a time period of 9 months
following the month of receipt.
For more information see:
http://www.ssa.gov/regulations/articles/rin0960_ae79f.htm
States may have different rules for how they look at a persons
resources and eligibility to both SSI and/or Medicaid in a
State. States decide what counts as income and resources
when there is a State Supplement to SSI and when
administering the Medicaid Program. Important to
understand State rules as well as the Federal rules above.
Individual Development Accounts

An IDA is a special savings account for people with low
incomes. The money set aside by a person who is earning
wages in an IDA Account will be matched with another dollar
or more for every dollar saved by the individual. An EITC is
looked at as earned income and can be matched in and IDA
program.
 Savings and matched money can be used for education, starting
a small business, or first time home purchase.
 A person will learn budgeting, saving, banking and credit
information
 Individuals in an IDA can also receive one-on-one counseling
and other training
 Match dollars come from a combination of Federal money and
other business, or organizations supporting Asset Development.
 A person who is eligible for SSI and/or Medicaid who has an
approved IDA account will not have money that is set aside for
the IDA count as a resource.
Websites of Importance














http://www.socialsecurity.gov Social Security Administration Home Page
http://www.socialsecurity.gov/work Social Security Administration Work
http://www.fdhc.state.fl.us/ Florida Agency for Health Care Admin
http://www.floridajobs.org/ Agency for Workforce Innovation
http://www.dcf.state.fl.us/ess/ssifactsheet.pdf Medicaid
http://www.dcf.state.fl.us/ess/fsfactsheet/pdf Food Stamps
http://www.myflorida.state.fl.us Public Housing Agencies
http://www.advocacycenter.org Protection and Advocacy
http://rehabworks.org Vocation Rehabilitation
http://www.fddc.org Florida Developmental Disabilities Council
http://www.apd.state.fl.us Agency for Persons with Disabilities
http://disability.law.uiowa.edu/dpn Law, Health Policy and Disability Center
http://www.cfed.or IDA Directory
www.reitour.org Real Economic Impact Tour