Transcript No Slide Title

Social Security Administration
SSA Disability Benefit Programs
Social Security
• Based on a
worker’s earnings
• Family members
possibly entitled
Supplemental Security
Income (SSI)
No work requirement;
income, resources are
factors
Only for individual,
not family
Definition of Disability
Same for Both Programs
• Physical/mental impairment
expected to last (or has lasted)
12 months
&
• Impairment prevents worker
from engaging in
“Substantial Gainful Activity” (SGA)
What is “SGA”?
• “Gainful activity” is work
• To be considered “substantial,”
gross earnings must be
at least $940* monthly
* $1,570 for blind
Disability “Onset Date”
• Refers to earliest date condition
meets medical requirements
&
• Person was not working
above SGA level ($940 monthly)
Who Qualifies for
Social Security Disability Benefits?
• Worker - filing on own work record
• Disabled widow(er) -
filing on deceased spouse’s record;
minimum age 50
• Disabled Adult Child -
filing on parent’s record;
over age 18, disabled before 22
To be Insured,
Workers need “Credits”
• $1,050 earnings = one credit
• Can earn maximum of four per year
For Worker, Age at Onset
Dictates Credits Required
•Age 31 or older:
- 20 credits in 40-credit period pre-onset
•Age 24 to 30
- credits for half the time from 21-onset
• Under Age 24
- 6 credits in three-year period pre-onset
Who Qualifies for SSI Benefits?
• Categories of recipients
- aged (65 and older)
- blind
- disabled adults and children
• Receive cash benefits, Medicaid
SSI Income Limits
• Federal maximum monthly payment,
no other income:
- $637 for individual
- $956 for couple (both on SSI)
• If other income, $20 exclusion applies
- e.g., $500 Social Security
results in $157 federal SSI
SSI State Supplement – Penna.
• State adds up to $27.40 or $48.30
in separate check
exception: residents of
Medicaid facility only due
federal payment of $30
SSI - Resource Limits
• Resources: cash, bank accounts,
bonds, stocks,
non-home property
• Limits:
$2,000 individual
$3,000 couple
Filing Disability Application –
Online at www.socialsecurity.gov
• For Social Security disability,
both medical and non-medical
portions can be completed online
• For SSI, only the medical portion
can be completed online;
non-medical must be completed
in-person or by telephone
Filing Disability Application –
By Telephone or In-Office
• Call 1-800-772-1213,
weekdays 7:00 a.m. to 7:00 p.m.
• Set up telephone/in-office appointment;
will be sent “Disability Starter Kit”
in advance
Speeding Up Application
• Average processing time: 92 days
• Applicant can help by supplying:
- names, dates, etc., of doctors,
hospitals, clinics, & institutions
- names of medications
- medical records, lab tests
summary of jobs, type of work
Who Makes Decision?
• Medical information sent to
Disability Determination Services
(DDS)
• Disability evaluation specialist,
physician review evidence,
make determination
If Social Security Claim Approved…
• Benefits due after 5-month waiting period
e.g.,
onset date - March 10, 2008
entitlement begins - September 2008
paid - October 2008
• Medicare begins after 24 months
of entitlement:
September 2010
If SSI Claim Approved…
• Benefits usually retroactive
to effective date of application
• Medicaid entitlement coincides
with benefit entitlement
If Claim Denied…
• Upon receipt of denial notice,
60 days to file hearing
• If hearing denied,
other appeals remain:
- Appeals Council Review
- Federal court review
Medicare
• Federal health insurance program
administered by Centers for Medicare
& Medicaid Services (CMS)
• SSA makes eligibility determinations,
enrolls people, gets card issued
Medicare – Who Gets It?
• 65 or older
- eligible for Soc. Sec. benefits, or
- worked 10 years for government entity,
paid Medicare tax
• Under 65
- entitled to Soc. Sec. disab. 24 months
(no waiting period for ALS)
or
kidney failure (& insured for benefits)
Traditional
Parts of Medicare
• Part A - Hospital Insurance
- covers inpatient care in hospital,
skilled nursing facility,
some home health care, hospice;
but .... long-term care limited
- length of in-patient stay
dictates amount of coverage
- no premium, but financed by
worker’s 1.45% tax
Traditional
Parts of Medicare
• Part B - Medical Insurance
- outpatient procedures,
medical supplies
- $96.40 standard monthly premium ...
.... but, sliding-scale premium
for singles with income $82K+,
couples with $164K+;
affects 4% of beneficiaries
Another “Part” of Medicare
• Part C – Medicare Advantage Plan
- health plan option, like Medigap plan;
receive all health care services
thru provider organization
- includes HMOs, PPOs, special needs
plans, private fee-for-service plans
- pay Part B premium & plan premium;
lower out-of-pocket costs,
more covered services
Newest Part of Medicare –
Part D Prescription Drug Plan
• Began 2006, CMS responsible
- open to all Medicare recipients
- choose from plans of private companies
- important: compare current plan
- enroll soon after applying for Medicare;
later, can only enroll Nov. 15 – Dec. 31
Part D “Extra Help”
• SSA responsible
• People of limited means can get help with:
- premium, deductible, co-pays
• Must apply, unless in “deemed” category
• Apply online or use paper application
Work Incentives
Social Security
&
Supplemental Security Income
(SSI)
Social Security Beneficiary
Returning to Work
• Trial Work Period
- can work in nine months
- regardless of earnings, benefit paid
- to count as TWP month,
earnings at least $670
- nine months can be scattered
over 60-month period
At conclusion of TWP,
ongoing work evaluated
• If work “not substantial” (under $940),
benefit continues
• If work “substantial” ($940+),
benefit paid months 10-12,
then suspended
Months #13 through #45 ....
Extended Period of Eligibility
• After 12-months TWP & grace months,
“EPE” runs 33 months, to month 45
• Benefit unpaid for months #13-45
whenever SGA ($940+) performed
• Likewise, benefit paid for EPE months
under $940
Impairment-Related
Work Expenses
• After TWP completed, the costs of some
impairment-related items, services needed to
work can be deducted from earnings in
determining SGA ...
$1100 earnings
- $165 IRWE
$935 = no SGA
• Individual must not be reimbursed for item,
cost must be “reasonable,”
and item paid for in a work month
What about Work after EPE?
• Month #45 is last EPE month
* SGA in month 46 or later
terminates eligibility
* But .....
“Expedited Reinstatement”
* If earnings fall below SGA, benefit
reinstated...no new application needed
* Request must be made within
60 months of termination
* Must have same disability
* Can receive up to six months of benefits,
including Medicare
Continuation of Medicare
• All disability recipients are
Medicare-eligible after
24 months of benefit entitlement
• After TWP, Medicare can continue
for 93 months regardless of SGA
SSI Recipient Returning to Work
• No TWP, no EPE
• SGA not an issue
• Earnings reduce payments,
but benefits continue as long as
income, resource limits not exceeded
How Earnings Reduce SSI
• Unlike unearned income,
earnings don’t reduce SSI dollar-for-dollar
• Subtract $65 ($85) from monthly gross
earnings; half of remainder counts against SSI
•
$600 earnings
-$85 exclusion
$515 remainder
Half of $515 =
$257.50 SSI reduction
Monthly Earnings Cut-off
• Earnings of $1,359+ results in no SSI payable
•
$1359 earnings
-$85 exclusion
$1274 remainder
• SSI limit:
Half of $1274
is
$637
$637.00
- $606.40 countable income
0 = no SSI payable
Impairment-Related Work Expenses
• Remember, SGA not an issue for SSI once on;
but IRWE reduces countable earnings
•
$1267.80 earnings
-$85.00 exclusion
$1182.80
$1182.80
- $52.00 IRWE
$1130.80
Half of $1130.80 = $565.40 countable earnings
•
SSI limit
$637.00
- $565.40 countable income
$71.60 SSI payable
Continuation of Medicaid
• If earnings too high to allow SSI
payment, Medicaid still continues if ...
.... yearly earnings don’t exceed
Pennsylvania threshold:
$28,554
Work Exclusion for Students
• Must be under age 22
and in regular school attendance
• Up to $1,550 earnings
excluded per month
• Maximum $6,240 excluded yearly
Plan for Achieving Self-Support (PASS)
• Use or setting aside of income, resources
to achieve work goal, increase prospects
for self-support
* Excluded income, resources don’t count
against SSI, thereby increasing payment
* Must be in writing,
estimate time period for attaining goal
Ticket to Work
• Gives disabled choice in obtaining
free rehabilitation & vocational services
• Provides more incentives for disabled
to work & lessen dependence on public benefits
• Removes barriers that make people choose
between medical coverage and work
The Ticket Itself
• New disability recipients, age 18-64,
will be sent Ticket, letter, & booklet
• Ticket certificate can be “used” to obtain free
vocational, employment services from
organizations called “Employment Networks”
- ENs are paid,
but only if disabled individuals work
• Ticket program is voluntary!
Upon Ticket receipt ...
• Recipient not required to do anything;
remember....voluntary program
• But ....if interested in receiving services,
call Program Manager (Maximus, Inc.)
• Later ... take Ticket to an
Employment Network (EN) to obtain services
Employment Network (EN)
• Any agency or instrument of the state, or a
private entity responsible for the
coordination or actual delivery of services
can become EN
• Can be single entity, consortium, or
association of organizations collaborating to
combine resources to serve Ticket holders
Examples of ENs
• State VR agencies
• Any public/private entity providing
appropriate services (job readiness,
placement, voc. rehab., training, etc.)
• Employers offering job training, voc. rehab.,
support, retention, or other types of jobrelated services and/or assistance for the
disabled
ENs Serving Philadelphia
• Currently, 34 ENs signed up
• Seven are based in city
How do People reach ENs?
• SSA contracted with a Program Manager –
Maximus, Inc.
• Maximus recruits, monitors ENs;
also facilitates access to ENs
• When Ticket sent, people referred
to Maximus toll-free number &
www.yourtickettowork.com
Assigning a Ticket
• Before “assigning” Ticket,
person first discusses services, etc., with EN
• EN can refuse to accept the Ticket
• If agreement is reached,
individual work plan which details
desired employment goals is written
• After plan drawn up,
Ticket considered assigned and “in use”
What’s in It for Disabled Individual?
• Ticket-users not subject to medical
Continuing Disability Reviews
as long as making “timely progress”
• “Timely progress”
- assumed in first two years of Ticket use
- in third year, 3 of 12 months must be SGA ($940)
- in fourth year, 6 of 12 months SGA
- in fifth year, 6 of 12 months must be non-pay
What’s in It for ENs?
• ENs paid when Ticket users either:
have earnings which result
in no cash benefit, or ....
have earnings at or above SGA
• ENs, therefore, have vested interest in getting
people back to work
The National Numbers So Far ....
•
•
•
•
10.4 million Tickets sent
192,000 Tickets assigned
One of every 54 Tickets sent out assigned
93% of assigned Tickets have gone
to state VRs, 7% to new ENs
• Note that pre-Ticket, state VRs
“rehabbed” 10,000 people yearly
Another Ticket Partner: WIPA
• SSA awarded contracts to organizations;
called Work Incentives Planning and Assistance
(WIPA) organizations
• They conduct outreach efforts re work incentives,
provide planning and assistance, can also provide
one-on-one counseling, advice, etc.
• Disability Rights Network serves Philadelphia
Another Ticket Partner:
Protection & Advocacy Program
• SSA awarded contracts to
legally-based disability rights agencies to provide
legal representation & other advocacy services
• In Pennsylvania, Disability Rights Network
has the contract