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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
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
• 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
• Disability evaluation specialist,
physician review evidence,
make determination
If Social Security Claim Approved…
• Benefits due after 5-month waiting period
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
• 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)
kidney failure (& insured for benefits)
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
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
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
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 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
- $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
- $52.00 IRWE
Half of $1130.80 = $565.40 countable earnings
SSI limit
- $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:
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
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 &
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