SSI and SSDI Work Incentives

   What are they How do you use them How to avoid problems 1

2 Key Work Questions

 SSI (Title XVI) or SSDI (Title II) ? If both, look at them separately.

 Application or Post-Entitlement ?

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SSDI Work Incentives – Trial Work Period

      9 months in any 60-month period “Services” = $580 gross wages per mo.

“Services” not merely training or therapy No upper limit on wages No effect on benefits Must remain medically “disabled” 3

SSDI Work Incentives – Extended Period of Eligibility

      36 consecutive mo.s after 9th TWP mo.

Continue to be medically “disabled”] No benefit payment in SGA months ($810 gross/mo.; $1350/mo. if blind) Reentitlement w/out new application Medicare continues throughout After EPE, eligibility terminates w/SGA 4

Substantial Gainful Activity (SGA)

    Substantial & gainful $810 gross earnings/month (in 2004), indexed to yearly COLA.

$1350 gross/month (in 2004) if benefits for blindness.

Income averaging during EPE. 20 CFR §404.1574a(d).

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SGA - Continued

     SGA amount is rebuttable presumption Deduct IRWEs Deduct Subsidies Special Circumstances Unsuccessful Work Attempts 6

SSDI Work Incentives – Medicare Coverage

     A creation of the Ticket to Work Act Continues throughout TWP Continues throughout EPE whether or not the recipient performs SGA and is eligible for a benefit payment Up to 4 ½ yrs after EPE eff. 10/00 IF the recipient remains medically disabled 7

SSI Earned Income Exclusion

 Less than ½ of earned income counted.

 Deduct $65 from gross earnings; also deduct $20 unearned income exclusion if not already taken.

 Divide the remainder by 2.

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SSI Earned Income Exclusion Example

$565 gross income – 65 = 500 500/2 = 250 countable earned income SSI payable = 678.39 – 250 = 428.39

Total monthly income = 428.39 + 565 = 993.39

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SSI Work Incentive – Student Earned Income Exclusion

     $1370/month, up to $5520/year of earnings excluded from SSI under age 22, and unmarried, and regularly attending school (college at least 8 hours/week; grades 7-12 at least 12 hours/week; training course at least 12 hours/week) unless reasons beyond control 10

SSI Work Incentives – 1619(a) Special SSI Benefits

      For SSI recipients who perform SGA All the SSI rules apply, EXCEPT Recipient must be doing SGA, AND Recipient must have received SSI for at least 1 prior month, AND Recipient must remain medically disabled Medicaid eligibility continues 11

SSI Work Incentives – 1619(b)

     For SSI recipients who earn too much to get cash SSI benefits.

Must have been eligible for an SSI cash payment for at least 1 prior month Must meet all SSI eligibility criteria except income Must meet “Medicaid Test” Can move between SSI, 1619(a), & 1619(b) without a new application 12

1619(b) - “Medicaid Test”

    Recipient must need Medicaid to work Gross earned inc.insufficient to replace SSI, Medicaid, & public attendant care “Threshold test” - earnings + annual per capita Medicaid exp in recipient’s state ($30,452/year in MA in 2004) Individual threshold possible if earnings higher & individual has high expenses 13

Impairment Related Work Expenses (IRWEs)

       Applies to SSDI and SSI Deduct from gross earned income for SGA & SSI countable income purposes Expense must be due to impairment Must enable recipient to work Recipient must pay Cost not covered/unreimbursed Cost must be reasonable 14

Examples of Deductible IRWEs

     medication needed to control disabling condition medical services (e.g., psychotherapy, PT, OT) medical supplies and devices (e.g., canes, braces, bandages, support stockings) cost of helper animals, including food, licenses, and veterinary services attendant care needed to prepare for work, travel to/from work, and work, including meals, ADLs 15

More IRWEs

    disability-related transportation costs (e.g., taxi cost where disability prevents use of bus/T; van modifications needed for work) impairment-related equipment and assistive devices for work (e.g., screen reader) exterior home modifications such as ramps & railings; interior modifications if self-employed non-medical appliances and devices where needed to control disabling condition (e.g., air cleaner to control respiratory disease) 16

Blind Work Expenses (SSI Only)

    For working people who receive SSI due to blindness.

Expenses that would be IRWEs + Work expenses that are not disability related:   Transportation to & from work Meals at work  Licenses, fees & taxes Apply BWEs after SSI earned income exclusion.

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Unincurred Business Expense (Self-Employed, SSDI Only)

   Contributions made/paid for by others to help business effort. Examples:  Unpaid help from friends, family  Computer bought by Mass. Rehab.

Must be IRS-allowable deduction Deduct cost from net earnings to determine SGA. Does not affect SSI payment amount. 18

Subsidy

   Employer pays more in wages than the reasonable value of services performed (e.g., worker receives more supervision, or is given fewer or simpler tasks than other workers in same job at similar pay).

Specific - amount set by employer.

Nonspecific - compare work in terms of time, skills, and responsibilities, and estimate proportional value of work based on prevailing pay scale. 19

Special Conditions

 Subsidy in the form of services or items provided by someone other than an employer (VR agency, job coach, etc.).

 Value = # hours of job coach or additional supervision X worker’s hourly wage.

 Note: Subsidies and special conditions affect initial SSI SGA determination but not SSI payment amount. Always apply to SSDI.

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Plan for Achieving Self-Support (PASS)

       Can make SSDI recipients and wage earners eligible for SSI Allows recipients to save $$ for other achievable vocational goal Must be designed for recipient, AND Must be specific & in writing, AND Must show how goal will be met, AND Must be approved by SSA PASS Cadre, AND SSA must review periodically 21

301 Voc. Rehab. Rule

     Benefit Continuation Despite CDR Applies to recipients in approved programs of vocational rehabilitation where: Recipient found no longer disabled AND Recipient started the program before disability ceased, AND SSA determines continued participation to result in increased likelihood of permanent removal from benefit rolls 22

Ticket to Work and Work Incentives Improvement Act P.L. No. 106-170 (12/17/99)

     Intent is to enhance voc. Rehab. & employment services choices Allow working recipients to keep health coverage (extended Medicare & new state Medicaid options) Eliminate long re-application process if need to get back on benefits after working Protect working recipients from CDRs Educate recipients about effect of work on benefits.

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Ticket Eligibility

    Certain SSI & SSDI benefit recipients receive a “Ticket” Must be a “recipient” of SSI/SSDI Must be elig. under adult disability std If “MIE,” must pass 1st CDR to be eligible to receive a Ticket 24

Ticket to Work

     Recipients choose Employment Network or Voc. Rehab. & agree on service plan Assign Ticket to EN or VR Follow Ticket use rules 20 CFR 411 Maximus = Ticket program manager No change in other work incentives 25

2 Kinds of CDR Protection

  Ticket Users Only (TWWIIA § 101C):  Effective 1/1/01.  No work-triggered or regularly scheduled medical CDRs while Ticket is “in use.” Long-Term SSDI Recipients (TWWIIA § 111):   Effective 1/1/02.

On SSDI at least 24 months.

  No work-triggered CDRs, but still have regularly scheduled medical CDRs.

No Ticket eligibility or use required. 26

Expedited Reinstatement of Benefits (EXR)

 Eligible for EXR if:   Previously entitled to Title II disability and benefits terminated due to SGA, or Previously entitled to SSI disability or blindness benefits and terminated due to excess earned income or combo of earned or unearned income; and  No longer able to perform SGA for medical reasons; and 27

EXR Eligibility (Cont.)

   Current disabling impairment(s) the same as or related to the impairment(s) for which received benefits previously; and Under a disability using medical improvement review (CDR) standards; and Request EXR within 60 months of termination of benefits. Late requests accepted for good cause.

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EXR Provisions

 6 months provisional benefits pending determination; can’t be overpayment.

 Initial Reinstatement Period: After 24 non-SGA months, new TWP, EPE, and EXR available (Title II). After 24 months of SSI payment, including 1619(b), new EXR available (Title XVI). 29

New Services Under TWWIIA

 Benefit Planning Assistance & Outreach: benefit planners available to SSI/SSDI recipients, with or without Tickets, to advise about effect of work on all benefits (Project IMPACT and BenePlan)  Protection and Advocacy Services: legal information, advocacy and representation for SSI/SSDI recipients, with or without Tickets, to overcome barriers to work (Disability Law Center) 30

SSA Staff & Procedures to Help with Work

    Work Incentive Liaisons Area Work Incentive Coordinators Modernized Return to Work System Benefits Query (BPQY) 31