The Work Incentive & Employment Education Program at LINC

2018 Work Incentives Guide for Workers with Disabilities

The Social Security Administration (SSA) disability benefit programs have guidelines that encourage people with disabilities to return to work or enter the work force for the first time. Known as work incentives these rules prevent the loss of a worker’s cash resources and medical benefits as they earn money from employment and seek to become more self-supporting. The Work Incentive & Employment Education program at LINC seeks to provide relevant, accurate information to Idaho worker’s with disabilities to allow them to make well-informed decisions about working and benefits.

The SSA administers two separate and very different programs that provide supports to people with disabilities (some beneficiaries may utilize both benefit programs at the same time, or “concurrently.”)

  • SSDI-Social Security Disability Insurance-Title II: this program is for those who have worked, paid into the Social Security trust fund, and collected enough “quarters” to qualify; generally associated with Medicare.
  • SSI-Supplemental Security Income-Title XVI: this program is “need-based” and is affected by resources like SSDI, wages from work, child support, etc.; generally associated with Medicaid.

The work incentives for each program and how they are applied/utilized are different, as eligibility for each is based on different criteria. Gross wages from working may affect each benefit differently. Below is a guide including all the work incentives that apply to SSDI and SSI.

SSDI Work Incentives

Trial Work Period (TWP)This is a 9-month period (within a 60 month timeframe; months do not have to be consecutive) during which an SSDI beneficiary can test their ability to work without losing SSDI cash payments and Medicare coverage. During the TWP a worker can earn any amount of money as long as the work activity is reported to the SSA and they continue to have a disabling impairment. Monthly earnings exceeding $850 or 80 hours of self-employment will count as a “service month” (one of the 9 allowed) for the month in which those wages are earned.

Substantial Gainful Activity (SGA) After the 9 months are accumulated, the TWP is complete and the Extended Period of Eligibility (see below) begins unless the SSA reviews the disability case and finds the impairment has medically improved. This may happen if a worker’s monthly wages exceed SGA, a threshold earnings level of $1180 for non-blind or $1970 if statutorily blind, and are found to no longer be disabled for SSA purposes. If this occurs, the worker will have their benefits suspended after a 3-month grace period (one “cessation” and two “grace period” months.)

Extended Period of Eligibility (EPE) For 36 month/3 years consecutive after the TWP is completed an SSDI beneficiary who continues to be medically disabled can earn an SSDI check for each month they earn below the SGA threshold. Months in which SGA is exceeded will result in no SSDI eligibility (outside the 3 grace period months.) After the EPE is completed the worker must earn less than SGA to maintain the SSDI benefit.

Medicare Continuation Medicare can continue for up to 93 months after successful completion of the TWP provided the individual continues to be medially disabled.

Impairment Related Work Expense (IRWE) IRWEs are documented expenses that a worker incurs due to their impairment that are necessary to work or perform a job. SSA deducts IRWEs from gross earnings (before taxes) during the EPE and afterward to determine if the worker is earning above SGA levels for initial or continuing SSDI eligibility. Examples include: vehicle modifications, transportation costs like taxis or driver assistance, specialized work-related equipment, attendant care services performed at work (and some at home,) wheelchairs, braces, and many prosthetics, residential modifications, and others.

Unsuccessful Work Attempt (UWA) This short-term safety net provision allows workers who are unable to work at the SGA level for more than 6 months to gain/retain their SSDI. There may be multiple UWA as long as criteria are met and earnings are not counted during an UWA.

Expedited Reinstatement of Benefits (EXR) This longer-term safety net provision allows a worker who lost benefits due to wages and later loses employment/works less due to their impairment/disability to have their SSDI reinstated without a new application. To qualify for EXR a worker must have been previously eligible, lost their benefit by working above SGA, requests reinstatement within 60 months of the last month of entitlement and the disability is the same as the one that was the basis for the original claim.

Section 301/Medical Recovery During Vocational Rehabilitation SSDI eligibility continues for individuals who medically recover from their impairment but are actively participating in a vocational rehab program (schools, Ticket to Work, IDVR, etc.) that will likely lead to self-support until participation ends or the VR program is completed.

Medicaid for Workers with Disabilities

Medicaid for Workers (MWD) is not to be confused with “regular” Medicaid! While available to both SSI and SSDI workers, MWD is most often used by SSDI workers (due to 1619b for SSI beneficiaries) and is thus included with the SSDI work incentives.

MWD allows people with disabilities who are employed/self-employed to “buy-in” to Medicaid by paying a premium based on the amount of gross earned income (and some SSDI if received.) For example, if a single worker earns $1207 or less the monthly premium is $0; $1208-$2269 the monthly premium is $10 and so on up to the wage threshold of $4538 with a monthly premium of $170 (data as of 2015.) This equates to nearly $55,000 per year before MWD eligibility ends!

Standard resource limits for regular Medicaid do not apply for MWD (up to $10,000, SSDI/retirement accounts, up to 2 vehicles, homes and other resources are not counted toward the limit unlike regular Medicaid) and workers can earn substantial amounts of money each month and still qualify. A worker does not have to be receiving any SSDI/SSI benefits to qualify for MWD! They must only be found “medically disabled.”

SSI Work Incentives

2018Federal Benefit Rate (FBR; the maximum SSI benefit a beneficiary may receive per month in 2018:) $750 individual/$1125 for couples

2018 Resource Limit:$2000 ($3000 for couples;) a beneficiary cannot have more than $2000 in the bank to be qualified for SSI!

SSI Notes:

  • Gross wages above $85.00/month (SSA Earned Income Exclusion: $65; General Income Exclusion: $20) will result in the lessening/loss of SSI cash benefits.
  • The higher the gross wages from working the lower the SSI cash payment
  • After the $85.00 in exclusions, for every $2 the worker earns $1 is deducted from the SSI check
  • Unearned income like SSDI, unemployment benefits, child support etc. may also affect SSI and other “needs-based” benefits like food stamps, housing, etc.

Retaining Medicaid While Working

1619(a) Continued Medicaid coverage is the primary benefit of this work incentive which states that a worker’s SSI cash payment is reduced proportionally to earnings rather than losing the SSI outright. 1619(a) allows for monthly earnings up to $1585.00 (the SSI Break-even Point/BEP) before all SSI cash payment eligibility ends (*loss of a monthly SSI cash benefit to wages does not mean the worker is removed from the SSI benefit indefinitely!)

1619(b) Continued Medicaid coverage is the primary benefit of this work incentive which states that an individual’s Medicaid coverage can continue even if earnings, along with any other income, become too high to receive an SSI cash payment. Additionally the worker must need Medicaid in order to work or continue working and earnings are below the Idaho threshold level of $39,943(2017) needed to replace the equivalent value of SSI/Medicaid coverage in Idaho.

Student Earned Income Exclusion (SEIE) Under this work incentive earnings up to $1820 per month, up to $7350 per year, are not counted for SSI income purposes for a student with a disability or blindness who is regularly enrolled in school up to age 22 (regularly enrolled for college: 8 hours/week; grades 7-12: 12 hours/week; training course: 12-15 hours/week.)

Plan to Achieve Self-Support (PASS) A PASS is a vocational plan for disabled or blind individuals interested in rehabilitation and becoming self-supporting (with no need for any cash benefit) or less dependent on benefits by means of a viable, realistic, and achievable occupational goal decided upon and pursued by the individual. Vocational, training, and educational expenses incurred by an individual can be returned/reimbursed through higher SSI payments under an approved plan. For example, this may include supplies to start a business, school tuition, equipment/tools, vehicles—anything needed to achieve the stated work goal. Income or resources other than SSI (SSDI, wages, unemployment, etc.) must be used to fund the plan, and the PASS is not intended only for SSI recipients, as SSDI beneficiaries may also potentially qualify.

Impairment Related Work Expenses (IRWE) IRWEs are documented expenses that a worker incurs because of their impairment that are essential for work (see above SSDI work incentives.) For SSI workers, half the cost of any IRWE can be recovered through increasedSSI payments and IRWE can also be used to establish initial SSI disability status and eligibility.

Blind Work Expense (BWE) BWEs are documented expenses that blind workers incur due to their disability that are necessary to work. Examples may include adaptive devices, guide animals, and many other items that would not qualify as a standard IRWE. Blind individuals may be able to recover 100% of those expenses through increased SSI cash payments.

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