Florida Benefits Information Resource Network
Presents
“THE CHANGING FACE
OF
BENEFITS”
April, 2009
Developed By
Sharon Brent
Director of Training and Technical Assistance
National Disability Institute
Edited by LeeAnn Herman, APD MIG Coordinator
and Melinda Coulter, APD F-BIRN Coordinator
Sponsored by the Agency for Persons with Disabilities (APD)
using funds from
Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
Medicaid Infrastructure Grant (MIG) # 1QACMS030231/02
Serving as a Resource on How SSA’s Work Incentives Can Impact the Competitive Employment of People with Disabilities
· You do not need to be the expert!
There are people who are experts in ALL of this complex information and who have many, many years of technical experience (many of whom also have personal experience as beneficiaries or parents of beneficiaries, and now work within the field).
· You do need to know how VALUABLE this information is to individuals with disabilities!
It is critical for individuals to receive accurate and detailed information regarding SSA and other work incentives in order to make informed choices about work which affects their livelihood.
· You do need to help educate people about available resources on SSA and other work incentives, since education can help alleviate their fear.
Many people are afraid to even discuss their benefits and the various work incentives because it can all sound very complex. However, you can help lessen the anxiety people feel by providing good, accurate resources that break down the information.
· You do need to know about the variety of useful tools and resources that can be passed on to customers.
There are many useful tools and resources available on a wide variety of topics including: how to find out if a person may be eligible for benefits, how to apply and file for benefits, who can help in understanding the work incentives, which resource can assist with appeals, and many other topics.
· You do not need to know how to assist a customer in filing for benefits or in utilizing the various work incentives.
There are many organizations that offer support services to assist individuals with applying for disability benefits and communicating with SSA, including Centers for Independent Living and some social workers and counselors whose jobs involve case management. There are also several different types of Work Incentives Specialists who can work with individuals one-on-one and assist them in making informed decisions.
TABLE OF CONTENTS
SSA & WORK INCENTIVES SERIES
______
Overview of Eligibility – SSI and SSDI 7
Initial Eligibility Determination 9
SSA Definitions 11
Eligibility of Benefits – SSI 13
SSI Calculation Sheet 15
Eligibility of Benefits – SSDI 17
Work Incentives Comparison Chart 19
SSDI-ONLY Work Incentives 21
SSI-ONLY Work Incentives 23
SSDI AND SSI Work Incentives 27
Program Resources 31
· Medicaid Buy-in Programs and Waivers……………………………….……………32
Other Work Incentives
· Individual Development Account (IDA)………………………………………………35
· Earned Income Tax Credit (EITC)……………………………………………………37
· Housing and Urban Development (HUD)……………………………………………42
· Work Opportunity Tax Credit………………………………………………………….43
Alphabet Soup & Terminology 47
Glossary of Terms 51
Websites of Importance……………………………………………………………………… 57
Handout Samples………………………………………………………………………………65.
SSA & WORK INCENTIVES
Overview of Eligibility – SSI and SSDI
______
Ø Call Social Security 1-800-772-1213, TTY 1-800-325-0778
Ø Complete Forms from SSA
Ø Collect information about the disability and about work history
Ø Keep appointment with SSA
Ø SSA moves file to DDS (Disability Determination Service) for medical review, returning decision to SSA
Ø SSA sends letter of either eligibility determination
Approved; or if Denied, Reconsideration; and/or 2nd Denial, Appeal
SSA & WORK INCENTIVES
Initial Eligibility Determination
______
Step 1: Disability Report Form-Application
A. Call 1-800-772-1213, TTY 1-800-325-0778; On Line www.socialsecurity.gov; local field office:
1. Interview will take place and information will be entered into the computer securing the date of application.
2. Paperwork will be mailed that is required to be completed and returned within a timeline.
3. Computer generated document will also be mailed to be signed for accuracy during the phone interview.
4. Before you mail the documents, copy all documents after they are filled out, including the computer generated document for signature sent by SSA.
5. Second interview will be set up to take place:
A. By phone; or
B. Face to face in a local SSA field office.
Step 2: SSA will send Disability Report Form to the Disability Determination Service (DDS)
A. Medical history information collected by DDS;
B. Information received will be reviewed;
C. DDS may or may not request information such as:
1. Work History
2. When disability began
3. Medical treatment received
D. DDS may request, on behalf of SSA, a medical exam
(SSA pays for exam by a physician chosen by SSA).
E. Determination will be sent to SSA (estimated 90 days)
1. Eligible for benefits;
2. Denial (60/days apply for reconsideration); and
3. If denial at reconsideration stage, next step is to Appeal within 60/days.
(This is the Administrative Law Judge System).
CHECKLIST DEVELOPING AN INITIAL APPLICATION - SSI/SSDI
Ø Review the application before you make contact to SSA
a. Get copy on the SSA website www.socialsecurity.gov
b. Look at the Adult Starter Kit also on website
c. Review with an advocate or your case manager, doctor, service provider – They might help fill out forms – Third Person vs. First Person
Ø Review the definition of the disability according to SSA
a. Understand the SSA medical definition:
http://www.ssa.gov/disability/professionals/bluebook
b. Understand the value of Substantial Gainful Activity
c. Think about the person’s most difficult day
Ø Gathering evidence while preparing the application
a. Making this part of the application
b. Who are the sources
c. Requesting letters related to ability to work and disability
Ø If possible get a vocational assessment
a. Current within the last 12 months
b. Detail of a person’s work history
Ø Know the application process and the timelines
a. Fill out application then
b. COPY
c. Always remember what you tell SSA
SSA & WORK INCENTIVES
SSA DEFINITIONS
______
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
Ø SGA is the performance of significant mental and/or physical duties for profit.
Ø 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.
Ø To meet this test a person must not be working, or if working earning less than the annual SGA level amount.
Definition of Continuing Disability Review Process (CDR)
Ø The Social Security Administration (SSA) is required by law to periodically determine whether beneficiaries continue to be disabled and therefore continue being eligible to receive either SSI and/or SSDI.
Ø Under SSA’s medical improvement standard, generally, once individuals are receiving benefits, evidence must show that medical improvement related to the ability to work and perform SGA can occur. This must occur before SSA can determine that individuals are no longer eligible to receive benefits.
· CDR’s involve an interview at the local SSA office
· Filling out a form about current medical information (similar to initial eligibility process)
· SSA will forward form to DDS for review and medical determination
SSA & WORK INCENTIVES
Eligibility of Benefits – SSI
______
Supplemental Security Income-SSI
Ø Unearned Income (Not Wages)
• SSDI, VA, Annuities
Ø Income (Earned Wages)
• 12 months no SGA income
• SGA factor at initial eligibility
• Once on SSI, SGA is no longer an issue
Ø Resources (NOT Wages or Unearned Income)
• $2,000/month/Individual
• $3,000/month/Couple
Ø Medical Eligibility
• DDS (STATE) Determines Medical Eligibility
Ø Medicaid (Medical Insurance)
• SSI connected, State Administered
• Regulations may be different State-to-State
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. (These must not exceed the specific amount at the beginning of each month).
SSI Resources Counted-Maybe
· Cash, Savings Accounts, Stocks, Bonds, CD’s, IRA’s etc.
· Land (Owned but not lived on)
· Anything owned which is converted to cash and used for Food, Shelter and Utilities
· Wages and resources of a spouse and Wages and resources of parent if beneficiary is under 18 (minor)
SSI Resources Excluded-Maybe
· 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 than $1,500
· Retroactive SSI or SSDI amount for up to 9 months (Keep receipts on how money is spent)
· Approved Specific Needs Trust
· A bank account for Plan for Achieving Self-Support (PASS)
· Earned Income Tax Credit (EITC)
· An Individual Development Account (IDA)
· Property Essential for Self-Support (PESS)
· One automobile, regardless of value (as of March 2005)
o Employment or medical treatment
o Modified for use by an individual with a disability
o Geographic climate, terrain, distance, or similar factors impeding the performance of essential daily activities.
SSA & WORK INCENTIVES
SSI Wage Calculation Sheet
______
Unearned Income and Earned Income and Work Incentives
Step 1
Unearned Income (Including SSDI) $
General Exclusion - $ 20.00 (if no unearned income, add $20 to $65.00 Earned Income Exclusion)
Countable Unearned Income $______
Step 2
Gross Earned Income $
*Student Earned Income Exclusion - $
New Countable Earned Income $
Earned Income Exclusion - $ 65.00
New Countable Earned Income $
*Impairment Related Work Expense - $
New Countable Earned Income $
¸ by 2 = $
Subtract from New Countable Income - $
New Countable Earned Income $
*Blind Work Expense (if Blind) - $
Total New Countable Earned Income $
Step 3
Total Countable Unearned Income $
Total New Countable Earned Income + $
Total Countable Unearned & Earned Income $
Step 4
Total Countable Unearned & Earned Income $
*PASS Plan - $
Total Countable Income $
Step 5
SSI FBR (include any State Supplement) $
Total Countable Income (Step 4) - $
New Adjusted SSI Payment $
*Italic indicates a work incentive
SSA & WORK INCENTIVES
Eligibility of Benefits – SSDI
______
Social Security Disability Insurance-SSDI
Ø Required Work Credits in F.I.C.A
Ø 5-Month Waiting Period + 12 months non-SGA income (Medical Connection)
Ø SGA
§ Initial Eligibility
§ During EPE and Beyond
Ø Medical Eligibility
§ DDS (STATE) Determines Medical Eligibility (Florida Dept. of Health)
Ø DAC –Disabled Adult Children; (now referred to as “Childhood Disability Benefit or CDB”)
§ Disability Prior to Age 22
§ Never Legally Married to a non-Title II beneficiary
§ Insufficient FICA or less than DAC parent connected amount
§ Parent is deceased, retired or disabled
§ Possible continuation of Medicaid as DAC eligible.
Ø Medicare (Medical Insurance)
§ 24 months upon eligibility determination
§ Part A/Hospitalization Free-Optional Part B and D-Has Premium Cost
SSA & WORK INCENTIVES
Work Incentives Comparison Chart
______
Social Security Disability Insurance (SSDI) Supplemental Security Income (SSI)
Trial Work Period (TWP) Continuation of SSI
Extended Period of Eligibility (EPE) Student Earned Income Exclusion (SEIE)
Special Rules for the Blind (Higher SGA) Blind Work Expense (BWE)
Continuation of Medicare 1619(a)
1619(b)
Property Essential for Self-Support (PESS)
Plan for Achieving Self-Support (PASS)
SSDI and SSI Work Incentives
Impairment Related Work Expense (IRWE) Impairment Related Work Expense (IRWE)
Section 301 Section 301
Subsidies Subsidies
Ticket To Work Ticket To Work
Expedited Reinstatement Expedited Reinstatement
SSA & WORK INCENTIVES
SSDI-ONLY Work Incentives
______
Trial Work Period (TWP)
Unless medical recovery is an issue, SSDI beneficiaries are entitled to a 9-month Trial Work Period (TWP) for testing work skills while maintaining 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.
Ø TWP months are counted when an individual earns a specific amount of income. (Determined January 1 each year by SSA)
Ø The TWP ends only when an individual has 9 months of TWP within a 60-month consecutive period of time (5 years).
Ø 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 Eligibility (EPE)
At the conclusion of the 9-month TWP beneficiaries will immediately enter into the 36-month EPE as long as the medical eligibility continues.
Ø The 36-month period begins in the month following the 9-month TWP whether a person is determined to be earning SGA or not.
Ø 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.
Ø 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.
Ø 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.