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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”
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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
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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
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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
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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 = 500500/2 = 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
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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
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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
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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
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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
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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
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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)
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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.
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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.
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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
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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
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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
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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
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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.
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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
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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).
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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)