Overview of the Work Incentives for Social Security Disability Benefits

Ambassador OrientationApril 9, 2010

Presented by:Karla BellCalifornia Health Incentives Improvement ProjectSan Diego State University Interwork Institute

Reasons to Work

More income Independence Learn New Skills Meet New People Build Assets Increase

Retirement Tax Credits

Social Security Administration (SSA)

1300 local Field Offices10 Regional OfficesOESP (Office of Employment Support

Programs)Oversees Ticket to Work and WIPA projects

Over 60,000 employees

Local SSA Field Office

Hierarchy and Individuality of Field Offices (aka District Offices) Service Representative (SR)

Usually first point of contact when an individual visits SSA Assesses situation, answer questions, investigates &

resolves problems Claims Representative (CR)

Help to establish entitlement to Social Security benefits. CR's can also be assigned as WIL's (not separate

positions) Work Incentive Liaisons (WILs)

Primary contact on work incentive issues for CR's and SR's.

Area Work Incentive Coordinator (AWIC) Coordinate with WIL's, Public outreach

Disability Benefit Programs

Social Security Disability Insurance (SSDI)

Supplemental Security Income (SSI) Both SSDI and SSI = Concurrent

benefits

How do I find out what benefits I receive?

Benefits Planning Query (BPQY) Request from your local Social Security

Office Call the Social Security Administration

(SSA) at: 800-772-1213 (voice); 800-325-0778 (TTY)

A Community Work Incentives Coordinator (WIPA projects) will request a BPQY for you as part of benefits counseling

Social Security Disability Insurance (SSDI) AKA: DI, SSA, Social Security or Title II Based on work, not financial need Must have worked long enough & recently enough

(FICA contributions) to become insured Disabled or blind under Social Security rules 5 month waiting period Medicare eligible after entitled for 24 months Not affected by resources 3 Different Forms: SSDI, Childhood Disability

Benefits (CDB), Disabled Widow(er)s Benefits (DWB)

Social Security Disability Insurance (SSDI)

Must have insured status on own work record At least 20 credits in the 10 years prior to onset of

disability Those disabled prior to age 31 need fewer credits to

qualify Possible to earn up to four credits per year -one

credit = $1,120 in 2010 The amount of disability benefits payable under title

II is determined by the number holder’s work record. The maximum monthly payment for 2010 is $2,346

Childhood Disability Benefits (CDB)

To be eligible for Social Security as an adult child with a disability, individuals must be:1. 18 years of age or older2. Disabled by SSA’s definition before age

22; and,3. Child of an insured worker who is either

disabled, retired or deceased. No 5-month waiting period required Benefits not payable prior to the month in

which the individual turns 18

Medicare Federally run program that has the same

eligibility standards and coverage rules across all 50 states

Medicare Part A: Hospital Insurance (HI) Helps pay for care in a hospital and skilled

nursing facility, home health care and hospice care

Medicare Part B: Helps pay for doctors, outpatient hospital

care and other medical services Medicare Part D:

Prescription Drug Program Participants choose a drug plan

Supplemental Security Income (SSI)

Federal income program funded by general tax revenues (not Social Security taxes)

Aged, blind or disabled people with limited income and limited resources

U.S. Citizen or qualified alien Income/resources of family members or living

arrangements may affect eligibility No waiting period Automatic Medi-Cal eligibility in CA

Medi-Cal is a state-run program designed primarily to help those with low income and little or no resources

2010 California SSI payment rates

SSI Payment= $674 Federal Benefit Rate + State Supplement Payment $845.00 (Individual-own household) $639.66 (Individual-household of another) $929.00 (Individual-no cooking facilities) $908.00 (Blind individual) $1407.00 (Couple) $1554.20 (Blind Couple)

SSI Resource Limit: $2000 (individual) $3000 (couple)

SSDI Work Incentives

Trial Work Period Extended Period

of Eligibility Expedited

Reinstatement Continuation of

Medicare

Trial Work Period (TWP) Allows you to test work for

at least 9 months while receiving full SSDI benefits

No limit to earnings during TWP

2010: $720 gross earnings or 80 hours in self-employment = TWP month

Trial Work Period (TWP)

Lasts until you complete 9 months (not necessarily consecutive) of work within a rolling 60-consecutive month period

After TWP, there is a 3 month grace period with full SSDI benefits in addition to earned income (may occur during Extended Period of Eligibility (EPE) or after EPE has ended)

No other work incentives apply during the TWP

Only one TWP per period of entitlement

What happens after I use my Trial Work Period (TWP)?

Your Extended Period of Eligibility (EPE) starts the month after TWP ends

36 consecutive months Once EPE starts, it cannot be stopped Key concept:

Substantial Gainful Activity (SGA) 2010: SGA is $1000 in countable earnings

($1640 for a Blind individual)

Extended Period of Eligibility (EPE)

First 36 months are Reinstatement Period If monthly countable earnings are over

$1000 not entitled to cash benefits If monthly countable earnings are less

than $1000 then entitled to cash benefits Benefits automatically reinstated without

need for new application or disability determination

During the EPE, work activity over $1000 may not cause termination of benefits only suspension

Extended Period of Eligibility (EPE)

There are work incentives that you can use during the EPE to lower your countable earnings:

Impairment Related Work Expenses (IRWE) Subsidy or Special Conditions

You require more supervision or help from coworkers

Your performance is at a lower standard You are provided with special equipment for your

job Your have irregular work hours and/or take

frequent rest breaks You have a job coach

What happens once my 36 month Extended Period of Eligibility ends?

Your benefits will continue if you are not working or earning above SGA

Your benefits will end if you work above SGA after the 36-month reinstatement period

Expedited Reinstatement provides an additional 5 years of reinstatement if work stops and there is no medical improvement

Expedited Reinstatement (EXR)

Previous entitlement to benefits terminated due to SGA

Unable to work or perform SGA due to a disabling impairment

Eligible within 60 months of benefit termination date

Up to 6 months provisional benefits payable during EXR decision making process

Medical decision needed

Example of TWP & EPE: (2010 Amounts)*Trial Work Amount = $720 total gross monthly earnings *SGA = $1000 total countable monthly earnings ($1,640 if Blind) (These amounts are likely to increase each year in January, but for this example the amounts remain the same each year for simplicity.)

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov. Dec

$800T1*Start TWP

$600 $800T2

$900T3

$700 $1500T4

$800T5

$0 $800T6

$550

$825T7

$1000T8

$1000T9

*End TWP

$900

*Start EPE

$950 $825 $1200 *Grace & Ces- sation

$1100Grace

$1200Grace

$1200Not Eligible

$1050Not Eligible

$950Eligible

$875Eligible

$1200Not Eligible

$1500Not Eligible

$1075Not Eligible

$850Eligible

$1200Not Eligible

$2000Not Eligible

$875Eligible

$1250Not Eligible

$980Eligible

$1025Not Eligible

$850Eligible

$120Eligible

$450Eligible

$1500Not Eligible

$1600Not Eligible

$865Eligible

$995Eligible

$1300Not Eligible

$1500Not Eligible

$1700Not Eligible

$875Eligible

$1400Not Eligible

$1250Not Eligible

$0Eligible

$1250Not Eligible

$800*End EPE

$850Eligible

$875Eligible

$1200*Termination

Due to the complexity of the SSDI work incentives it is helpful to see a WIPA Community Work Incentives Coordinator for benefits counseling

What happens to Medicare if SSDI benefits stop?

Medicare coverage uninterrupted during Trial Work Period

Continues for at least 93 months after the 9 month Trial Work Period

After that you may be able to purchase Medicare coverage

SSI and Work

Going to work can increase overall income

Medi-Cal can continue even if working

Reinstatement

How earnings affect SSI payments

SSA counts less than half of your earned income

For example: $885 in wages $400 counts against SSI

Certain Impairment Related Work Expenses and Blind Work Expenses can also be deducted from your gross wages

SSI Calculation Example-IRWE$885 Gross Wages-$20 General Income Exclusion $865 Remainder-$65 Earned Income Exclusion $800 Remainder-$100 Impairment Related Work Expense$700÷ 2$350.00 Total Countable Earned Income

 $845.00 Maximum SSI Rate-$350.00 Total Countable Income$495.00 Adjusted SSI Payment

$885.00 Gross Wages+$495.00 SSI-$100 IRWE$1280.00 Total Financial Outcome

Blind Work Expenses (BWE)

For SSI beneficiaries whose primary diagnosis is blindness

Allows the exclusion of any work related items that are paid out of pocket and not reimbursed

BWEs do not need to be related to blindness or any impairment

Examples: Service animal expenses, fees, State, Federal & local taxes, visual & sensory aids, driver services, transportation to and from work, childcare, meals consumed at work, union dues, uniforms, reader services, vehicle modification, mandatory pension contributions, training to use an impairment-related item, translation of materials into Braille

SSI Calculation Example-BWE$885 Gross Wages-$20 General Income Exclusion $865 Remainder-$65 Earned Income Exclusion $800 Remainder÷ 2$400 Remainder-$100 Blind Work Expense$300.00 Total Countable Earned Income

 $908.00 Maximum SSI Rate-$300.00 Total Countable Income$608.00 Adjusted SSI Payment

$885.00 Gross Wages+$608.00 SSI-$100 BWE$1393.00 Total Financial Outcome

IRWE & BWE

All Blind and Impairment Related Work Expenses must be verified by your local Social Security field office

Provide them with original receipts or canceled checks of the expenses

SSA will determine if the expense may be deducted

Request in writing in order to use appeal rights (if necessary)

SSI Calculation Example-SSDI & SSI Benefits

$520 Unearned Income (SSDI payment)-$20 General Income Exclusion $500 Countable Unearned Income

$885 Gross Wages-$65 Earned Income Exclusion $820 Remainder÷ 2$410.00 Countable Earned Income

 $500.00 Countable Unearned Income+$410.00 Countable Earned Income$910.00 Total Countable Income

 $845.00 Maximum SSI Rate-$910.00 Total Countable Income$0.00 Adjusted SSI Payment

What happens if my earnings are so high that my SSI stops?

1619(b) is a work incentive that allows working SSI recipients to keep FREE Medi-Cal (No Share-of-Cost)

Medi-Cal retained when SSI payment is reduced to $0.00 per month due to earned income

Medi-Cal continues until you earn above a Threshold

2010 California 1619(b) Threshold Amounts: Disabled = $34,324.00 Blind = $37,252.00

People with high medical costs can earn even more (Individualized Threshold)

Benefits can start again if you stop working or your earnings decrease (Reinstatement)

1619(b)

To qualify: Have been eligible for an SSI cash payment for at least 1

month; Would be eligible for cash payment except for earnings; Still be disabled or blind; Still meet all other eligibility rules, including the resources

test; Need Medi-Cal in order to work; Have gross earned income that is insufficient to replace

SSI, Medi-Cal, and any publicly funded attendant care.

1619(b)

Individualized Threshold: threshold can be adjusted on a case-by-case basis

Higher Individualized Threshold if: Blind Work Expenses (BWE)

Impairment Related Work Expenses (IRWE)

Plan to Achieve Self-Support (PASS Plan)

Publicly Funded Personal Attendant

(i.e. In-Home Supportive Services)

Medical Expenses above State Average

1619(b)

All Blind and Impairment Related Work Expenses must be verified by your local Social Security field office

Provide them with original receipts or canceled checks of the expenses

Section 301 SSI/SSDI benefits may continue in spite of

determination that medical improvement has occurred if enrolled in an appropriate program that increases likelihood of not returning to disability benefit rolls: Department of Rehabilitation (using an IPE) Individualized Education Plan (IEP) if under age 22 PASS Plan Ticket to Work Support Services using an individualized written

employment plan Benefits continue until you complete the program,

stop participation in the program or if your continued participation in the program no longer increases likelihood that you remain off the rolls

Ticket to Work

A ticket all SSI and SSDI recipients, ages 18-64, can use to get free employment services866-968-7842 (voice), 866-833-2967 (TTY)http://www.yourtickettowork.com/

Ticket to Work

Help you access vocational rehabilitation services, training, education and placement services

Ticket can be used with: Department of Rehabilitation or Employment Network

Your choice to use your Ticket or not and who you take it to

Protection from continuing disability review when Ticket is assigned and in use

Work Incentives Seminar Events (WISE)

Community Events FREE information about Ticket to Work and

other work incentives for SSDI and SSI recipients

Meet local Employment Networks and Work Incentives Planning and Assistance (WIPA) representatives

Upcoming San Diego WISE (see flier):May 25, 2010, 10 am – 2:00 pm

Goodwill Industries

Medi-Cal Working Disabled Program

An individual with a disability who is working full or part time may qualify

Individuals can earn up to $55,188 ($73,884 for a couple) gross per year and still qualify for Medi-Cal Higher gross wages possible when there are

Impairment Related Work Expenses (IRWEs) Affordable premiums:

$20 - $250 (Single Person) $30 - $375 (Couples)

Medi-Cal Working Disabled Program

Asset Limit ($2000 individual, $3000 couple) Retirement Plans allowed and not counted

towards asset limit All disability income is exempt in determining

eligibility and premium (Social Security Disability Insurance-SSDI, State Disability Insurance, Workers Comp., Childhood Disability Benefits, private disability insurance, etc.)

Maintain In-Home Supportive Services at home and in the workplace

Local Resources

Area Work Incentives Coordinator (AWIC)

Public outreach on work incentives Norma Richey Covers California South Coast

(714) 966-2410 ext. 246 17075 Newhope St., Ste. B Fountain Valley, CA 92708

Local Resources

Work Incentives Planning and Assistance (WIPA)-San Diego County

One on one benefits planning Steve Stover, Community Work

Incentives Coordinator 619-840-6616 Email:

Sstover@proindependence.org

Local Resources

Disability Rights California advocacy, appeal rights & assistance

PABSS: Protection & Advocacy for Beneficiaries of Social Security

http://www.disabilityrightsca.org/

800-776-5746

TTY 800-719-5798

Resources

Talent Knows No Limits

http://www.talentknowsnolimits.info/

Disability Benefits 101

http://www.disabilitybenefits101.org/

SSA Red Book-Guide to Work Incentives

http://www.ssa.gov/redbook/

WISE Events

http://www.cessi.net/WISE/

Resources

Area Work Incentives Coordinators (AWIC)http://www.ssa.gov/sf/awic.htm

Ticket to Workhttp://www.yourtickettowork.org/

Ticket to Work FAQShttp://www.cessi.net/ttw/faqs/beneficiaries.html

Questions

You are welcome to contact Karla Bell at619-594-5381 (office)760-579-3474 (cell)

karlabella@disabilityskunkworks.com