MYTH BUSTERS HOW EMPLOYMENT IMPACTS BENEFITS A CRASH COURSE IN SOCIAL SECURITY WORK INCENTIVES

Transcription

1 MYTH BUSTERS HOW EMPLOYMENT IMPACTS BENEFITS A CRASH COURSE IN SOCIAL SECURITY WORK INCENTIVES

2 TOPICS TO BE COVERED TODAY SSI SSDI (Supplemental Security Income) (Social Security Disability Insurance) MEDICAID AND OTHER STATE MEDICAL PROGRAMS MEDICARE TICKET-TO-WORK BENEFITS COUNSELING PROJECT 2

3 It is a common misperception that: Once I apply for Social Security disability benefits, I should not no cannot work. The fact is, there are 2 criteria for being determined disabled by Social Security. One is: Does the individual meet the required disability criteria? And the second: Is the individual capable of performing substantial work? The first is a given in your patient population, so we will focus on the second criteria in this segment. 3

4 Let s look at SSI first, as that s the easier of the 2 social security disability programs SUPPLEMENTAL SECURITY INCOME (SSI) Needs-based program Maximum Benefit of $710/mo in 2013 Any type of income reduces the Benefit Maximum Asset limit of $2,000 Cash assistance can often continue with work until earnings are sufficient for self-support. Associated with Medicaid/Title XIX. Medicaid/Title XIX can continue even when earnings exceed the SSI break-even point. 4

5 SSI and Work With $710 SSI, the first $85, then 50% of gross earnings are disregarded. The balance is then subtracted from the SSI benefit. Break-even amount in 2013 is $1,505. Example: Gina gets a full $710 SSI benefit each month. She received her first paycheck in December and took home gross wages of $885 that month. Social Security will count (i.e., subtract) $400 of those earnings from her February SSI check, leaving her $310 in SSI plus the $885 earnings from December. 5

6 SOCIAL SECURITY DISABILITY INSURANCE (SSDI) Amount is based on what the Beneficiary, or sometimes parent(s), paid into Social Security. SSDI has work incentives allowing you to try working while keeping SSDI support. SSDI recipients are given Medicare after the 24- month qualifying period, EXCEPT with diagnoses of ESRD or ALS, in which cases Medicare begins sooner. Medicare usually continues for many years even if the cash benefit stops and/or until the individual ceases to meet the Social Security disability standard. 6

7 SSDI and Work Beneficiaries have 9 months (consecutive or not) for the opportunity to test his/her ability to work while maintaining a full benefit, no matter how much the beneficiary earns. This is called a 9-month Trial Work Period. SSA sets a monthly dollar amount to determine the use of Trial Work months. In 2013 that amount is $ gross a month and/or work 80 or more hours a month in self-employment. 7

8 SSDI and Work (continued) After the use of the 9-month Trial Work Period, Social Security determines if the value of the work activity exceeds a specific dollar figure, known as the Substantial Gainful Activity guideline. In 2013 that amount is $1,040 gross a month ($1,740 for beneficiaries on SSDI for blindness), which applies to both wage and selfemployment. If the work activity is above SGA, the SSDI benefit will most likely cease. However, there are several other work incentives (i.e., deductions ) that could be applied to the individual s earnings, very dependent upon his/her circumstances and disability. 8

9 MEDICAID AND OTHER STATE OF CONNECTICUT MEDICAL PROGRAMS There are over 50 Medicaid programs in the State of CT. Eligibility is oftentimes dependent on household composition. For today s purposes, the focus will be primarily on Medicaid groups for disabled individuals and will use figures for single and/or married individuals. 9

10 S01, S02 & S03 Medicaid Who Qualifies Those on SSI (automatically qualify), small amount of SSDI, and those determined disabled per Social Security disability standards but not on a federal benefit Income Limit of about $830 gross a month Asset Limit of $1,600 (single), $2,400 (married) 10

11 S04 Medicaid Who Qualifies Those currently (or within the past year) on SSI or State Supplement Cash Assistance (also known as 1619b or 1905q status) AND WORKING Income limit of $6,000 gross a month Asset limit of $2,000 (single), $3,000 (married) 11

12 S05 Medicaid/MED-Connect Who Qualifies Those on SSI, SSDI, State Supplement Cash Assistance, or determined disabled per Social Security disability standards but not on a federal benefit AND WORKING. Income limit of $6,250 gross a month. Income more than $1,916 ($2,586 married) is assessed a 10% premium, minus other out-of-pocket medical insurance premiums Asset limit of $10,000 (single), $15,000 (married), excluding home, 1 vehicle, IRAs, 401Ks, medical savings and/or special employment account Eligibility can continue up to a year after the individual stops working. 12

13 S05 Medicaid/MED-Connect (continued) Another little-used qualifying category for this Medicaid program is the Medically-Improved Group If the beneficiary loses Medicaid eligibility because of medical improvement, but continues to have a severe medically-determinable impairment, even though the impairment doesn t meet the criteria for regular Medicaid, s/he continues to be eligible for MED- Connect, as long as s/he is earning at least $290 a month (in 2013). There is no extension of coverage under this group once the individual loses employment. 13

14 Medicare Savings Program 3 Levels INCOME LIMITS QMB $ single $ couple Pays Medicare B premium Also pays annual hospital and physician deductible, as well as 20% co-insurance for Medicare approved services. SLMB $ single Pays Medicare B premium $ couple ALMB $ single Pays Medicare B premium $ couple Subject to available funding. Not available to those on Medicaid (i.e., S05/MED-Connect reviewed above). 14

15 Income Limits above refers to unearned income. Earned income of the disabled individual gets reduced by more than 50% Extreme Example: Married couple, husband receives $1,000 SSDI, wife has no earned/unearned income. During his 9-month Trial Work Period, he can earn well over $4,400 gross a month and be eligible for the Medicare Savings Program ($4,425 - $65 = $4,360 2 = $2,180 + $1,000 = $3,180) Medicare Savings Program beneficiaries also automatically become eligible for the Medicare Low Income Subsidy category, which prevents the individual from going into the donut hole as well as keeping formulary prescription co-pays low 15

16 CONNECTICUT TRANSPLANT PROGRAM ConnTRANS 2 programs with 2 criteria levels 1. Assistance paying initial medical expenses of the transplant Monthly Income Limits 100% CT Median $4,400+ (single), 5,800+ (married) 2. Assistance paying ongoing transplant-related medical needs Monthly Income Limits 300% FPL $2,800+ (single), $3,800+(married) Income Limit Gross income minus health insurance premiums Asset Limit $10,000 16

17 For those who exceed these income or asset limits, ConnTRANS may be able to assist, if money is available in the fund. Example 1: Income exceeds the limit by $500, then $500 is subtracted from total amount of transplant related expenses, and ConnTRANS pays the difference. Example 2: Assets exceed the limit by $1,000, then $1,000 is subtracted from the expenses owed, and ConnTRANS pays the difference. 17

18 MEDICARE For those who continue to meet Social Security s disability standard, Medicare continues more than 7 years after the person works his/her way off SSDI. Medicare coverage will stop if an individual ceases to meet the Social Security disability standard. End Stage Renal Disease Medicare is a special program not tied to receipt of cash benefits, has less stringent rules to get on & different rules for when coverage begins & ends. Unless these individuals are also entitled to cash benefits under the disability programs, the Social Security disability work incentives covered in slides 7 and 8 above do not apply to the individual. 18

19 Highlights of the provisions under ESRD Medicare 1) A person may receive ESRD Medicare on the work record of himself, a spouse, or parent if the required amount of time was worked. 2) Medicare usually begins the 3rd month after dialysis begins. 3) Coverage can begin earlier if the person selfadministers dialysis, or is scheduled for a transplant. 4) Coverage ends either 12 months after dialysis stops, or 36 months after a successful transplant, but 5) Can be extended if the person was previously entitled to Medicare under the ESRD provisions. 19

20 TICKET-TO-WORK Social Security provides protections to people receiving SSI/DI under the Ticket-to-Work. Voluntary program that allows beneficiaries to use services needed to become employed or get a better job using the state vocational rehabilitation agencies (BRS, BESB) and/or Employment Networks (ENs) who have a signed contract with Social Security to provide these services. Once there is a signed employment plan with any of these programs, Social Security will not conduct a continuing medical review as long as timely progress is being made. Timely progress is reviewed once a year by SSA. Specifics on timely progress are in a handout in your packet, but for example, the first year would be earnings of $750 or more a month for 3 out of the first 12 months. 20

21 Who can Help Beneficiaries Understand all this information? Connect-to-Work Project has 6 Benefits Specialist and a Project Director who cover the State of Connecticut Meet with beneficiaries one-on-one Provide individualized assessment and analysis of the person s current situation and impact of potential earnings/ employment on federal and state benefits Asset building strategies and programs, as well as other community assists are also recommended, according to the individualized assessment 21

22 We reviewed the basics of work incentives and medical programs available to persons with disabilities in the topics covered today. Specifically addressed were the SSI, SSDI, Medicaid and Other State Medical Programs, Medicare, Ticketto-Work and Benefits Counseling program to help understand how these programs work together. There are many nuances of the social Security work incentives that couldn t be addressed in this time frame, as well as other work incentives that are available, such as PASS, IRWE s, Unsuccessful Work Attempt, Special Conditions, Subsidies, to name a few. There is more detailed information in your packets, as well as the availability of Benefits Specialists to answer specific questions. 22