Introduction to Social Security Work Incentives 2015 APD SE Pre-service Training - Part II
Your Presenter Type Trainer s Name Here APD Certified Trainer Type Trainer s Email Address Here Type Trainer s Phone # Here
Why are you here today? What s your name? What s your job? Do you work for an agency or on your own? Why did you come to this training? 3
Ground Rules Please mute cell phones Please return from lunch and breaks on time You must attend the entire class both days Your complete attention and active participation is expected 4
Test Score of 70% or higher to pass the test (until the Medicaid Waiver Handbook is amended) Timed 30 minutes allowed to take test Administered on site No books, notes, or talking permitted Certificate of Successful Completion (if pass test), or Certificate of Attendance issued 5
Please complete evaluation form Go to the 6
FEAR of the System What if? I earn too much money? I don t earn enough money? I get sick again? I can t get my benefits back? 7
Knowledge Is Power You Are Here to Learn Exciting New Ways to Help Others or Yourself! 8
Review Agenda Section 1: Section 2: Section 3: Section 4: Section 5: Section 6: Section 7: Section 8: Introduction Advocacy Eligibility Effects of Earned Income on SSDI Effects of Earned Income on SSI SSDI and SSI Work Incentives Resources Glossary/Acronyms/Websites 9
Must Learn - ACRONYMS SSA Social Security Administration SSDI Social Security Disability Insurance SSI Supplemental Security Income 10
Section 1 Introduction 11
Barriers High unemployment rate for people with disabilities = up to 80% unemployed Unemployment and under-employment among working-age Americans with disabilities continues to be a problem One of the most significant barriers to employment is the fear of losing benefits (SSA benefits and attached health care) 12
FEAR of the System What if? I earn too much money? I don t earn enough money? I get sick again? I can t get my benefits back? 13
Training Principles Information provided in the training is one tool for making good decisions about employment Good decisions are the result of good planning The training is based on the philosophy of self-determination and person-centered planning 14
Self-Determination Building Blocks Freedom Authority Support Responsibility Confirmation 15
Person-Driven Planning Person Futures Planning MAPS/PATH Circles of Support Essential Lifestyle Planning 16
Section 2 ADVOCACY One that supports or promotes the interests of another ~Merriam Webster 17
Rules Of Engagement Before any rules are discussed, all parties must be clear what benefits a person is receiving from all sources, private and public, before information is exchanged. Sharon Brent, National Disability Institute 18
What law will be 80 years old this year? 19
The Social Security Act 20
Overview SSDI (Title II) (Soc. Sec. Disability Insurance) FICA Medicare (federal rules) V E R S U S SSI(Title XVI) (Supplemental Security Income) General Revenue Medicaid (state rules) 21
Expert? You do NOT need to be the expert! You do need to know how valuable this information is. You do need to educate people. You do need to know about the tools at your disposal. 22
Checklist for Success When you call SSA (1-800-772-1213): Date Name of person you spoke with What you asked What they told you Make copies Don t lose them! 23
Checklist (continued) Report Pay monthly to SSA If receiving SSI and SSDI, must report separately to each program Promptly open and read all mail Respond on time If you don t understand, seek help Keep wage records in your file 24
Checklist (continued) If person receives SSI and/or Medicaid, keep all resources/assets below $2,000/individual and $3,000/couple in any month (The law since 1974!!) *But are there exceptions to the above? Always report major life changes to SSA immediately (address, marriage, employment, loss of job, divorce, etc.) 25
Benefits Planning Query Free if request is made by: 1. Beneficiary or Rep Payee 2. Work Incentive Planning and Assistance (WIPA) A program that employs Community Work Incentive Coordinators (CWICs) to provide free benefits counseling, planning and technical assistance to SSA recipients who work or plan to work 26
(BPQY) Benefits Planning Query First step in planning! Analysis of an individual s disability and work status 27
Florida is a 1634(d) State Social Security Act Section1634(d) allows Florida to use the same eligibility criteria for SSI eligibility as for the state s Medicaid Program 28
Section 3 Eligibility 29
SSI/SSDI Initial Eligibility - Contact SSA - Complete application forms - Collect information - Make and keep appointments - SSA coordinates with state s disability determination office (Florida Department of Health) SSA sends letter of eligibility determination 30
Forms & Checklist Review SSA application Review SSA s definition of disability Gather evidence Know process and timelines 31
SSA s Definition of Disability For SSI and SSDI: The inability to engage in Substantial Gainful Activity (SGA) by reason of any medical impairment (physical and/or mental) Note: SSA s definition of disability differs from the ADA s definition and other laws definitions of disability. 32
Substantial Gainful Activity SGA is: a basic test used by SSA to determine disability status Performance of significant mental or physical duties for profit To meet this part of the disability test, individuals must not be working or, if working, earning less than the annual SGA amount 33
SGA 2015 SGA Non-Blind - $1,090 SGA Blind - $1,820 34
SGA (continued) For people on SSDI, SGA is looked at by SSA during initial eligibility process and while continuing to receive SSDI For people on SSI, SGA is looked at by SSA during initial eligibility process only 35
SSA Requirement Continuing Disability Review (CDR) Periodic eligibility re-determination for both SSI and SSDI Does the beneficiary continue to be disabled? 36
CDR Process 1. Interview at the local SSA office 2. Completion of form about current medical information (similar to initial eligibility process). 3. SSA forwards form to DDS for review and medical determination 4. Occurs every 3, 5, or 7 years. If you have a condition not expected to improve, SSA will review your case, but not as often 37
SSDI: Eligibility of Benefits Required Work Credits in F.I.C.A. 5 Month Waiting Period SGA 12 prior months Factor during EPE and beyond Medical Eligibility Medical eligibility defined DAC Disabled Adult Child Disability prior to age 22 Never legally married to non- Title II person Insufficient FICA or higher parent amount Parent FICA opens (Dies; Retires; Disabled) Possible continuation of Medicaid Pickle Amendment MEDICARE (Medical Insurance) 24 months upon eligibility Part A - free in most cases Part B/D - premium 38
SSDI Title II (1935) F.I.C.A. Waiting Period SGA Eligibility DAC/CDB Medicare (1960 s) 39
Who was Frances Perkins? What did she do? and what she did? 40
Frances Perkins (1880-1965) Secretary of U.S. Dept. of Labor 1933-1945 The woman behind FDR s New Deal, promoter of the Social Security Act and a champion of rights for the American work force 41
Frances Perkins Legacy: Social Security Unemployment Insurance Minimum Wage What is Florida s Minimum Wage? 42
Florida s 2015 Minimum Wage $8.05 per hour 43
SSDI You may receive this benefit if: You have a work history and are disabled Disabled before 22 and receiving childhood disability CDB or DAC* Medicare is usually associated with this benefit * Disabled Adult Child 44
Medicare Federal Health Insurance Program For people 65+ People <65 with certain disabilities People with end-stage renal disease 45
Medicare (Components) Part A - Hospital Insurance Part B - Medical Services Part C - Private Insurance Part D - Prescription Drug Coverage 46
Medicare: Part A Covers inpatient care in hospitals, skilled nursing facilities, hospice care and some home health care Most people don t have to pay because they or a spouse paid Medicare taxes while working 47
Medicare: Part B Covers Doctor s services Outpatient care Medically necessary physical and occupational therapy and some home health care Part B has a premium that changes January 1 st of each year with an annual deductible ($104.90 per month/$147 deductible) 48
Medicare: Part C Medicare Part C combines Part A and Part B options and must cover all medically needed services The difference is that private insurance companies that are approved by Medicare provide this type of coverage In most cases, Part C is a lower-cost alternative to the Original Medicare Plan, and providers usually offer extra benefits and include prescription drug coverage (Part D) 49
Medicare: Part D Prescription Drug Coverage Most people will pay a monthly premium Medicaid will pay premium, if on 1/1/06 available to everyone on Medicare 2015 Medicare Costs at a Glance: http://www.medicare.gov/your-medicarecosts/costs-at-a-glance/costs-at-glance.html 50
SSI Title XVI (1974) General Revenue Needs Based No Waiting Period Looks at Earned and Unearned Income Resources Count Medicaid 51
SSI - Resources May Be Countable by SSA Cash, Savings Accounts, CD s, IRA s, etc. Land (owned by recipient but not lived on) Anything owned which can be converted to cash and used for purchasing food and shelter (including utilities) Resources of a spouse Resources of a parent if beneficiary is under 18 53
SSI - Resources: May Be Excluded Home and household goods Burial space and burial funds up to a certain amount Retroactive SSI or SSDI amount for up to 9 months Property in Specific Special Needs Trust Approved by SSA One automobile, regardless of value (as of March 2005) 54
More SSI Resources May Be Excluded by SSA A bank account for Plan to Achieve Self-Support (PASS) An Individual Development Account (IDA) Property Essential for Self-Support (PESS) One automobile, regardless of value (as of March 2005) 55
Special Needs Trusts Purpose 1. To benefit individuals with disabilities 2. Maintain eligibility for public assistance programs 3. Provides funds for supplemental needs 56
Special Medicaid Groups Protected Medicaid special continuation provisions Section 1619(b) of the Social Security Act Title II COLA (Pickle Amendment) CDB/DAC Widower's (ARF) Drug/Alcohol Addiction 57
Section 1619 (b) Individuals utilizing 1619(b) are not receiving SSI payments due to the level of their countable earnings. But, they remain deemed by law to be SSI eligible for Medicaid purposes. 58
The Pickle Amendment July 1,1977, Medicaid eligibility was protected for SSI recipients who had lost SSI due to COLA increases of SSDI checks Beneficiaries who lost SSI now eligible to continue receiving Medicaid as an SSI eligible Will continue to be SSI recipients for Medicaid purposes 59
The Exclusions When determining Medicaid eligibility for these special former SSI recipients, state Medicaid agencies must exclude the portion of the individual s applicable Title II disability cash benefit that caused their ineligibility for SSI payments. 60
What They Get If, by excluding the appropriate portion of the Title II benefit, the individual would otherwise be eligible for an SSI cash benefit, the person is lawfully deemed eligible for Medicaid. These individuals are deemed SSI recipients for Medicaid purposes, though they are NOT entitled to SSI monetary benefits and are not listed on the Social Security Administration s SSI rolls. 61
Who Determines Eligibility? State Medicaid agencies or their designees In FL, AHCA delegated function to DCF SSA does provide information about why SSI was lost and the amount of Title II payment that caused the loss 62
Watch for Pickle People! There are many current SSDI Beneficiaries who lost SSI years ago who are potentially eligible for Medicaid under the Pickle provisions! Eligibility can be established ANY time there is no statute of limitations or sunset date time Always ask SSDI beneficiaries about former SSI eligibility and check for Pickle Medicaid eligibility. 63
Childhood Disability Beneficiary 1. Requires States to consider Title II Childhood Disability Beneficiaries (CDBs) who lose SSI eligibility as if they were still SSI recipients for Medicaid purposes (keep Medicaid) - as long as they would have remained otherwise eligible for SSI benefits but for their entitlement to (or increase in) their SSDI (Title II) payment. (CDB = DAC or Disabled Adult Child) 64
Childhood Disability Beneficiary A DAC or CDB may also be an adopted child a step-child a grandchild a step-grandchild 65
Section 4 EFFECTS OF EARNED INCOME ON SSDI 66
GETTING STARTED WAGE FORMULA 1. Number of hours x rate of pay = weekly gross income 2. Take the weekly gross income x 4.3/weeks in a month 67
SSDI Work Incentives Trial Work Period 9 months w/earnings of $780 or more within a 60-month rolling window of time Extended Period of Eligibility 36 months Grace Period a 3-month period which runs once upon 1 st earning SGA during or after EPE Extension of Medicare Coverage 93 months 68
TRIAL WORK PERIOD - SSDI Unless medical recovery is determined, SSDI beneficiaries are entitled to a nine-month Trial Work Period (TWP) for testing work skills while maintaining the monthly SSDI cash benefits. During this TWP their full benefit checks will continue regardless of the amount of money earned. The nine months of TWP do not need to be consecutive or earned in a row. 69
TRIAL WORK PERIOD SSDI TWP months are counted when an individual earns a specific amount of income. (Determined January 1 each year by SSA) 2015 = $780.00/month The TWP ends only when an individual has 9 trial work months within a 60-month consecutive period or rolling window of time (5 years). Once all 9 months of TWP have been earned within a 60- month window a person then enters the Extended Period of Eligibility (EPE). 70
Trial Work Period Applies only to SSDI Trial Work Month = Earnings over $780.00 gross (2015) Nine months - do not have to be consecutive All 9 must occur within a rolling 60-month period Can earn any amount of money and still get DI cash benefit One TWP per SSDI eligibility EPE begins automatically once TWP has been earned Tracking TWP is imperative! 71
Extended Period of Eligibility The EPE Begins the month immediately following the TWP Lasts 36 consecutive months (3 years in a row) Benefits continue if earnings are below SGA No cash benefit when earnings are above SGA 72
EPE: Grace Period The first month of SGA (cessation month) benefits continue. Next two months are considered grace months and even if SGA is earned benefits continue. (Total of 3-month grace period.) 1 2 3 73
EPE (continued) When the three-year EPE is completed, (has run its course), a person earning gross wages below SGA will continue to receive an SSDI benefit check. Receives the whole check If a person is earning SGA or above, a person is no longer eligible for a cash benefit. Receives no check 74
EPE (continued) 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. (See Work Incentive Subsidies and Impairment Related Work Expenses) 75
Extended Medicare Coverage Extended Medicare coverage is available for SSDI beneficiaries who lose their cash benefit due to performing SGA Coverage is for a minimum of 3 years following the TWP Coverage continues (Part A Free) for an additional 4 ½ years Individuals can buy into Medicare once coverage is exhausted 76
Continuation of Medicare Continuation of Medicare-SSDI Only Receive at least 93 consecutive months The 93 months start the month after the last month (the ninth month) of your TWP. You must continue to work and perform SGA, but not improve medically. You must satisfy Medicare s (24 month) waiting period. 77
Work Incentives (continued) Rules For Individuals Who Are Blind-SSDI See Definition of blindness (SSA Redbook) Has lasted or is expected to last 12 months (no duration requirement) Higher SGA If self employed and blind, SGA solely based on earnings, not time spent/services rendered 78
Work Incentives Comparison Chart Social Security Disability Insurance Trial Work Period Extended Period of Eligibility Continuation of Medicare Special Rules for the Blind (SGA) Supplemental Security Income Continuation of SSI Student Earned Income Exclusion Blind Work Expense 1619 (a) 1619 (b) Property Essential For Self-Support Plan for Achieving Self-Support Work Incentives for Both SSDI and SSI Impairment Related Work Expense (IRWE) Subsidies Section 301 (Not Ticket Rules) Expedited Reinstatement Ticket to Work \ 79
Section 5 Effects of Earned Income on SSI 80
Student Earned Income Exclusion (SEIE) - SSI Must be under the age of 22 and regularly attending school. Can exclude earned income up to a certain amount (changes annually) Amount earned looked at monthly, with a yearly maximum This exclusion applies before any other exclusion Can carry the balance over the following month 81
SEIE - 2015 2015 $1,780.00 per month $7,180.00 per year 82
SEIE SSI Report the following to the SSI claims representative: Proof of regularly attending school at least one month during the current calendar quarter or expectation to attend school at least one month in the next quarter and Pay stubs showing the amount of earned income while considered a student and under the age of 22. 83
Blind Work Expense (BWE) SSI Work Incentive When a person s primary diagnosis is blindness, SSI will not count any earned income which is used to meet any expense reasonably attributed to earning that income. Just a few examples of Expenditures: Guide Dog Transportation to and from work Meals during work hours Child Care 84
Section 1619(a) SSI Work Incentive Enables a person to still receive an SSI cash payment when earnings exceed SGA 85
Section 1619(a) SSI Work Incentive Eligibility for SSI will continue as long as requirements are met. SSA will continue to calculate income as before. A person continues being eligible for Medicaid. This happens automatically when wages are reported to SSI monthly. 86
When a beneficiary earns enough income to no longer receive an SSI monthly cash payment, 1619(b) provides for the continuation of Medicaid. There are Qualifications: 1619(b) SSI Work Incentive Eligibility Disability Need Medicaid Under State Income Threshold 87
1619(b) State Income Threshold There is a state income threshold amount used to measure if earnings are high enough to replace SSI and Medicaid. 2015 Florida Annual Income Threshold Amount: $30,594 88
Income Threshold Calculation 2 x the FBR + 85 x 12 = the base amount (the annual amount of earned income it takes to reduce the annual SSI Federal Benefit to zero) $733x2 = $1,466+85 = $1,551 x 12 = $18,612 $18,612 + (Average per capita Medicaid expenses in Florida of $11,982) Equals Florida s Income Threshold Amount: $30,594 89
Individualized Income Threshold If a person has: Impairment Related Work Expenses (IRWE) Work Incentive Plan For Achieving Self-Support (PASS) Work Incentive Medicaid-funded Personal Assistance Services (PSA) Medical expenses above the average state per capita amount 90
Plan for Achieving Self-Support (PASS) = SSI Is an income/resource exclusion Allows a person to set aside income and/or resources for purposes of achieving an occupational objective Helps an individual to establish or maintain SSI eligibility 91
PASS - SSI Can increase or help maintain the individual s SSI payment amount as the person gains the capacity for self-support. SSI will not count the income or resources that are set aside in a PASS when they figure your SSI payment amount. 92
PASS - SSI Requirements: a. Must be approved by SSA PASS Cadre b. Will be reviewed periodically to assure plan is working c. Money set aside in a PASS will not be considered a resource by SSI, Medicaid, HUD, Food Stamps, etc. d. Recommend utilizing the SSA 545 Form 93
PASS - SSI e. Must be in writing on the SSA-545 form f. Must have a specific work goal and plan to reach that goal g. Must contain a reasonable time frame h. Must need training, items or services not paid for by any other source i. Must use income other than SSI, or use an excess resource 94
PASS - Self Employment j. Must include a business and marketing plan k. What will the business do? l. Include Profit/Loss projections m. How will the business be funded? n. Plan must have a reasonable time frame o. Materials needed
Property Essential for Self-Support PESS - SSI SSI will not count certain resources that are essential to a person s means of self-sufficiency Utilized when initially applying for SSI Maintains resource eligibility for SSI/Medicaid
PESS (SSI) Property used for work as an employee (required tools, equipment, transportation etc.) Property used in a trade or business (inventory, business owned property) 97
PESS (SSI) SSI will NOT count up to $6,000 of equity value of non-business income-producing property if the property yields an annual rate of return of at least 6%: a) Rental Property b) Produce grown on land for sale 98
Work Incentives for both SSI and SSDI 99
Impairment Related Work Exp. IRWE = SSI PURPOSE: IRWE is used to enable beneficiaries of: SSI IRWE is used to reduce gross income Why? SSDI - IRWE is used to reduce countable earnings below SGA Why? What is the difference between gross income and countable earnings? 100
IRWE Due to out of pocket expenses that support a disability to allow a person to earn income, even if those items or services are also needed for non-work activities. I - Impairment R - Related W - Work E - Expense 101
IRWE Examples: Transportation Medications Medical Devices PCA 102
IRWE (continued) How To Apply 1. Submit, the first month in writing, the reason, cost, receipts and pay-stubs to SSI and/or SSDI. 2. Each month expense is necessary, submit receipts and pay-stubs to SSI and/or SSDI. 3. The SSI/SSDI claims representative will review and adjust SSA benefit(s) accordingly. 103
Without IRWE *First Step $785 Earnings *Last Step - $20 General Income Excl. $383.00 SSI Income - $65 Earned Income Exclusion +$785.00 Earnings $700 New Countable Income $1,168.00 Total Income *Second Step Divide by 2 the new countable income amount of $700 $700 /2 = $350.00 New Countable Income *Third Step $733 FBR (Maximum SSI Benefit Payment) - $350.00 Newest Countable Income Above $383.00 Adjusted SSI Monthly Payment 104
With IRWE $ 785 Earnings Last Step - $20 General Exclusion $483.00 SSI Check - $65 Earned Income Exclusion +$785.00 Earnings $700 New Countable Income $1,268.00 Total Income - $200 Medications(IRWE) $500 New Countable Income Divide by 2 = $500/2 = $250.00 New Countable Income $733 FBR -$250.00 New Countable Income $483.00 New SSI Payment 105
What s the Difference? Without IRWE $1,168.00 With IRWE Total monthly income: $1,268.00 106
Subsidies: SSI and SSDI Subsidies Applies to SSI during initial eligibility only Applies to SSDI during the initial eligibility process as well as keeping a beneficiary below SGA to maintain SSDI eligibility Financial Value The dollar amount of the subsidy is subtracted from gross monthly earnings, potentially reducing gross wages below the SGA level 107
Evidence of receiving a subsidy Extra Support Supervision Lower productivity level than co-workers having similar jobs A Subsidy can only be Employer Sponsored. A Special Condition may be: Agency sponsored Employer sponsored Self-employment supports 108
Subsidies/Special Conditions Agency-sponsored Special Condition Compare the time, energies, skills and responsibilities of the workers with disabilities to the workers without disabilities who are performing the same or similar duties: How do I compare these factors?.. (see next slide) 109
Subsidies/Special Conditions Estimate the proportionate value of the work being done by the worker being supported according to the pay scale for such work Determine how frequently the agency support monitors the worker and how involved the support is with the actual function of the job. 110
Subsidies/Special Conditions There may also be continuing support being given that is not as obvious. Job coaching services are a strong indication that the work is subsidized. 111
Employer-sponsored Subsidy Employers are requested by SSA to submit a statement documenting the actual value of employee s services which will be less than the dollar value ($) received in earnings. 1. Specific Subsidy: Employers designate a specific dollar amount after calculating the reasonable value of employee s services. 112
Employer-sponsored Subsidy 2. Non-specific Subsidy (if unable to designate a dollar amount): a. Compare the work in terms of time, skills, and responsibilities with that of a person without a disability performing similar work. b. The proportional value of the employee s work can then be estimated according to the prevailing pay scale. 113
Section 301 SSI and SSDI Allows individuals who improve medically and are no longer considered medically eligible through a Continuing Disability Review (CDR) to continue receiving a cash benefit if: Participating in an approved vocational rehabilitation program (public or private); or While participating in an IEP (Effective July 2005) 114
Expedited Reinstatement SSI and SSDI When a person s SSDI cash benefit stops due to wages, or Medicaid benefits stop due to wages, a request to reinstate the benefits without filing a new SSDI or SSI application can occur (effective January 1, 2001). Beneficiaries must be unable to work (or earn SGA anymore) because of their medical condition. 115
Expedited Reinstatement The person must file the request for reinstatement with Social Security within 60 months from the month his SSDI cash benefits are terminated and SSI Medicaid benefits are terminated. In addition, the person may receive temporary benefits, as well as, Medicare and/or Medicaid for up to six months while his case is being reviewed. 116
Expedited Reinstatement SSDI after Extended Period of Eligibility completed and termination of SSDI cash payment due to earnings SSI after one year suspension of Medicaid due only to earnings (first year is a suspension, and the next five years allow for Expedited Reinstatement option)
Expedited Reinstatement Both SSI and SSDI 60-month period to request expedited reinstatement following SSDI/SSI termination due to working and earning wages 6-month provisional cash benefits payable while SSA reviews reinstatement request May also re-apply for new eligibility determination 118
A voluntary program for people with disabilities who want to work. A person who receives a ticket will have: Greater Choice Increased Network of Vocational Service Providers (ENs) Ticket to Work SSI AND SSDI Work Incentive Not be subject to a Continuing Disability Medical Review (CDR) 119
Ticket to Work What is an Employment Network? Certified Private Contractor with SSA to provide vocational services State Vocational Rehabilitation is also a required Employment Network 120
Section 7 Resources 121
State Agencies APD Medicaid Waiver; GR/IFS; EEP DVR Supported Employment Phase 1 Employment Related Services NEW Abilities Work Help Desk DEO Abilities Work Employment Portal 122
Individual Development Accounts (IDA) Corporation for Enterprise Development (CFED) Housing and Urban Development (HUD) Supplemental Nutrition Assistance Program (SNAP) 123
Thank you! 124