Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social...

115
Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II

Transcript of Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social...

Page 1: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Introduction

to

Social Security Work

Incentives

2014 APD SE Pre-service Training - Part II

Page 2: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Your Presenter

Trainer’s Name ___________________

Phone No. _______________________

Email Address_____________________

APD Certified Trainer

Page 3: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

3

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?

Page 4: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

4

Please mute cell phones

Please return from lunch and breaks on time

You must attend both days, (the entire class)

Your complete attention and active

participation is expected

Ground Rules

Page 5: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

5

Score of 70% or higher to pass the test

Timed - 1/2 hr to take test - (30 minutes)

Administered on site

No books, notes, or talking permitted

Certification or Certificate of Attendance issued

Test

Page 6: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

6

Please

complete

evaluation form

Go to the

Page 7: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

7

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?”

Page 8: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Knowledge is Power

You are Here to Learn

Exciting New Ways to Help

Others or Yourself!

8

Page 9: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Review Agenda

Section 1: Introduction

Section 2: Advocacy

Section 3: Eligibility

Section 4: Effects of Earned

Income on SSDI

Section 5: Effects of Earned Income on SSI

Section 6: SSDI and SSI Work Incentives

Section 7: Resources

Section 8: Glossary/Acronyms/Websites

9

Page 10: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

ACRONYMS

“SSA” – Social Security Administration

“SSDI” – Social Security Disability Insurance

“SSI” – Supplemental Security Income

10

Page 11: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Section 1

Introduction

11

Page 12: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

Barriers

12

Page 13: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

13

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

Training Principles

Page 14: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Freedom

Self-Determination

Building Blocks

Authority

Support

Responsibility

Confirmation

14

Page 15: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Person Futures Planning

MAPS/PATH

Circles of Support

Essential Lifestyle Planning

Person-Driven Planning

15

Page 16: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Section 2

ADVOCACY

Merriam Webster:

One that supports or promotes the

interests of another

16

Page 17: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

17

Page 18: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

18

Overview

SSDI (Title II) (Soc. Sec. disability insurance)

FICA

Medicare

(federal rules)

SSI(Title XVI) (supplemental security income)

General Revenue

Medicaid

(state rules)

V

E

R

S

U

S

Page 19: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

19

Page 20: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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!

20

Page 21: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

21

Page 22: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

If person receives SSI and/or Medicaid,

keep all resources/assets below

$2,000/individual - $3,000/couple in any

month

Report major life changes to SSA

immediately (address, marriage,

employment, lose of job, divorce, etc.)

Checklist-continued

22

Page 23: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Free if request is made by:

1. Beneficiary or Rep Payee

2. WIPA (Work Incentive Planning

and Assistance – program that

employs CWICs (Community Work

Incentive Coordinators) to provide

free benefits counseling, planning

and technical assistance to SSA

recipients who work or plan to

work)

Benefits Planning Query

23

Page 24: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Benefits Planning Query

• First step in planning!

• Analysis of an individual’s disability and work status

(BPQY)

24

Page 25: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

25

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

Page 26: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Eligibility

Needs vs. Entitlement

Section 3

26

Page 27: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SSI/SSDI Initial Eligibility

- Contact SSA

- Complete 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 27

Page 28: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Forms & Checklist

Review SSA application

Review SSA’s definition of disability

Gather evidence

Know process and timelines28

Page 29: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

29

Page 30: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Substantial Gainful Activity

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

SGA is:

a basic test used by SSA

to determine disability status

30

Page 31: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SGA

2014

SGA Non-Blind - $1,070

SGA Blind - $1,800

31

Page 32: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SGA (cont’d)

•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

What does it mean to say “SGA is looked at by SSA?”

32

Page 33: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SSA Requirement

Periodic eligibility re-determination

for both SSI and SSDI

Does the beneficiary continue to be disabled?

Continuing Disability Review

(CDR)

33

Page 34: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

34

CDR Process

1. CDRs involve an interview at the local SSA

office.

2. Also includes filling out a form about current

medical information (similar to initial eligibility

process).

3. SSA will forward form to DDS for review and

medical determination as in initial eligibility

determinations.

4. Happens every 3, 5, or 7 years.

Page 35: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

SSDI: Eligibility of Benefits

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

36

Page 37: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Do you know who Frances Perkins is

and what she did?

38

Page 38: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Frances Perkins (1880-1965)

Secretary of US. Dept. of Labor

1933-1945

The woman behind FDR’s New Deal,

promoter of the Social Security Act and

a champion of the rights of American workers 39

Page 39: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Frances Perkins’ Legacy:

Social Security,

Unemployment Insurance,

and the

Minimum Wage –

What is Florida’s Minimum Wage? 40

Page 40: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

2014 Minimum Wage –

$7.93

41

Page 41: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

42

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

Page 42: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Medicare

Federal Health Insurance Program

For people 65+

People <65 with certain disabilities

People with end-stage Renal

Disease

43

Page 43: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

44

Medicare (Components)

Part A - Hospital Insurance

Part B - Medical Services

Part C - Private Insurance

Part D - Prescription Drug Coverage

Page 44: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

45

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

Page 45: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

46

Medicare: Part B

Covers medical services :

– Doctor’s services

– Outpatient care

– Medically necessary physical,

occupational therapy and

some home health

Part B has a premium that changes

January 1st of each year with an

annual deductible – ($104.90 per

month/$147 deductible).

Page 46: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

Medicare: Part C

47

Page 47: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Prescription Drug Coverage

• Most people will pay a monthly

premium – Medicaid will pay premium,

if on

• 1/1/06 – available to everyone on

Medicare

Medicare: Part D

48

Page 48: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SSI

Title XVI (1974)

General Revenue

Needs Based

No Waiting Period

Looks at Earned and

Unearned Income

Resources Count

Medicaid 49

Page 49: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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 is 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

(is a minor)50

Page 50: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SSI - Resources:

(Maybe) 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) 51

Page 51: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

52

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)

More SSI Resources that

(Maybe) Excluded

Page 52: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Special Needs Trusts

Purpose

1. To benefit individuals with

disabilities

2. Maintain eligibility for public

assistance programs

3. Provides funds for supplemental

needs

53

Page 53: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

54

Page 54: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

55

Page 55: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

56

Page 56: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

When determining Medicaid eligibility

for these special former SSI recipients,

State Medicaid agencies must exclude that

portion of the individual’s

applicable Title II disability cash benefit

that caused their ineligibility for SSI payments.

The Exclusions

57

Page 57: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

What They Get

58

Page 58: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Who Determines Eligibility?

59

Page 59: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

Watch for Pickle People!

60

Page 60: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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”)

Childhood Disability Beneficiary

“CDB”

61

Page 61: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

EFFECTS OF

EARNED INCOME

ON

SSDI

Section 4

62

Page 62: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

GETTING STARTED

63

Page 63: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SSDI Work Incentives

Trial Work Period --- 9 months w/earnings

of $770 or more within a

60-month rolling window of time

Extended Period of Eligibility – 36 months

Grace Period (3 months)

Extension of Medicare Coverage – 93 months

64

Page 64: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.”

TRIAL WORK PERIOD - SSDI

65

Page 65: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

TWP months are counted when an individual earns a specific amount of income. (Determined January 1 each year by SSA)

2014 = $770.00/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).

TRIAL WORK PERIOD

SSDI

66

Page 66: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Applies only to SSDI

Trial Work Month = Earnings over $770.00 gross (2014)

– 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!

Trial Work Period

67

Page 67: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Extended Period of Eligibility

68

Page 68: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

EPE: Grace Period

69

Page 69: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

EPE (Cont’d.)

70

Page 70: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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).

EPE (Cont’d.)

71

Page 71: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Extended Medicare Coverage

72

Page 72: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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. 73

Page 73: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Work Incentives (cont’d)

Rules For Individuals Who Are Blind-SSDI

• See Definition of blindness (SSA

Redbook)

• Has to have 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 74

Page 74: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

75

Work Incentives

Comparison ChartSocial Security Disability Insurance Supplemental Security Income

Trial Work Period Continuation of SSI

Extended Period of Eligibility Student Earned Income Exclusion

Continuation of Medicare Blind Work Expense

Special Rules for the Blind (SGA) 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

\

Page 75: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Effects of Earned

Income

on SSI

Section 5

76

Page 76: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

• 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 an yearly maximum

• This exclusion applies before any other exclusion,

• Can carry the balance over the following month

Student Earned Income Exclusion

(SEIE) - SSI

2014

$1,750.00 per month $7,060.00 per year 77

Page 77: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

SEIE - 2014

2014

$1,750.00 per month

$7,060.00 per year

78

Page 78: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

SEIE– SSI

79

Page 79: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Blind Work Expense

(BWE) SSI Work Incentive

80

Page 80: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Enables a person

to still receive an SSI cash

payment when earnings exceed SGA

Section 1619(a)

SSI Work Incentive

81

Page 81: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

• 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.

Section 1619(a)

SSI Work Incentive

82

Page 82: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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:

– Eligibility

– Disability

– Need Medicaid

– Under State Income Threshold

1619(b)

SSI Work Incentive

83

Page 83: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

State Income Threshold

There is a “state income threshold amount” used

to measure if earnings are high enough to

replace SSI and Medicaid.

2014 in FL - $30,750

1619(b)

84

Page 84: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

85

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

Individualized Income Threshold

Page 85: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

• 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

Plan for Achieving Self-Support

(PASS) = SSI

86

Page 86: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

87

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.

PASS - SSI

Page 87: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

PASS - SSI

88

Page 88: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

PASS - SSI

89

Page 89: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

PASS - Self Employment

Page 90: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Property Essential for Self-Support

PESS - SSI

Page 91: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

92

• Property used for work as an employee

(required tools, equipment, transportation

etc.)

• Property used in a trade or business

(inventory, business owned property)

PESS (SSI)

Page 92: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

93

• 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

PESS (SSI)

Page 93: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

94

Work Incentives for

both

SSI and SSDI

Page 94: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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?”

Impairment Related Work Exp.

IRWE = SSI

95

Page 95: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

96

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

IRWE

Page 96: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Examples:

Transportation

Medications

Medical Devices

PCA

IRWE

97

Page 97: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

IRWE – Cont’d.

98

Page 98: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Without IRWE

*First Step $785 Earnings *Last Step

- $20 General Income Excl. $371.00 SSI Income

- $65 Earned Income Exclusion +$785.00 Earnings

$700 New Countable Income $1,156.00 Total Income

*Second Step

Divide by 2 the “new countable income” amount of $700

$700 /2 = $350.00 New Countable Income

*Third Step$721 FBR (Maximum SSI Benefit Payment)

- $350.00 Newest Countable Income Above

$371.00 Adjusted SSI Monthly Payment 99

Page 99: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

With IRWE

$ 785 Earnings Last Step

- $20 General Exclusion $471.00 SSI Check

- $65 Earned Income Exclusion +$785.00 Earnings

$700 New Countable Income $1,256.00 Total Income

- $200 Medications(IRWE)

$500 New Countable Income

Divide by 2 = $500/2 = $250.00 New Countable Income

$721 FBR

-$250.00 New Countable Income

$471.00 New SSI Payment

100

Page 100: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

What’s the Difference?

Without IRWE – $1,156.00

With IRWE

Total monthly income:

$1,256.00

101

Page 101: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Subsidies: SSI and SSDI

102

Page 102: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

103

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,

or

self-employment supports.

Subsidies or

Special Conditions

Page 103: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

Subsidies / Special Conditions

104

Page 104: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

105

Estimate the proportionate value of the

work being done by the worker being

supported according to the pay scale for

such work; and

Determine how frequently the agency

support monitors the worker, and how

involved the support is with the actual

function of the job.

Subsidies/Special Conditions

(Cont’d)

Page 105: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

106

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.

Subsidies / Special Conditions

Page 106: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

Employer Sponsored Subsidy

107

Page 107: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

108

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.

Employer Sponsored Subsidy

Page 108: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

Section 301

SSI and SSDI

109

Page 109: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

Expedited Reinstatement

SSI and SSDI

110

Page 110: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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.

Expedited Reinstatement

111

Page 111: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Page 112: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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

Expedited Reinstatement

113

Page 113: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

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)

Not be subject to a Continuing Disability

Medical Review (CDR)

Ticket to Work

SSI AND SSDI Work Incentive

114

Page 114: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

What is an Employment Network?

• Certified Private Contractor with SSA to

provide vocational services

• State Vocational Rehabilitation is also a

required Employment Network

Ticket to Work

115

Page 115: Introduction to Social Security Work Incentives SSWI Students.pdf · Introduction to Social Security Work Incentives 2014 APD SE Pre-service Training - Part II. Your Presenter ...

Thank you!

116