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Transcript of Social Security Administration. SSA Disability Benefit Programs Social SecuritySupplemental Security...
Social Security Administration
SSA Disability Benefit Programs
Social Security Supplemental Security Income (SSI)
• Based on a No work requirement; worker’s earningsincome, resources are factors
• Family members Only for individual, possibly entitled not family
Definition of Disability Same for Both Programs
• Physical/mental impairment expected to last (or has lasted) 12 months
&
• Impairment prevents worker from engaging in
“Substantial Gainful Activity” (SGA)
What is “SGA”?
• “Gainful activity” is work
• To be considered “substantial,” gross earnings must be at least $940* monthly
* $1,570 for blind
Disability “Onset Date”
• Refers to earliest date condition meets medical requirements
&
• Person was not working above SGA level ($940 monthly)
Who Qualifies for Social Security Disability Benefits?
• Worker - filing on own work record
• Disabled widow(er) - filing on deceased spouse’s record; minimum age 50
• Disabled Adult Child - filing on parent’s record;
over age 18, disabled before 22
To be Insured, Workers need “Credits”
• $1,050 earnings = one credit
• Can earn maximum of four per year
For Worker, Age at Onset Dictates Credits Required
•Age 31 or older:- 20 credits in 40-credit period pre-onset
•Age 24 to 30 - credits for half the time from 21-onset
• Under Age 24- 6 credits in three-year period pre-onset
Who Qualifies for SSI Benefits?
• Categories of recipients- aged (65 and older)- blind- disabled adults and children
• Receive cash benefits, Medicaid
SSI Income Limits
• Federal maximum monthly payment, no other income:
- $637 for individual- $956 for couple (both on SSI)
• If other income, $20 exclusion applies- e.g., $500 Social Security results in $157 federal SSI
SSI State Supplement – Penna.
• State adds up to $27.40 or $48.30 in separate check
exception: residents of Medicaid facility only due federal payment of $30
SSI - Resource Limits
• Resources: cash, bank accounts, bonds, stocks, non-home property
• Limits: $2,000 individual $3,000 couple
Filing Disability Application – Online at www.socialsecurity.gov
• For Social Security disability, both medical and non-medical portions can be completed online
• For SSI, only the medical portion can be completed online; non-medical must be completed in-person or by telephone
Filing Disability Application – By Telephone or In-Office
• Call 1-800-772-1213, weekdays 7:00 a.m. to 7:00 p.m.
• Set up telephone/in-office appointment; will be sent “Disability Starter Kit”in advance
Speeding Up Application
• Average processing time: 92 days
• Applicant can help by supplying:- names, dates, etc., of doctors,
hospitals, clinics, & institutions- names of medications- medical records, lab tests- summary of jobs, type of work
Who Makes Decision?
• Medical information sent to Disability Determination Services
(DDS)
• Disability evaluation specialist, physician review evidence, make determination
If Social Security Claim Approved…
• Benefits due after 5-month waiting period e.g., onset date - March 10, 2008 entitlement begins - September 2008
paid - October 2008
• Medicare begins after 24 months of entitlement: September 2010
If SSI Claim Approved…
• Benefits usually retroactive to effective date of application
• Medicaid entitlement coincides with benefit entitlement
If Claim Denied…
• Upon receipt of denial notice, 60 days to file hearing
• If hearing denied, other appeals remain: - Appeals Council Review - Federal court review
Medicare
• Federal health insurance program administered by Centers for Medicare
& Medicaid Services (CMS)
• SSA makes eligibility determinations, enrolls people, gets card issued
Medicare – Who Gets It?
• 65 or older- eligible for Soc. Sec. benefits, or - worked 10 years for government entity,
paid Medicare tax
• Under 65 - entitled to Soc. Sec. disab. 24 months (no waiting period for ALS)
or kidney failure (& insured for benefits)
Traditional Parts of Medicare
• Part A - Hospital Insurance - covers inpatient care in hospital, skilled nursing facility, some home health care, hospice; but .... long-term care limited - length of in-patient stay
dictates amount of coverage - no premium, but financed by
worker’s 1.45% tax
Traditional Parts of Medicare
• Part B - Medical Insurance- outpatient procedures,
medical supplies- $96.40 standard monthly premium ... .... but, sliding-scale premium for singles with income $82K+,
couples with $164K+;affects 4% of beneficiaries
Another “Part” of Medicare
• Part C – Medicare Advantage Plan - health plan option, like Medigap plan; receive all health care services thru provider organization- includes HMOs, PPOs, special needs plans, private fee-for-service plans
- pay Part B premium & plan premium; lower out-of-pocket costs, more covered services
Newest Part of Medicare – Part D Prescription Drug Plan
• Began 2006, CMS responsible - open to all Medicare recipients - choose from plans of private companies - important: compare current plan - enroll soon after applying for Medicare; later, can only enroll Nov. 15 – Dec. 31
Part D “Extra Help”
• SSA responsible
• People of limited means can get help with: - premium, deductible, co-pays
• Must apply, unless in “deemed” category
• Apply online or use paper application
Work Incentives
Social Security
&
Supplemental Security Income (SSI)
Social Security Beneficiary Returning to Work
• Trial Work Period- can work in nine months- regardless of earnings, benefit paid- to count as TWP month,
earnings at least $670- nine months can be scattered
over 60-month period
At conclusion of TWP, ongoing work evaluated
• If work “not substantial” (under $940), benefit continues
• If work “substantial” ($940+), benefit paid months 10-12, then suspended
Months #13 through #45 .... Extended Period of Eligibility
• After 12-months TWP & grace months, “EPE” runs 33 months, to month 45
• Benefit unpaid for months #13-45 whenever SGA ($940+) performed
• Likewise, benefit paid for EPE months under $940
Impairment-Related Work Expenses
• After TWP completed, the costs of some impairment-related items, services needed to work can be deducted from earnings in determining SGA ... $1100 earnings
- $165 IRWE $935 = no SGA
• Individual must not be reimbursed for item, cost must be “reasonable,” and item paid for in a work month
What about Work after EPE?
• Month #45 is last EPE month
* SGA in month 46 or later terminates eligibility
* But .....
“Expedited Reinstatement”
* If earnings fall below SGA, benefit reinstated...no new application needed
* Request must be made within 60 months of termination
* Must have same disability
* Can receive up to six months of benefits, including Medicare
Continuation of Medicare
• All disability recipients are Medicare-eligible after 24 months of benefit entitlement
• After TWP, Medicare can continue for 93 months regardless of SGA
SSI Recipient Returning to Work
• No TWP, no EPE
• SGA not an issue
• Earnings reduce payments, but benefits continue as long as income, resource limits not exceeded
How Earnings Reduce SSI
• Unlike unearned income, earnings don’t reduce SSI dollar-for-dollar
• Subtract $65 ($85) from monthly gross earnings; half of remainder counts against SSI
• $600 earnings Half of $515 = -$85 exclusion $515 remainder $257.50 SSI reduction
Monthly Earnings Cut-off
• Earnings of $1,359+ results in no SSI payable
• $1359 earnings Half of $1274 -$85 exclusion is
$1274 remainder $637
• SSI limit: $637.00 - $606.40 countable income 0 = no SSI payable
Impairment-Related Work Expenses
• Remember, SGA not an issue for SSI once on; but IRWE reduces countable earnings
• $1267.80 earnings $1182.80 -$85.00 exclusion - $52.00 IRWE
$1182.80 $1130.80 Half of $1130.80 = $565.40 countable earnings
• SSI limit $637.00 - $565.40 countable income $71.60 SSI payable
Continuation of Medicaid
• If earnings too high to allow SSI payment, Medicaid still continues if ...
.... yearly earnings don’t exceedPennsylvania threshold:
$28,554
Work Exclusion for Students
• Must be under age 22 and in regular school attendance
• Up to $1,550 earnings excluded per month
• Maximum $6,240 excluded yearly
Plan for Achieving Self-Support (PASS)
• Use or setting aside of income, resources to achieve work goal, increase prospects for self-support
* Excluded income, resources don’t count against SSI, thereby increasing payment
* Must be in writing, estimate time period for attaining goal
Ticket to Work
• Gives disabled choice in obtaining free rehabilitation & vocational services
• Provides more incentives for disabled to work & lessen dependence on public benefits
• Removes barriers that make people choose between medical coverage and work
The Ticket Itself
• New disability recipients, age 18-64, will be sent Ticket, letter, & booklet
• Ticket certificate can be “used” to obtain free vocational, employment services from organizations called “Employment Networks”
- ENs are paid, but only if disabled individuals work
• Ticket program is voluntary!
Upon Ticket receipt ...
• Recipient not required to do anything; remember....voluntary program
• But ....if interested in receiving services, call Program Manager (Maximus, Inc.)
• Later ... take Ticket to an Employment Network (EN) to obtain services
Employment Network (EN)
• Any agency or instrument of the state, or a private entity responsible for the coordination or actual delivery of services can become EN
• Can be single entity, consortium, or association of organizations collaborating to combine resources to serve Ticket holders
Examples of ENs
• State VR agencies
• Any public/private entity providing appropriate services (job readiness, placement, voc. rehab., training, etc.)
• Employers offering job training, voc. rehab., support, retention, or other types of job-related services and/or assistance for the disabled
ENs Serving Philadelphia
• Currently, 34 ENs signed up
• Seven are based in city
How do People reach ENs?
• SSA contracted with a Program Manager – Maximus, Inc.
• Maximus recruits, monitors ENs; also facilitates access to ENs
• When Ticket sent, people referred to Maximus toll-free number & www.yourtickettowork.com
Assigning a Ticket
• Before “assigning” Ticket, person first discusses services, etc., with EN
• EN can refuse to accept the Ticket
• If agreement is reached, individual work plan which details desired employment goals is written
• After plan drawn up, Ticket considered assigned and “in use”
What’s in It for Disabled Individual?
• Ticket-users not subject to medical Continuing Disability Reviews as long as making “timely progress”
• “Timely progress” - assumed in first two years of Ticket use - in third year, 3 of 12 months must be SGA ($940) - in fourth year, 6 of 12 months SGA - in fifth year, 6 of 12 months must be non-pay
What’s in It for ENs?
• ENs paid when Ticket users either:have earnings which result in no cash benefit, or .... have earnings at or above SGA
• ENs, therefore, have vested interest in getting people back to work
The National Numbers So Far ....
• 10.4 million Tickets sent
• 192,000 Tickets assigned
• One of every 54 Tickets sent out assigned
• 93% of assigned Tickets have gone to state VRs, 7% to new ENs
• Note that pre-Ticket, state VRs “rehabbed” 10,000 people yearly
Another Ticket Partner: WIPA
• SSA awarded contracts to organizations; called Work Incentives Planning and Assistance (WIPA) organizations
• They conduct outreach efforts re work incentives, provide planning and assistance, can also provide one-on-one counseling, advice, etc.
• Disability Rights Network serves Philadelphia
Another Ticket Partner: Protection & Advocacy Program
• SSA awarded contracts to legally-based disability rights agencies to provide legal representation & other advocacy services
• In Pennsylvania, Disability Rights Network has the contract