Work and SSI and SSDI 2017.6 (1).ppt - Mass Legal Services and SSI... · Disability Law Center 7...

1Disability Law Center

How Work AffectsSSI and SSDI

Linda Landry, Svetlana Uimenkova,Senior AttorneysDisability Law CenterBasic Benefits November 2017


3 Questions

How does work affect SSI and/or SSDIbenefits?

If a recipient loses SSI and/or SSDI dueto work, will the recipient also loseMedicaid or Medicare?

What can recipients do to avoid aproblem with SSI or SSDI benefitswhen working?


SSI Benefits and Work

SSI is a “needs-based” benefit.

SSA must consider countable monthlyincome for ongoing SSI eligibility

SSA must also consider countable“resources” for ongoing SSI eligibility.


SSI Benefits and WorkEffect of Wages

For SSI recipients the main workincentive is the earned incomededuction.

For SSI, wages count when paid.

For working SSI recipients, the questionis:

How much of my wages will count toreduce my SSI benefit?



For employees, SSA considers grossmonthly wages when paid

To compute countable monthly wages,deduct $65 plus ½ of the remainder

A good estimate of countable wages is½ of gross monthly wages



SSI recipients may also deduct the $20“general income disregard” fromwages, if not used on “unearned”income.

Unearned income includes SSDI,interest, pensions, worker’scompensation, alimony and otherincome that is not wages


SSI Benefits and WorkEffect of Wages – Example 1

Carmen receives $735 in SSI & $114.39SSP in Mass. for disability in 2017.

She takes a job paying $985 in grosswages per month.

Will Carmen remain eligible for SSI withthese wages?

What should Carmen do when shetakes this job?



SSA will count $450 of the wages [$985– 85 ($65 + $20) divided by 2 = $450].

Her new benefit amount will be$399.39 ($735- $450 +$114.39=$399.39)

Total gross monthly income will be$1384.39 ($985 + $399.39). It was$849.39 before she had earnings.



Joe receives $520 in SSDI, $235 in SSI& $114.39 in SSP benefits based ondisability per month in 2017.

He also takes a job paying $985 permonth in gross wages.

These wages make him SSI ineligible.

What should Joe do when he takes thisjob?



$520 SSDI - $20 = $500 countable SSDI

$985 gross wages - $65 = $920

$920 divided by 2 = $460 countable wages.

$500 + 460 = $960, in countable income forSSI/SSP purposes – too much to remaineligible for SSI/SSP.

Joe’s new total gross monthly income is$1505. ($985 + $520)


SSI Benefits and WorkSelf Employment Income

For SSI recipients who are self-employed, SSA counts net selfemployment income against theamount of SSI the individual wouldotherwise be eligible to receive.


SSI Benefits and WorkIRWE Deductions

Impairment related work expenses(IRWEs) may be deducted to determinecountable gross monthly wages andcountable net self-employment income.

IRWE deductions are in addition toother permitted earned incomedeductions.

20 CFR 416.1112(c)(6).


SSI Benefits and WorkIRWE Deductions

IRWEs are:

impairment related items andservices

needed in order to work

that the individual pays for and thatare not covered or reimbursed by anysource, i.e., the individual must payfor them out of pocket.


SSI Benefits and WorkExamples of IRWEs

Attendant care services provided atwork or at home to prepare for work.

Transportation costs required becauseof disability.

Durable medical equipment, workassistive equipment, and prostheses.


SSI Benefits and WorkExamples of IRWEs, cont’d

Medical treatment necessary to or control orimprove a condition to permit work

Expendable medical supplies

Medical devices and appliances

Non-medical devices and appliances whereverified as essential for control of a condition,e.g., an air cleaner for a severe respiratorycondition


SSI Benefits and WorkBWE Deductions

Blind Work Expense (BWE) deductionsare available to SSI recipients eligibleon the basis of legal blindness.

BWEs are in addition to other permittedearned income deductions.

20 CFR 416.1112(c)(8), POMS SI00820.535


SSI Benefits and WorkBWE Deductions

Examples of BWEs: service animal expenses; transportation to and from work; taxes; attendant care services; visual aids; translation of materials into Braille; lunches; professional association dues.


Work & SSI Benefits-Student Earned Income

Deduction

The student earned incomededuction is for SSI recipients who: are under age 22, and

are regularly attending school.

20 CFR 416.1112(c)(3), POMS SI00820.510.


Work SSI & SSI Benefits-Student Earned Income

Deduction

Regularly attending school means:

For grades 7-12, attending at least 12 hrsper week;

For college or vocational program,attending at least 8 hrs per week.


SSI Benefits & Work -Student Earned Income

Deduction

In 2017, the student earned incomededuction is $1790 p/mo. up to amaximum of $7200 p/calendar year.($1820/$7350 in 2018)

This amount is indexed to the yearlycost of living increase.

This deduction is in addition to otherpermitted earned income deductions.


Federal EducationalAssistance

All student financial assistance receivedunder Title IV of the Higher EducationAct of 1965, or under BIA StudentAssistance Programs, is excluded fromincome and resources, regardless ofuse. Title IV programs include: PellGrants; federal work study programs;Upward Bound, and others specified inPOMS SI 00830.455


Other EducationalAssistance

any portion of a grant, scholarship, orfellowship used for paying tuition, fees,or other necessary education expensesis not countable income

any grant scholarship, fellowship, or giftfor the cost of tuition or fees does notcount as a resource for nine months.


Plan to Achieve Self-Support(PASS)

Set aside income and resources to useto achieve an occupational goal.

Occupational goal must be feasible.

PASS must be in writing and includebudget (& business plan if self-empl.).

If PASS is followed, income andresources don’t count for SSI.

POMS SI 00870.000


SSI and Medicaid“MassHealth”

In Massachusetts, the Medicaidprogram is called MassHealth.

Medicaid is a needs–based healthcoverage program.

In Massachusetts, all SSI recipient areautomatically eligible for MassHealth.


Keeping MassHealth WhileWorking - Loss of SSI

Will SSI recipients lose MassHealthcoverage if they make too much moneyto receive SSI benefits, even with allthe deductions they can take?

Probably not – they should be eligiblefor “1619b Medicaid” or MassHealthCommonHealth.


SSI Benefits and Work1619b Medicaid

1619b Medicaid is continued Medicaid for SSIrecipients who make too much money to beeligible for an SSI cash payment

These individuals can be “deemed” eligiblefor MassHealth - if they continue to meet allother SSI eligibility criteria, including theasset limit, AND if they meet the “MedicaidTest.”


SSI Benefits and Work1619b “Medicaid Test”

The individual must:

have been eligible for SSI for at least1 month;

remain medically disabled;

need MassHealth in order to work;and

have insufficient income to replaceMedicaid and SSI.



The beauty of 1619b Medicaid is thatindividuals can move back and forthbetween SSI cash eligibility and 1619bMedicaid as the ability to fluctuate – aslong as they remain medically disabled– without having to reapply for SSI.



The bad news is having to continueto meet the SSI asset test – whichcan be hard while working.

$2,000 for individual

$3,000 for couples


SSI Benefits and WorkMassHealth CommonHealth

MassHealth CommonHealth is availablefor those who lose SSI cash eligibilitydue to income from work and who donot meet the 1619b Medicaid Test –most often those people who do notmeet the SSI asset test.


SSI Benefits and WorkMassHealth CommonHealth

To be eligible for MassHealthCommonHealth, an individual must: Meet a one-time deductible; OR

Meet the SSI disability standard, except forthe inability to work at the substantialgainful activity level; and

Work an average of 40 hrs per month (or240 hrs over a 6 month period); and

Pay a premium based on income andfamily size.


How Do SSI Recipients AvoidProblems When Working?

Be ready:

Understand the SSI income counting rulesand their likely impact on SSI benefit

Provide SSA with verifications for allincome deductions which appear to beapplicable.


How Do I Avoid Problemswith SSI When I Work?

Report

Report to SSA anything that might affectyour SSI eligibility, e.g., new job, changein pay, bonus, loss of job, etc.

Report within 10 days of the end of themonth in which the change occurs.

Report in person at your local SSA office ifat all possible.

Ask SSA about telephone and mobile wagereporting.


How Do I Avoid Problemswith

SSI When I Work?

Keep records/copies

of everything you provide to SSA

of your notices

of when, where & to whom youspoke and/or provided records.

Telephone and Mobile WageReporting- POMS SI 00820.143

Ask SSA about telephone and mobilewage reporting.

It’s convenient and timely.

Applies only to certain SSI wagereporting

Requires training by SSA.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0500820143

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SSDI and Work


What is SSDI(Social Security Disability Insurance)?

SSDI is a Social Security insurance programthat pays a monthly cash benefit to peoplewho are:

Disabled = same definition of disability as withSSI (for adults), AND

Insured = worked and earned enough SocialSecurity credits by paying FICA taxes. For mostadults, this means working for about 5 of the last10 years before becoming disabled.

SSDI has no income or asset limits.


Earning Credits to BecomeInsured for SSDI

Earn 1 credit for every $1300 earned in 2017.$5200 earned = 4 credits. ($1320/$5280 in2018).

Maximum of 4 credits/year.

Must pay FICA taxes. No credits for “underthe table” work.

Special SSDI Rule for Young Adults: To be insured for SSDI, adults under 24 years old

only need to earn 6 credits in the 3 years beforethey become disabled.


More About SSDI The SSDI benefit amount depends on how much you

earned. Average is @ $1166, but could be muchlower or higher. Maximum is $2687 in 2017.

Certain dependents of the wage earner may beeligible for benefits on SSDI recipient’s wage record.

SSDI recipients receive Medicare after 24 months ofeligibility (Recipients with ALS do not have to wait 24months.) SSDI recipients may also qualify forMedicaid, but need to apply for it.


How Does Work Affect SSDI ?

The rules for SSDI and work are completely different thanfor SSI. It’s like being on another planet.


SSDI Work Incentive Scheme

9 Month Trial Work Period

Extended Period of Eligibility -36 Month Re-entitlement Period

The Cliff:Benefit Termination if over SGA


What Recipients Need toKnow

Have I completed my 9-month TrialWork Period? When?

If yes, when does/did my 3-yearExtended Period of Eligibility end?

Are my countable earnings above theSubstantial Gainful Activity level?


Trial Work Period

9 service months in any 60-monthperiod

SSDI benefits payable no matterhow much earned as long asrecipient remains medically disabled

ONLY 1 Trial Work Period per periodof disability


Trial Work Period

A trial work month used if “services”performed, meaning:

Earn more than $840 in gross wages per month in2017 ($850 in 2018).

If self-employed, earn more than $840 grossp/mo in 2017, $850 in 2018. Or, work more than80 hours/month.

Not just training or therapy

No deductions for IRWEs or subsidy and noaveraging earnings during TWP


Trial Work Period –Example 1

Joe went back to work for the first time afterqualifying for SSDI. His gross earnings were:

$500 in January 2017

$800 in February 2017

$1000 in May 2017

$875 in June 2017

How many trial work months did he use?

Should he get his SSDI for all these months?


Trial Work Period –Example 2

Jill’s gross earnings went over the trial work month “services”limit in the following months: 1. June 2010

2. January 2011

3. February 2011

4. March 2011

5. April 2011

6. May 2011

7. June 2011

8. August 2017

9. September 2017

10. October 2017

11. November 2017

What month of her TWP is she in as of November 2017?


Example 2 – The Answer

TWP 1 - June 2010

TWP 2 - January 2011

TWP 3 - February 2011

TWP 4 - March 2011

TWP 5 - April 2011

TWP 6 - May 2011

TWP 7 - June 2011

TWP 1 - August 2017 (more than 60-mo. to 6/2011)

TWP 2 – September 2017

TWP 3 - October 2017

TWP 4 - November 2017


The Extended Period ofEligibility – An All or Nothing

Deal

The EPE starts the month after the 9thTrial Work month.

The Re-entitlement Period portion ofthe EPE is the first 36 months.

Get SSDI in months where countablegross earnings are under substantialgainful activity (SGA) level, as long asremain medically disabled.

SSDI not payable in months earningsare at or over SGA level.

The Extended Period of Eligibility– an All or Nothing Deal

During the Re-entitlement Period portion ofthe EPE (first 36 months), entitlement toSSDI does not terminate with SGA.

Individual not payment eligible and in suspense inSGA months.

Can come out of suspense by verifying wages nolonger over SGA.

SGA does result in termination of entitlementwith SGA after the 36th month of the Re-entitlement Period.

20 CFR 404.1592a 49


EPE Example

The 9th month of Joe’s Trial WorkPeriod was December 2014. Whendoes his EPE start?

Answer: January 2015.

What months are the Re-entitlementPeriod portion of his EPE?

Answer: January 2015 through December2017.


Is it SGA?

Work must be substantial and gainful.

In 2017, work presumed to be SGA ifgross countable earnings are$1170/mo. or higher ($1950/mo. orhigher if SSDI for statutory blindness).($1180/$1970 in 2018)

Three additional SGA tests for self-employed, based on worth of work.


How to Count Earningsfor SSDI

Earnings count when they are earned, notwhen the paycheck is received, unlike SSI.

Count gross earnings unless self-employed.

Only pay for work activity counts Pay for sick or vacation time doesn’t count

Bonus pay counts if based on productivity

Earnings put into pre-tax Cafeteria and retirementplans count

POMS DI 10505.010.


Is It SGA? – DeductionsAvailable During the EPE

Impairment Related Work Expenses

20 CFR 404.1576

Subsidies

Employer pays more than actual value of servicesperformed ($ amount or % reduction)

20 CFR 404.1574(a).

Special Conditions

E.g., close and continuous supervision; work doneby job coach; frequent rest periods

20 CFR 404.1573(c).


Is it SGA? - Continued

Unsuccessful Work Attempt (UWA)

Yes - If work ended or reduced below SGA within6 months due to the impairment or removal ofspecial conditions related to the impairment.

No – If work lasted more than 6 months.

20 CFR 404.1574(c).

If it’s a UWA, it’s not SGA.

Unincurred Business Expenses (self-employment only) – e.g., free help.

POMS DI 10510.012.


Is it SGA? - Continued

Averaging Earnings

Can average until first month of SGA inEPE

Average over entire work period unless:

Significant change in work patterns orearnings, or

Change in SGA level (e.g., yearly COLA)

20 CFR 404.1575


SGA Example

Carmen gets SSDI based on disability. She isin her EPE. Her gross earnings in October2017 were $1200.

In October 2017 she paid for the followingimpairment related work expenses:

$10 for prescription copays

$65 for therapy

$25 for her support dog Max

Are her countable earnings presumed SGAfor October 2017?


The Answer

NO. It’s not presumed SGA.

IRWEs: $10 + $65 + $25 = $100

Gross income $1200 – $100 IRWEs

= $1100 countable income for SGApurposes., which is less than the 2017

presumed SGA amount of $1170.


Cessation and GracePeriod

The 1st month of SGA after the 9th TrialWork month is the cessation month.

Despite SGA, SSDI benefits are payablefor the cessation month and thefollowing 2 months.

Income averaging and unsuccessfulwork attempt cannot be used after thecessation month.


After the Re-entitlementPeriod of the EPE – The Cliff

SSDI eligibility ends with the first month ofSGA after the end of the EPE.

IRWEs, subsidies and special conditionsdeductions continue to apply after the EPE.

Averaging and Unsuccessful Work Attempt donot apply after the EPE.

If SSDI terminated due to SGA after EPE, noright to continuing benefits during appeal,unlike medical Continuing Disability Review.


Getting Back on SSDIAfter Benefit Termination

New Application; OR

Expedited Reinstatement of Benefits (SSDI and SSI) If benefits terminated due to earnings;

Unable to perform SGA in month of application;

Disabled due to the same or related impairmentsas those for which previously on benefits; and

Request reinstatement within 60 months fromdate of termination.

Up to 6 months of “provisional” benefits availablewhile eligibility is decided.

20 CFR 404.1592b - .1592f


Extended Medicare

Medicare continues during EPE even ifnot eligible for SSDI cash.

If SSDI terminates after EPE due toSGA, Medicare continues for up to 54additional months, if remain medicallydisabled.

Must pay Medicare Part B premiumsquarterly if no SSDI to deduct from.


How To Avoid Problems withSSDI When Working

Be Ready Understand the Trial Work Period, the EPE, SGA,

and how Social Security counts earnings for SSDI.

Keep track of and keep records of the amount youearn each month, and of deductions such asIRWEs and subsidies.

Know if you’ve finished your trial work period;where you are in your EPE; if your EPE hasended.

Talk with a Community Work IncentiveCoordinator.


How To Avoid Problems withSSDI When Working, cont’d

Report. Report. Report. Report to SSA when you go back to work,

your earnings, and changes in jobs orearnings.

Report within 10 days of the end of themonth in which the change occurs. Thesooner the better.

Report in person at your local SSA office ifat all possible, and get a receipt.

New Online Wage ReportingOption for SSDI Recipients

Starting October 2017, SSDI recipientscan report wages online using the mySocial Security account portal atwww.SSA.gov .

The recipient can save or print a receiptfor the wage report.

A limitation is that recipients cannot usethis option to report IRWEs, UWAs,subsidies/special conditions.

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How To Avoid Problems withSSDI When Working, cont’d

Verify and Record

Provide SSA with verification of all earningsand all income deductions you think youare eligible for.

Keep copies of everything you give to SSAand keep a record of when, where & towhom you gave it.

Help With Understanding theWork Incentive Rules

https://www.ssa.gov/redbook/ SSA’s Red Book onwork Incentives.

https://www.ssa.gov/pubs/EN-05-10060.pdf

Incentives To Help You Return To Work

https://www.ssa.gov/pubs/EN-05-10095.pdf

Working While Disabled - How We Can Help

https://www.ssa.gov/pubs/EN-05-10069.pdf HowWork Affects Your Benefits

https://www.ssa.gov/pubs/EN-05-11005.pdfWhat You Need to Know About Your SupplementalSecurity Income (SSI) When You Turn 18 66

Free Benefits CounselingAssistance

Available to SSI disability and SSDI benefitrecipients who:

Are working, or

Are moving into work.

Work Incentive Planning & Assistance (WIPA)programs

Certified Work Incentive Counselors.

Effect of work on all benefits.

BenePlan

Project Impact67


Other Places to FindInformation

www.ssa.gov Social Security Admin.

http://www.mass.gov/eohhs/consumer/disability-services/vocational-rehab/ses/impact/ Project Impact

http://www.beneplan.org/ BenePlan

www.hcfama.org Health Care for All


DLC Contact Information

Disability Law Center

11 Beacon street, Suite, 925

Boston, MA 02108

617-723-8455

800-872-9992

www.dlc-ma.org

Work and SSI and SSDI 2017.6 (1).ppt - Mass Legal Services and SSI... · Disability Law Center 7...

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