The Ticket to Work and Self-Sufficiency Program Training for Employment Networks and State Vocational Rehabilitation Agencies January 2007 Module 3 Social Security Administration Employment Supports Learning Objectives List the incentives for SSDI beneficiaries List the incentives for SSI beneficiaries Describe Medicare and Medicaid options Calculate Countable Income Calculate cash benefits for SSI beneficiaries SSDI Benefit Process Social Security Disability Insurance (Title II) Applies to beneficiaries who: Have a work history Have paid into the Social Security Trust Fund Are unable to engage in substantial gainful activity (SGA) as a result of medical or mental impairment expected to last longer than 12 months or that will result in death SSDI Eligibility To qualify for SSDI payments, a person must have worked and paid Social Security taxes for enough years to be covered under Social Security insurance, some of the taxes must have been paid in recent years, and the beneficiary must be: The worker or the worker's adult child or widow(er) Considered medically disabled, and Not working, or working but earning less than SGA SSDI Employment Supports Trial Work Period Begins with the first month a beneficiary is eligible for SSDI benefits Cash benefits continue regardless of income Any month in which a beneficiary earns more than $640 counts as a "services" month Allowed 9 non-consecutive "services" months within a 60 month period Extended Period of Eligibility If disability benefits stop after successful completion of the Trial Work Period because SGA was achieved, benefits are automatically reinstated without a new application for any months in which earnings drop below the SGA level. Extended Period of Eligibility Begins after the Trial Work Period (TWP) Lasts for 36 consecutive months Provides cash benefits during months when countable income is less than SGA level Prepares beneficiary to live off earnings through "Cessation" and the "Grace Period" Cessation and Grace Period Cessation The first month after the Trial Work Period that the beneficiary demonstrates SGA. The beneficiary receives his/her cash benefit regardless of earnings. Grace Period The two months immediately following Cessation, during which the beneficiary receives his/her cash benefits regardless of earnings. **Cessation and the Grace Period usually occur during the EPE, but might not necessarily, depending on the beneficiary's earnings. SSDI Employment Support Process Expedited Reinstatement of Benefits Working beneficiaries may be eligible for Expedited Reinstatement of Benefits if benefits have been terminated due to income. Benefits will start immediately Benefits will continue for six months while reinstatement is processed If reinstatement is denied, beneficiary will not have to return the cash benefits received during the processing period Extension of Medicare Coverage Premium free Medicare hospital insurance coverage continues for 93 months (7 years, 9 months) after the end of the Trial Work Period After premium-free Medicare coverage ends, Medicare hospital and medical insurance can be purchased if disability continues SSI Benefit Process SSI Eligibility Financially Needy Based on income level and other resources Aged Aged 65 or older Blindness 20/200 vision or less Disabled Unable to engage in SGA by reason of medically determinable impairment expected to result in death, or that has lasted or can be expected to last for a continuous period of 12 months Federal Benefit Rate (FBR) The maximum dollar amount a person can receive in federal SSI cash benefits on a monthly basis, provided his/her countable income and resources are less than the SSI limits SSI pays the difference between the FBR and countable income $623/month for individuals & $934/month for couples SSI Employment Supports 1619(a) and (b) Status and Eligibility Requirements SSI recipients who work still receive benefits despite earning at or above SGA level provided they remain disabled Income disregards formula used to reduce cash benefits as earnings increase Disabled beneficiaries are eligible for Medicaid despite earning above the "break even point" Income Exclusions Some income is excluded when determining SSI eligibility. These steps include: General $20 income exclusion is applied to unearned income A monthly deduction of $65 is applied to earnings If there is no unearned income a monthly deduction of $85 is applied to earnings Half the earnings over the first $85 is deducted Student Earned Income Exclusion Excludes up to $1,510 of earnings per month, to a maximum of $6,100 per year Applies before deducting the $20 general exclusion or the $65 earned income exclusion Plan for Achieving Self Support (PASS) Allows beneficiary to use personal income and/or things owned to reach a work goal that reduces or eliminates the need for SSI benefits Examples include setting aside money to return to school or get specialized job training Money set aside is not included when determining SSI eligibility Property Essential to Self-Support Some resources needed for self support are not counted when determining eligibility Examples include tools and equipment needed for work or a business's inventory, or if a business is owned, the property is not counted as a resource Blind Work Expenses Earned income that a blind beneficiary uses to meet work expenses is not counted when determining SSI eligibility and payment amounts Expenses do not need to be related to blindness Includes earned income used to pay income taxes, meals during working hours, transportation, and guide dog expenses Items are treated as blind work expenses instead of impairment-related work expenses when determining payment amount Continued Medicaid Eligibility Section 1619(b) enables beneficiaries to receive Medicaid coverage despite having income that is too high for an SSI cash payment Reinstating Eligibility without a New Application If beneficiary has been ineligible for an SSI benefit for 12 months or less, a new application to reinstate benefits does not have to be filed SSDI and SSI Employment Supports Impairment Related Work Expenses (IRWE) The cost of certain impairment related expenses needed in order to work are excluded from determining earned income Available to SSDI and SSI beneficiaries IRWE Attendant Care Transportation Costs Work Related Equipment and Assistants Prosthesis Residential Modifications Routine Drugs & Medical Services Diagnostic Procedures Subsidies and Special Conditions Supports received on the job that result in receipt of more pay than the value of the job Values are deducted from earnings when it is decided if SGA is reached Not deducted when SSI payment amount is figured Examples: receiving more job supervision, having a job coach, etc. Unincurred Business Expense Refers to self-employment business support that someone provides the beneficiary at no cost Is deducted from the net earnings Includes examples such as a friend working for free, receipt of computer used for work, etc. Not deducted when SSI payment amount is figured Unsuccessful Work Attempt An effort by a person with a disability to perform substantial work that either stopped or produced earnings below the SGA level after 6 months or less because of: The individual's disabling condition, or Elimination of the special services or assistance that the individual needed in order to work Not deducted when SSI payment amount is figured Continued Payment Under a VR Program If medical recovery is achieved and a beneficiary no longer meets the Social Security Administration definition of disability, monthly payments can continue if the beneficiary is actively participating in a VR program that is expected to aid in self-support SSI Benefit Calculation Earned Income $65 Earned Income Exclusion IRWE Divide by 2 PASS Exclusion = Countable Earned Income SSI Benefit Calculation Countable Earned Income + Countable Unearned Income Countable Income $623.00 (FBR) - Countable Income = Cash Benefit Amount SSDI & SSI Employment Supports Cessation and Termination of Benefits Last Month of Entitlement The last month of entitlement to benefits is whichever of the following occurs earliest: Second month after the month in which the disability ceases The month before the worker attains age 65, or The month before the month the worker dies. Termination of Benefits Requires Four Events TWP has ended -9 "services" months have occurred within 60 months EPE has ended-36 months of EPE have occurred "Cessation" has occurred The next month of SGA the beneficiary is off the disability rolls & termination occurs if all three other conditions have been met Methods of Reporting Income and Managing Records Beneficiaries Must Report Changes in Circumstances Reports of events/changes in circumstance are required if they affect a person's eligibility or SSDI/SSI cash benefit amount Report must be made within 10 days after the end of the month in which the change occurred Failure to report changes may result in penalty deduction in payments Changes in the Following Conditions Must be Reported Income Residence Marital status Absence from the US Disability improvement Eligibility for other benefits Changes in the Following Conditions Must be Reported (continued) School attendance Household composition Citizenship or alien status Criminal justice status Parole or probation violations The Ticket to Work and Self-Sufficiency Program Training for Employment Networks and State Vocational Rehabilitation Agencies January 2007