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Greg Makely

www. njwins .org 1-866-946-7465 Greg Makely Project Director Definition of Disability

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Greg Makely

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  1. www.njwins.org 1-866-946-7465 Greg Makely Project Director

  2. Definition of Disability • “the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

  3. What is Supplemental Security Income? • Known as SSI • Based on disability and financial need • Requires no work history • Has a resource limit • Any income will affect your payment level

  4. To receive a check, you must… • Have a disability, as defined by • SSA • Be 65 or older • Meet the income and resource • tests

  5. Resources Defined Resources are anything you own, such as a bank account, stocks, business assets, real property, or personal property that you can use for your support and maintenance.

  6. Resource Limits and Outcome • Limits - $2,000 single / $3,000 couple • Limit cannot be exceeded at the beginning of each month • Being over limit will render individuals ineligible for entire SSI benefit for as long as they are retained by the beneficiary • After 12 consecutivemonths over resource limit, the beneficiary will have to reapply

  7. Property Essential To Self-Support All primary possessions, such as primary residence or primary vehicle.

  8. Reporting to SSA • Always use copies of check stubs to report earnings and submit them in person at the SSA Office for your zip code area. • Always keep copies of everything you submit, and get a receipt from the Claims Rep before leaving the SSA Office.

  9. Reporting to SSA (Con’t.) • If you can’t submit in person, send it certified mail, so you have proof SSA received it. • Proof can be used to file a waiver of overpayment, if you are unable to pay it back. • Never report earnings over the phone.

  10. Law Provision 1619a • Allows SSI recipients to work and keep a portion of their cash benefit. • Runs all earned and unearned income through an income test formula to lessen the check amount due. • Means that check amounts can change as often as income changes.

  11. An Income Test Formula is… …a formula which combines earned and unearned income with work incentives and standard exclusions and compares them to the Federal Benefit Rate in order to come up with a monthly cash benefit payment amount.

  12. Income Test Formula Unearned Income Only

  13. Income Test Formula Unearned & Earned Income

  14. Income Test Formula Earnings Only

  15. Income Test Formula For 1/3 Reduction Beneficiaries

  16. Requirements for Student Earned Income Exclusions • Under age 22 • Not married or head of your household • Regularly attending school

  17. Student Earned Income Exclusions • $1,640 of earned income per month, in 2010, not counted. • $6,600 annually These amounts are for the year 2010; they are adjusted each year based on the cost-of-living.

  18. An IRWE is... • Impairment Related Work Expense • Paid for by the beneficiary • A service or product the beneficiary needs in order to work.

  19. Examples of IRWE’s • Attendant care services • Transportation Costs • Medical Devices • Work-related equipment • Prosthesis

  20. More IRWE’s • Residential Modifications • Routine Drugs & Medical Services • Diagnostic Procedures • Non-Medical Appliances and Devices • Other Items and Services (Expendable Medical Supplies, Cost of helper animals)

  21. Examples of Blind Work Expenses (BWE’s) • Guide Dogs • Fees • Transportation to & from work • Vehicle Modifications • Training to use impairment-related items

  22. More BWE’s • Taxes • Prosthesis • Meals consumed during work • Other work-related equipment • Non-medical equipment/services

  23. Still More BWE’s • Drugs • Physical therapy • Expendable Non-medical Supplies • Mandatory pension contributions • Non-medical equipment/services

  24. Definition of Blindness 20/200 or less in better eye with glasses or field of vision less than 20 degrees

  25. Plan for Achieving Self Support (PASS Plan) • A way to save for a big ticket item • Used to exclude income & resources • An alternate method of obtaining or retaining SSI

  26. Criteria for PASS Approval • Must be in writing • Must contain: • A feasible occupational goal • A savings and spending plan • A list of items and services needed andtheir cost • A timetable for achieving goal • Must be expected to increase person’s prospect for self-support

  27. The feasible occupational goal must… • Specify a job or profession • Have a reasonable chance of attaining goal Supported employment can be a goal

  28. Additional Income Exclusions • Parent’s income / resources once a child reached age 18, regardless of student status • Income set aside or being used to pursue a Plan for Achieving Self-Support by a disabled or blind individual

  29. Additional Income Exclusions Continued • State or locally funded assistance based on need • Rent subsidies under HUD programs and the value of food stamps • Infrequent or irregularly received income($20 or less a month)

  30. State Supplements

  31. FBR’s Past & Present

  32. Break Even Point 2010

  33. Law Provision 1619b • Allows for a beneficiary to continue to receive Medicaid coverage after he has reached the break even point and lost his monthly cash benefit. • Allows a beneficiary to remaineligible for resumption of cash benefits for 12 months. • Has an annual earnings threshold.

  34. 2010 NJ 1619b Medicaid Earnings Threshold • If earnings exceed $34,284 in 2010, SSI Medicaid will stop. • In NJ, beneficiaries who lose SSI Medicaid can regain Medicaid through the NJ WorkAbility (Medicaid Buy-In) Program.

  35. NJWORKABILITY is… • The Medicaid Buy-in program in NJ. • Allows individuals who work to be eligible for Medicaid.

  36. NJWORKABILITY 2010 Income Allowances Earned Income • 250% of Federal Poverty Level • Single:$ 54,948per year($4,579 per month) • Couples: $ 73,644 per year ($ 6,137 per month) Unearned Income • 100% of Federal Poverty Level • $ 903 per month for singles • $ 1,215 per month for couples

  37. NJWORKABILITY Disregarded Income • Social Security Disability Insurance from own account • Railroad Retirement Benefits from own account

  38. NJWORKABILITY Countable Assets • Individuals Under $20,000 • Couples Under $30,000

  39. NJ WorkAbility Coverageincludes, but is not limited to: • Doctor • Dentist • Hospital • Personal Care Assistant Services • Podiatry • Laboratory Services • Out Patient Psychology Service • Home Health Care • Medical Transportation • Surgery Medical Supplies • Nursing Facility • Occupational Therapy • Prescription Drugs • Psychiatry • Durable Medical Equipment • Eye Glasses • Hearing Aides • Dentures • Speech Therapy

  40. NJWORKABILITY Allowable Assets • IRA/401K account funds • Value of home • Value of vehicle

  41. NJWORKABILITY Premium • Under 150% of federal poverty level No premium is paid. • Over150% of the federal poverty level Individuals:$25.00 mo Couples: $50.00 mo

  42. NJWORKABILITY Application Process • County Boards of Social Service will process the applications and establish service. • Bring the following information to your appointment: a. Birth Certificate b. Proof of SSDI benefitor proof of the disability itself c.Recent pay stubs or a letter from the employer detailing gross monthly wages d.Recent bank statement

  43. What is Social Security Disability Insurance • Known as SSDI • Work history determines the • amount of your benefit • Has no resource limit • Only Worker’s Compensation or • other Federal and State Disability • checks affect your benefit amount

  44. SSDI is… • …not based on need • …based on work done by you • …the benefit which comes from your FICA deduction • …an all or nothing payment

  45. Trial Work Period 2009 • Unless medical recovery is an issue, beneficiaries are entitled to a Trial Work Period • TWP provides opportunities to test work skills while maintaining full benefit checks • Begins first month of entitlement to benefits • Trial Work Amount is annually indexed All earnings $720 80 hr. 60 mos. window 9 mo.

  46. Trial Work Amounts

  47. Extended Period of Eligibility (EPE) • Begins month following 9th TWP • 36 consecutive months • Eligible for check when earning below thecurrent Substantial Gainful Activityfigure • First time at or above SGA kick in a 3 month “Grace Period” • After “Grace Period”, ineligible for a check during months earnings are at or above SGA

  48. SGA Amounts Index Up

  49. Subsidies Goods or services received that a person or an entity other thanthe beneficiary pays for.

  50. Types of Subsidies • Employer Wage Subsidy • Employer Accommodation Subsidy • Agency Job Coach Subsidy • Agency Job Sampling Wage Subsidy

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