NTW AgrAbility Conference Grand Rapids, MI

1. Work Incentives and Work Supports: The Ins And Outs Social Security, Medicaid Buy-In's And Other Community Supports Joe Entwisle NCHSD NTW AgrAbility Conference Grand Rapids, MI

2. OUTLINE • SSI: Eligibility, Resources, Income, Work, Medical Assistance, PASS • SSDI: Eligibility, Work, Medicare • Self Employment • Work Incentive Planning and Assistance • Ticket to Work • Employed Individuals with Disabilities MBI

3. Social Security’s Benefit Programs RSDI/SSDI Retirement, Survivors, Disability Insurance) Medicare SSI- Supplemental Security Income Medicaid* Concurrent

4. WHAT ARE THE SSDI AND SSI PROGRAMS? • Social Security Disability Insurance(SSDI) provides benefits to disabled or blind people who are “insured” by workers’ contributions to the SSA trust fund. • Supplemental Security Income makes cash assistance payments to the aged, blind and disabled who have limited income and assets.

5. SSA DISABILITY PROGRAMS KEY CONCEPTS “SGA” “COUNTABLE INCOME” Social Security Disability Insurance (SSDI, Title II) Supplemental Security Income (SSI, Title XVI)

6. ... inability to engage in substantial gainful activity by reason of any medically determinable...impairment which can be expected to result in death or which has lasted or can be expected to last for…not less than 12 months.` Definition of Disability for both SSDI and SSI

7. SUPPLEMENTAL SECURITY INCOME • “Assistance Program” • Must have low income & resources • “Countable Income” = Key Concept • = $674 or less • Resources = less than $2,000 • Cash payment + Medical Assistance

8. SSI Federal Benefit Rate • The maximum dollar amount a person can receive in federal SSI cash benefits on a monthly basis • $674 month for eligible individual • SSI pays the difference between the FBR and countable income

9. SSA Doesn’t Count All of Your Income... General Income Exclusion of $20 Deducted first from unearned income Earned Income Exclusion $65 per month plus 1/2 of the rest

10. SSI - Work IncentivesEARNED INCOME EXCLUSIONSTUDENT EARNED INCOME EXCLUSIONIMPAIRMENT RELATED WORK EXPENSESPASSSECTION 1619BPay stubs needed every month

11. Impairment Related Work Expenses (IRWEs) • These are expenses that one must pay for out-of pocket in order to work. • They must be related to the primary disability or an established secondary disability. • The individual must have an IRWE approved by SSA first and must show receipts.

12. Examples of Possible IRWES • medical appointment payments • prescription co-payments • prosthetic devices • transportation costs for taxis • costs of adaptive devices for automobiles • special transportation used by persons who cannot drive an unmodified automobile.  

13. Where Do IRWE’s Fit In? • IRWE’s deducted from countable income before we divide by 2. • Therefore, IRWE is not subtracted from countable income dollar for dollar (like it is with SSDI).

14. Sample IRWE Calculation Mary pays $100 per month for specialized transportation to and from work. She is paid $500 per month from her job. 500 Earned Income • 20 General Disregard • 65 Earned Income Disregard • 100 IRWE =315/2 =157.50 Countable Income

15. Blind Work Expenses (BWEs) • A person whose primary disability is a visual impairment can use BWE’s to deduct the cost of a large list of items. • Unlike IRWES, BWEs are deducted AFTER we divide by 2. The entire BWE is deducted from income dollar for dollar. • Because of this, BWEs can be used to deduct so much from countable income that often times the SSI check is not reduced at all! :

16. Types of BWEs IRWEs State and Federal Taxes Union Dues Mandatory Pension Cost of Uniforms Reader Services, Driver Services, and Cost of Service Animal’s Care Childcare Transportation Meals Consumed at Work Adaptive Equipment

17. Blind Work Expense Example Mary earns $500 per month. She has $100 in various BWEs (taxes, etc.) $500 Earned Income -20 General Disregard -65 Earned Income Disregard =415/2 =207.5 -100 BWE $107.5 Countable Income!

18. Student Earned Income Exclusion • Must be under the age of 22 and regularly attending school. • Exclude up to $1550 of earned income per month when they figure the SSI monthly payment amount. • The maximum yearly exclusion is $6,240.

19. Student Earned Income Exclusion Example • Mary earns $500 a month. But, she is also attending community college with enough hours to qualify for Student Earned Income Exclusion. • $500 Earnings minus $500 SEIE (out of the possible $1550 max per month) • NO SSI REDUCTION until she uses $6240!

20. Continued Medical Assistance Section 1619 (b) When work earnings reduce SSI payments to zero, MA will continue if yearly wages below “Threshold” amount Individual Thresholds can be higher based on an individual’s actual MA use

21. Social Security Disability Insurance(Title II) SSDI DAC Entitlement programs Disability Medicare Coverage

22. SSDI - Social Security Disability Paid from Social Security Disability Insurance Trust Funds Have worked in “covered” employment May be eligible on parents record if disability began before age 22 Gateway to Medicare

23. How SSA computes if an employee’s work and earnings are at the SGA-level 1. Gross average earnings minus any: - impairment-related work expenses;& - special conditions or subsidy 2. Consider the value of the work 3. Consider if work is an “unsuccessful work attempt” ( lasted 6 mo or less)

24. SSDI Work Incentives TWP -Trial Work Period SGA - Substantial Gainful Activity EPE - Extended Period of Eligibility Expedited Reinstatement IRWE/Subsidy EPMC Medicare for people with disabilities who work

25. Trial Work Period (TWP) 9 months of $700 or more (no limit) 80 hours of self-employment activity per month Don’t need to be consecutive Only one TWP per disability entitlement Review by SSA when completed

26. Substantial Gainful Activity(SGA) • Measure of ability to work • $980 per month for 2009 • $1,640 per month for the blind SGA • If performing work that is “SGA” after the TWP cash SSDI benefits stop

27. Reducing Countable Income IRWE Subsidy

28. Impairment Related Work Expenses (IRWE) Expenses that are necessary to work, related to the person’s disability and paid for by the worker May be considered to reduce countable income below SGA

29. Subsidy • Value of additional support to perform a job, or difference between actual wages received and value of work performed • May reduce income below SGA like IRWE EXAMPLES: more frequent breaks, more supervision/support, lower production requirements

30. Extended Period of Eligibility(EPE) Consecutive 36 month period after TWP Cash benefits reinstated for months under SGA ($980) without a new application If at SGA at end of EPE, no more SSDI payments

31. Expedited Reinstatement of Benefits When someone’s Social Security or SSI disability benefits have ended due to earnings from work, he/she is able to request reinstatement without filing a new application Within 5 years of last benefits received Beneficiaries must be unable to work due to their medical condition They may receive temporary benefits (as well as Medicare/ Medicaid) for up to 6 months while SSA evaluates their medical condition

32. Medicare Federal health insurance program 24-month waiting period after SSDI benefits start $96.40/month Part-B premium (2009); Part A is free

33. Extended Period of MedicareCoverage (EPMC) Continued Medicare coverage even if no longer eligible to receive SSDI payment because of work At least 93 months of coverage after TWP ends Billed quarterly for months an SSDI payment isn’t received

34. Medicare for People With Disabilities Who Work • After EPMC, Medicare can continue if beneficiary pays the monthly premiums • Must continue to have disabling condition • State may pay Medicare premium through the Medicare Buy-In program, if income guidelines are met

35. Medicaid Buy-In Programs • Programs designed to allow workers with disabilities to buy into Medicaid at higher income and asset levels • First and only Medicaid work incentive • Operating in 40 states • Program features: • Vary from state to state • Required to pay premiums • Eligible from 16-64 and above • Most offer ability to increase assets

36. Medicaid Buy-In Programs • Must have a disability to participate • Must be working to participate • Provides wrap around coverage for private insurance • More than 100,000 participants nationwide • Many offer participants the ability to retire while maintaining eligibility • Utilize net income for eligibility on self-employment

37. Self Employment: A Viable Goal! • 7.8% of the general population is self employed • 12.2% of people with disabilities are self employed • 90% of businesses started by people with disabilities are successful due to planning and pre-determined supports

38. Self Employment May Be A ChoiceBecause It Can . . . • Provide greater flexibility and freedom to the owner • Allow independence and autonomy • Provide greater income potential • Allow for building of assets • Accommodate some disabilities more readily than wage employment

39. SSA Self-Employment Analysis • Determine if it is self employment. • Determine Net Earnings from Self Employment (NESE). • For SSDI, determine TWP • Determine countable earnings for SSDI and SSI (NESE minus any applicable deductions). • Adjust checks accordingly.

40. Is It Self-Employment? • Is the beneficiary showing good faith intention of making a profit or producing income? AND • Is the beneficiary engaged in the activity on a regular basis? AND • Is the beneficiary presenting him/herself to others as ‘a business’?

41. Open for Business! • SSA will calculate the Net Earnings from Self Employment (SSI and SSDI) • Utilize SSA deductions (IRWE, Unpaid help etc..) • Establish countable income • Determine impact on benefit

42. Public Programs That Could Help Fund A Business • Plan for Achieving Self Support • Individual Development Accounts • Vocational Rehabilitation Services

43. Using PASS to Fund Business • SSI recipients submit their business plan to SSA for approval as a PASS. • Expenses within the business plan may be approvable for a PASS. • A SSI recipient must have NESE or assets in order to fund the PASS! • May use SSDI as funds for PASS, making SSI eligible

44. Vocational Rehabilitation • Under the Rehab Act, VR agencies are allowed to support self-employment as a goal and can help to fund a business. • Rules vary from state to state and some states have strict requirements. • VR agencies can work with other workforce systems, such as the Small Business Development Centers, to support individuals.

45. Individual Development Accounts • A matched savings account in cooperation with a local bank; goal can be small business. • Individual Development Accounts may be used on their own, or in conjunction with a PASS or Family Self-Sufficiency Plan, to fund a business. • Federal IDA programs are exempt from most public benefit programs like SSI. This means that what the individual deposits, matching deposits and interest earned will not count as a resource.

46. Blended and Braided Funding Pizza Restaurant Owner: • Developed PASS to fund rent for restaurant ($35,000). • State VR funded a Business Enterprise Program grant ($50,000). • Individual Development Account containing wages from previous employment ($15,000) $100,000 for the Business!!

47. ADDITIONAL RESOURCES • www.start-up-usa.biz • http://www.worksupport.com/resources/listContent.cfm/5/2/0 • http://digitalcommons.ilr.cornell.edu/edicollect/53/ • www.griffinhammis.com • Self Employment For People with Disabilities http://www.brookespublishing.com/store/books/griffin-6520/index.htm

48. What does WIPA have to offer? Work Incentive Planning and Assistance • Information and Referral • Benefit Problem Solving and Advocacy • Benefits Analysis and Advisement • Benefit Support Planning • Benefit Management

49. How to contact WIPA? SSA’s Website https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate

50. Ticket to Work Program Provides beneficiaries with more choices for receiving employment services Provides greater incentives for entities providing employment services