Navigating SSA Work Incentives and Employment

1. Navigating SSA Work Incentives and Employment Work Incentives Planning and Assistance (WIPA) Project and the Freedom to Work Project Brooke Lusk

2. Cash Benefits Programs for People with Disabilities • Social Security Disability Insurance • Supplemental Security Income • Same definition of disability used to qualify for both programs. • SSA determines what, if any, program a person qualifies for and how much the cash benefit will be.

3. Definition of Disability • Inability to do any 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.

4. SSA’s Adult Sequential Evaluation Are you working at or above SGA? Are your impairments severe? Do you meet or equal a listing? Can you do your past relevant work? Can you do any other work?

5. Social Security Disability Insurance • Insurance system • Individual must have relevant work history or be related to somebody (child, spouse, former spouse, parent) who is disabled, retired, or deceased with work history. • Benefit will vary depending on when relevant work income earned and the amount earned.

6. More on the SSDI Benefit • Assets and amount of unearned income are irrelevant. • Can vary in amount enormously. • For SSDI on own account, first check begins on 6th month after entitlement and SSA can award benefits retroactively for up to 12 months prior to application. • Wages count when earned, not necessarily when paid.

7. SSDI on Own Work Record • Individual worked and paid into the system. • Individual earned sufficient amount in a sufficient amount of quarters at the relevant time. • Number of quarters of coverage needed differ depending on age. • Minor children or spouse can receive a dependent benefit.

8. Disabled Adult Child/Childhood Disability Beneficiary • 18 or older • Disabled by SSA’s definition before the age of 22. • Child of insured workers who are either disabled, retired, or deceased. • If adult child marries, benefits will cease unless marriage is to another Title II beneficiary.

9. Disabled Widow/Widower • Must be widow/widower or surviving divorced spouse. • Must be found disabled before a prescribed period of time. • Payments are not payable prior to age 50.

10. SSDI Beneficiary: Medicare • SSDI beneficiaries are eligible for Medicare after 24 month waiting period. • Waiting period begins with the first month in which person is eligible for check. • Many have already passed waiting period when they receive first check because case was pending for so long. • Some SSDI beneficiaries are eligible for Medicaid assistance in paying for the Medicare premiums.

11. Supplemental Security Income Needs based program. Strict asset and resource guidelines. Countable income includes both earned and unearned income. Any money coming in could count, even gifts! Also considers the income of other relatives in certain cases (deeming).

12. Why Two Cash Systems? SSDI is only for people who paid into the system or related to somebody who paid. What about those with same exact disability who were not able to pay into the system or do not have the “right” relative who is retired/disabled/deceased? SSI system was created later and helps fill in this gap.

13. SSI fills in this gap, but……….. SSI is very different from SSDI in key aspects. SSI is best thought of as a “payer of last resort.” So, everything you receive or have could potentially count against the SSI check.

14. Supplemental Security Income Federal Benefit Rate – standard amount of SSI in 2011 is $674 for individual and $1011 for couple. The amount you actually receive may vary if there has been an overpayment or other income is being counted. Usually received on the 1st of the month. Can supplement a low SSDI check. Both children’s SSI and adult SSI.

15. Supplemental Security Income – Resource Rules Asset limit is $2000 for single, $3000 for couple. Home in which person resides does not count. One car does not count. Long list of other exceptions in the Program Operating Manual System (POMS).

16. Supplemental Security Income – Counting Other Income Almost all unearned income counts against the check. Less than ½ of earned income counts. In-Kind Support and Maintenance can be considered. Income of certain relatives can be considered.

17. Supplemental Security Income - Medicaid In South Dakota, Medicaid eligibility is automatic when SSI is approved. This is not the case in all states.

18. What is the Difference Between Medicare and Medicaid? • Medicare is run by feds, Medicaid is run by states within parameters set by federal. • They can cover different services or cover its cost sharing in different ways. • They have different rules for how they are impacted when a person has employment income. • Doctors may take one and not the other. • And on, and on, and on…………………

19. Shifting Gears…..Work Incentives Social Security’s definition of disability involves inability to engage in substantial gainful activity. Once in the system, there are rules and policies called “work incentives” to encourage beneficiaries to work! Some incentives have been around a long time and others were created through the Ticket to Work and Work Incentives Improvement Act of 1999.

20. Work Incentives Policy Term used for policies and procedures created to address barriers to employment caused by benefits eligibility. Some remove the barrier, while others encourage working by rewarding employment activity. Work incentives have changed and improved significantly over time. The Ticket to Work and Work Incentives Improvement Act was the latest and largest work incentives policy shift.

21. Program Rules are Different Rules for SSDI and SSI when you go back to work are different. Often, beneficiaries and their service providers get confused as to which rules apply. If person receives both checks, one set of rules applies to one check and the other set of rules applies to the other check.

22. Impact of Unearned Income on SSDI? NONE! Receiving alimony Child support Gifts Dividends Interest or Even winning the lottery will not have ANY impact on receiving a SSDI check

23. Impact of Earnings on SSDI SSDI is an ALL or NOTHING program. The amount of the check is not reduced – a person either gets their check or they do not get a check.

24. Trial Work Period • An individual is eligible to receive a total of 9 Trial Work Period (TWP) months. • Over a rolling 60-month (five-year) period. • The Trial Work Period amount for 2010 and 2011 is $720.00 or 80 hours of work in self-employment.

25. Trial Work Period An individual is not required to use these nine TWP months consecutively. During the Trial Work Period phase, a beneficiary is entitled to keep their SSDI cash benefit regardless of how much is earned.

26. Substantial Gainful Activity (SGA) SSA determines the amount each year 2010 and 2011 SGA: $1,000 in countable earnings 2010 and 2011 SGA for people whose primary disability is statutory blindness: $1,640 Important to remember deductions such as IRWE and Subsidy!

27. Extended Period of Eligibility The Extended Period of Eligibility (EPE) is a 36-month continuous period following the Trial Work Period. When in the EPE, an individual can receive a SSDI cash benefit when countable earnings are less than SGA (2010 and 2011 - $1,000 a month or $1,640 Blind). However, any month in which countable earnings are above SGA, an individual will not receive a SSDI cash benefit.

28. Impairment Related Work Expenses (IRWE) Enables SSDI beneficiaries to recover some of their out-of-pocket expenses incurred as a result of their disability to support their work. IRWE’s expenses are subtracted from a person’s earnings. By reducing countable income, IRWEs result in a decrease in the amount counted towards SGA; a beneficiary can use an IRWE to remain eligible for SSDI cash benefits.

29. Possible IRWEs -- Examples Medical appointment co-payments Prescription co-payments Prosthetic devices Certain transportation costs Costs of adaptive devices for motor vehicles by persons who cannot drive an unmodified vehicle

30. Example of IRWE • Mary works and earns $1,000.00 per month. However, she pays co-pays on her medications of $80 per month. Mary’s countable income is: • $1,000 per month during TWP. • $920 per month after TWP. • Mary’s SSDI cash benefit will continue because she is earning under SGA!

31. Subsidy & Special Conditions Support received on the job that may result in you receiving more pay than the actual value of the services performed. “Subsidy” is support provided by the employer (extra breaks, more time to finish work) “Special conditions” are something provided by someone other than the employer (VR pays for a job coach)

32. Example of a Subsidy Bill has finished his TWP. He earns $8.00 per hour and works 30 hours per week ($1,039.20). He receives 16 hours a month of support on the job from the employer. Step 1: Hours of job coach intervention on site 16 hours per month or number of hours of additional supervision x $8.00 hourly wage of worker =$128 monthly subsidy Step 2: $1,039.20 Monthly Gross Earings - 128.00 Monthly Subsidy = $911.00 Monthly Gross Wages Counted towards SGA Bill had earnings over SGA but with a subsidy, his countable income of $911 is less than $1,000 (SGA). Bill would be entitled to an SSDI cash benefit.

33. Expedited Reinstatement (EXR) Must apply within 5 years of the last time eligible to receive a SSDI cash benefit or last month of the EPE, whichever is later. Stopped receiving benefits because of work. Must continue to meet the medical definition of disability and not be earning over SGA. Use medical improvement standard. Decision is made quickly. Eligible for 6 months provisional benefits while a decision is pending.

34. Remember!Report Income Every Month!!!!! STOP

35. Will Medicare Continue When Person Gets a Job? Medicare continues as long as you get a disability check. Even if the disability check stops, most individuals who work will continue to receive at least 93 consecutive months of Medicare after the Trial Work Period.

36. Supplemental Security Income Federal Benefit Rate – standard amount of SSI in 2011 is $674 for individual and $1011 for couple. The amount you actually receive may vary if there has been an overpayment or other income is being counted. Usually received on the 1st of the month. Can supplement a low SSDI check. Both children’s SSI and adult SSI.

37. (Almost) Everything Matters Purpose of SSI is to help you obtain food and shelter. Any factor impacting this (who you live with, how much you make, how much you have, etc) may impact SSI. Rules are complicated and complex. Always look at the Program Operating Manual (POMs).

38. What is NOT income? Medical and social services Personal service Income tax refund (resource after nine months) Loan Somebody pays a bill that is not food or shelter Clothing Others……….

39. What is Income? Unearned income (SSDI check, Retirement check, etc.) Earned income (earnings, self-employment) In-kind support and maintenance (food and shelter provided by someone else) Other – Check POMs

40. What is the Resource Limit? • $2000 individual, $3000 couple • Exclude: • Home the person resides in • One automobile • Retro SSA benefits for 9 months • Certain trusts • Burial fund up to $1500 • PASS funds • Income tax refund (up to 9 months) • Others

41. When does Earned Income Count? For SSI, earned income always counts in the month that it is RECEIVED. Therefore, paychecks every two weeks can come up with months where 2 pay checks are issued and months where 3 paychecks are issued!

42. Supplemental Security Income and Employment • SSI and earnings are calculated with a formula. These deductions are subtracted from the gross income to determine countable income: • General Income Exclusion $20.00 • Earned Income Exclusion $65.00 • Deductions/Exclusions

43. Examples of Working @ $8.25/hr.Total Gross Earnings From Work Part Time Full Time $8.25 Hourly Wage $ 8.25 x 20 Hours/Week x 40 $165.00 $330.00 x 4.33 Avg Hours/Month x 4.33 $714.45 Gross Monthly Earnings/Employment $1,428.90

44. Calculating Total Monthly Countable Income From Employment Part Time Full Time $714.45 Monthly Income $1,428.90 -$20.00 General Income Exclusion - $20 $694.45 $1,408.90 -$65.00 Earned Income Exclusion - $65 $629.45 Gross Monthly Earnings/Employment $1,343.90 /2 Divide by 2 /2 $314.73 Total Monthly Countable Income $671.95

45. Calculating SSI payment Part TimeFull Time $ 674 2011 Federal Benefit Rate $ 674.00 - 314.73 Total Countable Income - 671.95 $ 359.27 Adjusted SSI Benefit Check $ 2.05

46. Total Monthly IncomeAdjusted SSI Benefit + Monthly Income from Employment Part TimeFull Time $ 714.45 Earnings from Employment $1,428.90 + 359.27 Adjusted SSI Benefit Check + 2.05 $ 1073.72 Total Monthly Income $1430.95

47. SSI Work Incentives Impairment Related Work Expense (IRWE) Blind Work Expense (BWE) Student Earned Income Exclusion (SEIE) Plan for Achieving Self-Support (PASS) 1619(b) – Medicaid ($32,991/year in SD for 2011)

48. Impairment Related Work Expenses (IRWE) These are expenses 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

49. Where Do IRWEs Fit In? IRWEs deducted from countable income before dividing by 2 in the calculation Therefore, IRWE is not subtracted from countable income dollar for dollar (like it is with SSDI)

50. 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 Income Exclusion • $65 Earned Income Exclusion • $100 IRWE =$315/2 = $157.50 Countable Income