Benefits Counseling & Work Incentive Management

1. Benefits Counseling & Work Incentive Management Traumatic Brain Injury (TBI) Conference Presented by: Karyn Stenzler June 12, 2012

2. Objectives • Dispel myths of working • Impact of wages on SSI and SSDI • Medicaid and Medicare • Work Incentives

3. Key to Success Knowledge + Education = Financial Self Sufficiency & Independence

4. TRUE or FALSE • I can’t work more than part time or I will lose my benefits. FALSE • I can’t earn more than $1010 or I will lose my benefits. FALSE • I can’t go to work because I might lose my Medicare/Medicaid (Medical Assistance). FALSE

5. Benefits Counseling • Information to gain knowledge of benefits/work incentives to make informed decisions • How employment will affect benefits • Provide ongoing support and assistance • Reporting wages, Impairment Related Work Expense (IRWE), Plan for Achieving Self Support (PASS), etc.

6. Who provides benefits counseling services? • Work Incentive Planning and Assistance (WIPA)- 104 across the country: Benefits INfoSource serves the State of Maryland (ending June 30th)– Community Work Incentive Coordinators (CWIC) • Certified Benefits Counselors- independent and agency CWICs provide counseling through Division of Rehabilitation Services (DORS) • Employment Networks (ENs)- through Social Security Administration’s Ticket to Work program

7. Supplemental Security Income-SSI Unearned Income (Not Wages) SSDI, VA, Annuities, Unemployment Child Support, Alimony Income (Earned Wages) 12 months no SGA income SGA factor at initial eligibility Once on SSI SGA is not at issue Resources (NOT Wages or Unearned Income) $2,000/month/Individual $3,000/month/Couple Medical Eligibility DDS (STATE) Determines Medical Eligibility Medicaid (Medical Insurance) SSI connected, State Administered Social Security Disability Insurance-SSDI Required Work Credits in F.I.C.A 5 Month Waiting Period + 12 months non SGA income SGA Initial Eligibility During EPE and Beyond Medical Eligibility DDS (STATE) Determines Medical Eligibility DAC –Disabled Adult Children Disability Prior to Age 22 Not Married to Non-Title II Beneficiary Insufficient FICA Parent: Retires, Dies, Becomes Disabled Possible continuation of Medicaid Medicare (Medical Insurance) 24 months upon eligibility determination Part A/Hospitalization-Part B or D Premium Payment Eligibility of Benefits

8. What is SSDI? Social Security Disability Insurance (SSDI) • SSDI is a program term not MEDICAL term. • SSDI is a Title II Program benefit. • SSDI benefits are based on a person’s work history, looking at length of time and amount of money earned in F.I.C.A. SSA provided an annual statement to workers on current & historical work history. • SSDI check amount will vary from person to person. • A person could also qualify for SSDI when connected legally to an open work history of the worker. Example: Disabled Adult Child (DAC) • If you become eligible for SSDI then you will be eligible for Medicare after a 24 month waiting period.

9. What is SSI? Supplemental Security Income • Supplemental Security Income (SSI) is a Title XVI program term not MEDICAL term. • SSI comes from Federal Income Tax-Tax Payer dollars • One of the criteria for SSI is based on a person’s financial picture : Unearned Income, Wages, and Resources • FBR—Federal Benefit Rate Maximum: 2012 = $698 SSI cash benefit comes 1st day of month.

10. Medicaid/Medical Assistance • The Medical Assistance program is administered by Maryland • Health and medical services for individuals and families that qualify • SSI eligibility opens one of the MD Medicaid doors • MD follows the Federal SSI eligibility rules to determine SSI door into Medicaid eligibility

11. Medicaid Waiver Programs • Programs that provide services in the community (instead of institutions): • People with Traumatic Brain Injury • Adults with developmental disabilities • Medically fragile children • Children with autism • Adults with physical disabilities • Older adults with disabilities • People with developmental disabilities who want customized services • All the programs provide Medicaid eligibility

12. Medicaid Waiver Con’t • Eligibility • Receive SSI or TCA, or • Another coverage group that provides full Medicaid • Have “countable” income below $2,094/month (three times the maximum SSI check) in 2012 OR, for some Waivers, • Receive EID • Countable Resource Limit: $2000 • Do not transfer from state to state

13. Employed Individuals with Disabilities Program (EID) • Also known as Maryland Medicaid Buy-In • Meet SSA’s disability criteria after reaching age 18 • Are U.S. citizens or qualified aliens aged 18 – 64 • Are working for pay • Meet income and resource limits • Only income from individual and spouse is counted • Monthly premium on a sliding scale • EID provides “fee for service” Medicaid – don’t join a managed care organization

14. Overview of Work Incentives • Work incentives are individualized based on a beneficiary’s situation • Benefits Summary and Analysis • Work Incentive Plan • SSDI (Title II)- see separate handout • SSI (Title XVI)- see separate handout

15. Highlight of Work Incentives • Student Earned Income Exclusion= excludes wages • Blind Work Expense= Credit for Out of pocket expenses • 1619b = Protects State Medicaid and SSI eligibility • Plan For Achieving Self-Support (PASS)= Saving for Reaching An Occupation • Impairment Related Work Expense (IRWE)= Credit for Out of Pocket Expenses that support the disability when earning income • Special Condition/Subsidies=Calculating Value of Work vs. SGA • Ticket to Work=Vocational Services Program to Return to Work

16. SSI Work Incentives and Wages • Sample of an SSI wage Formula: $1085 gross Wages -20 General Exclusion -65 Earned Income Exclusion Wages = $1085.00 $1000 New Countable Wage New SSI = 198.00 $1283.00 $1000 ÷ 2 = $500 New Countable Wage $698 Federal Benefit Rate for SSI 2012 - 500 Countable Wage $198 New SSI and Keep Medicaid

17. Going to Work • Once you start working: • Notify Social Security Administration (SSA) immediately in writing and via phone. • Notify SSA of any potential “tools” that could be utilized to reduce Substantial Gainful Activity (SGA) or apply a credit reduction to your gross earned income • IRWE, Subsidy, Special Conditions

18. Reporting Wages to SSA • Report wages to SSA for both SSI and SSDI by the 6th of each month • Report in person, certified mail, via fax • You receive both benefits- report to SSI and SSDI • Obtain a receipt from SSA for each report made • This will help protect against overpayments

19. Checklist for Success • When you call SSA (1-800-772-1213) keep a record: • Date • Name of person you spoke to • Location of the Call Center • What you asked • What they told you • Make copies of all documents you give to SSA: both forms you fill out and evidence you want them to have that are in your possession. Do not LOSE your copies!!

20. Checklist- continued • Promptly open and read ALL mail sent by SSA. When SSA gives a deadline response date, compliance within that date is required. Seek help immediately if needed. Keep ALL paperwork, letters, and mailing envelopes in your file. Do Not Lose!!!! • You must report pay stubs each month to SSA. Be sure to report to correct field office (Zip Code of the payee is the key). Report by certified mail, and/or walk into the office or Fax. Keep wage records in your file and proof you reported wages each month.

21. Checklist- continued • If a person receives SSI and/or Medicaid, also Food Stamps (SNAP), receives Housing Subsidy (Choice Voucher) remember to keep all resources/assets below $2,000/individual or $3,000/couple in any month to maintain eligibility. Medicaid eligibility may vary from State to State. • When a major life change occurs (address, marriage, employment, lose of job, divorce, children) report to SSA immediately, both to 1-800-772-1213 and in writing to local SSA field office.

22. TAKE AWAY • Know the benefits you’re on and how wages impact them • Work incentives are safety nets for returning to work- under utilized • REPORT, REPORT, REPORT wages • In almost every case, monthly financial outlook will be better with work!

23. Contact Information Karyn Stenzler Certified Benefits Counselor Full Circle Employment Solutions LLC 202.285.1656 karyn.stenzler@fullcircledc.com www.fullcircledc.com