ADEN core competencies training series

1. ADEN core competencies training series Social Security work incentives: a message of hope for Social Security disability Beneficiaries Kevin Nickerson American Dream Employment Network (ADEN) American Dream Employment Network, a division of National Disability Institute, is an authorized Social Security Ticket to Work service provider. 2019 Series

2. Introduction to American Dream Employment Network (ADEN) Comparison of SSI and SSDI disability benefits Overview of SSDI (Social Security Disability Insurance) benefits and work incentives Overview of SSI (Supplemental Security Income) disability benefits and work incentives Getting help in the return to work agenda ADEN is a Division of National Disability Institute

3. ADENKey stakeholders Participants Members Employer Partners Administration Job seekers who received Social Security disability benefits, ages 18-64, who voluntarily use their Ticket to Work to secure employment leading to greater self-sufficiency. Employers who have an interest in hiring and retaining qualified personnel with disability, and enter into a Memorandum of Agreement with NDI. Employment service providers, located across the country, who help job seekers with disabilities seek and retain employment. ADEN is lead by two national recognized subject matter experts providing administrative duties and technical assistance to Members.

4. SSA increases certain rates each year as an attempt to keep up with the cost of living, the following rates will be referenced throughout this training: Substantial Gainful Activity = $1,220 (non-blind rate) $2,040 (blind rate) Trial Work Level = $880/month (gross wages) Federal Benefit Rate = $771 (single individual) Federal Benefit Rate = $1,157 (couple) 2019 RATES

5. Social Security Disability Insurance Otherwise known as: SSDI (Social Security Disability Insurance) Title II, DIB (Disability Insurance Benefits) Comparing SSA Programs Supplemental Security Income • Otherwise known as: • Supplemental Security Income (SSI) • Title XVI • Also covers aged and blind individuals

6. Social Security Disability Insurance Wage earner must have accrued sufficient “Quarters of coverage” Must have recent work Note – Blind individuals do not need to have recent work, but must be insured For 2019, One Credit (Quarter) of Coverage = $1,360 Relationship between SSA disability benefits and Work History Supplemental Security Income • No work history is required

7. Social Security Disability Insurance Spouses: If at least age 62, or if caring for either a child under 16, or a disabled child of the worker. Divorced Spouses: If the marriage lasted at least 10 years and the person is age 62 years old or older and remains unmarried. Child: If under age 18 (or under 19 if a full-time high school or elementary student) and dependent unmarried child of an insured eligible worker. Disabled Adult Child: Adult children (18 or older) of a retired, disabled or deceased worker, if the disability began before the age of 22. Benefits to Recipient’s Family: SSDI

8. Supplemental Security Income No family member of the SSI recipient will be eligible for SSI benefits unless he or she independently establishes eligibility for SSI This is a means-tested program, therefore it is based on individual need Benefits to Recipient’s Family: SSI

9. Social Security Disability Insurance From the date one becomes disabled, there is a five-month waiting period prior to receipt of benefits NOTE: Except DAC/CDB beneficiaries (no waiting period) Waiting Periods for cash benefits Supplemental Security Income • NO waiting period. An individual may receive benefits as of the first day of the month following month of application

10. Social Security Disability Insurance Provision for payment up to 12 months before the date of application. Note: Depends on date of disability onset and application date. Retroactive Payments Supplemental Security Income • Only paid as of first day of month following month of application.

11. Social Security Disability Insurance Only Worker’s Compensation or other non-covered earnings such as Federal or State disability payments may impact payment level. What Affects Benefit Amount? Supplemental Security Income • Any income (earned or unearned) impacts benefits. • Deemed income from a spouse can potentially reduce SSI payments

12. Social Security Disability Insurance No resource limits Resource Limits Supplemental Security Income • Resources must be below $2,000 for an individual and $3,000 for an eligible couple (this means married or presenting themselves as married in the community).

13. Social Security Disability Insurance Checks are paid one month behind (ex: check received in May is beneficiary’s April check). When Checks are Paid – Part I Supplemental Security Income • Checks are paid for the month in which they are received.

14. Social Security Disability Insurance Checks are paid on the 3rd day of the month for beneficiaries who filed for benefits prior to May 1997. Otherwise, beneficiaries will receive checks on either the 2nd, 3rdor 4th Wednesday of the month, based on their dates of birth. Birthdate Benefits paid on 1st - 10th Second Wednesday 11th - 20th Third Wednesday 21st - 31st Fourth Wednesday When Checks are Paid – Part iI Supplemental Security Income • Checks are paid on the 1st day of the month.

15. SSI payments are based on the eligibility month and the budget month. In most cases, SSA looks at the month the payment will be received as the eligibility month, and two months prior to the eligibility month as the budget month. If the SSI recipient is not eligible for cash benefits in the eligibility month, even if they were two months prior in the budget month, SSA will recalculate the benefit amount, which can result in an overpayment. Timely wage reporting helps to minimize issues related to overpayments! Retrospective Monthly accounting: How SSI payments are calculated

16. Social Security Disability Insurance Eligible for Medicare after 24-month waiting period after establishing eligibility for SSDI (begins with first month entitled to cash payment after five-month waiting period) NOTE: Exception, no waiting period for ALS or permanent kidney failure and dialysis Health Benefits Supplemental Security Income • In two-thirds of states, eligible for Medicaid if receiving even $1.00 of SSI

17. Countable gross earned income over a set amount per month. Currently the set amount is $1,220/month for all SSDI beneficiaries who are not legally blind. Currently the set amount is $2,040/month for those that are legally blind. SGA Rule does NOT apply to SSI recipients after initial eligibility! SGA Rule applies to SSDI beneficiaries after the nine (9) month Trial Work Period has been used. SGA is also looked at during the 5 month waiting period, and prior to the date of final determination NOTE: Figures indicate 2019 SGA amounts Substantial Gainful Activity (SGA)

18. Work Incentives for SSDI Beneficiaries

19. Based on the Bipartisan Budget Act of 2015, SSA may now presume earnings were earned in the month they were paid Prior to using this new policy, SSA will evaluate any readily available earnings verification sources, including submission of pay check stubs, to determine when earnings were earned This is most advantageous to beneficiaries! Recommendation: Providepay check stubs to local SSA Field Office by 6th day of next month Submit paycheck stubs monthly as a general rule This means you should NOT count wages in a month based on pay date, but rather, count wages when they were earned if reporting pay check stubs regularly to SSA SSDI & SGA: When Wages are counted

20. Example – Joe earns $1,000 and is paid bi-weekly. Examining his pay for April will require that you break down his wages correctly between March and April. For SGA determination purposes, wages would be broken into both months as follows: Day rate = $1,000/10 days = $100/day March = 2 days = $200 April = 8 days = $800 SSDI Example: If Wages are counted when earned End of bi-weekly pay period

21. A nine-month rolling period, within 60 months, in which a SSDI beneficiary can work and earn ANY amount of money without impacting SSDI eligibility or cash benefits! Each month a SSDI beneficiary earns more than $880 counts as one month of the TWP (indicates 2019 amount) These months do NOT need to be consecutive Purpose: To evaluate your ability to engage in full-time work that leads to self-sufficiency Trial Work Period (TWP)

22. The trial work period was established in 1960 to encourage individuals with disabilities to test their ability to work. It permitted beneficiaries to work for 9 months (which need not be consecutive) and earn as much as they were able to without losing cash benefits. Beginning in 1992, the 9-month trial work period was changed to a rolling 9 months in any 60-month period, permitting persons who failed at a work attempt to obtain additional months of trial work. The History of the Trial Work Period

23. The Extended Period of Eligibility starts with the month after the TWP ends and continues for the next 36 months For any month during this period that countable earned income is less than the current SGA level, cash benefits continue When countable wages exceed the SGA level (cessation month), Social Security will plan to “suspend” benefits - but will allow the beneficiary to receive a check for that month and for 2 more months as a “grace period” Extended Period of Eligibility (EPE)

24. After the grace period ends, the beneficiary’s SSDI cash benefits are suspended if their countable earnings are more than the SGA level. If the beneficiary’s countable earnings again fall below the SGA limit during the remaining months of the EPE, the SSDI cash benefits will be reinstated. Purpose: The EPE protects eligibility for 36 months, not necessarily cash benefits, in order to evaluate individual ability to maintain employment long-term leading to self-sufficiency. More about the Extended Period of Eligibility

25. SSDI Timeline 3 Month Grace Period – Can occur anytime AFTER the TWP is completed EPE TWP 9 Months of Trial Work available 36 Months for Extended Period of Eligibility [SSA looks at “countable” wages to determine if earnings are over SGA ($1,220 for most), during this period of time] Count when earnings are over $880/month 2019 figures

26. Work Incentives that can reduce Gross Monthly Wages and/or assist in the return to work

27. Impairment-related work expenses(IRWE) An IRWE exists when the following apply: • Expense is directly related to enabling a beneficiary to work • Beneficiary would NOT be able to work if they did not purchase the item or service, therefore, it is necessary to maintain employment • The expense is related to a “medically determinable condition” • Unrelated expenses, such as FICA tax contributions for example, would NOT count, as they are not directly tied to a beneficiary’s condition (i.e., everyone pays FICA taxes) • The expense (item or service) is paid for out of pocket • Expense is NOT reimbursable from another source • Receipts must be available and furnished to SSA when requesting IRWE • Generally, expense must be paid for in a month the beneficiary is working • There are some circumstances where costly durable goods, purchased during the 11 months prior to work starting, could be counted as an IRWE • Expense must be reasonable • SSA defines as “usual and customary” Note: can be used with both SSI and SSDI beneficiaries

28. IRWE – how does it help? For SSDI Beneficiaries: • IRWE can be used to reduce gross wages, leaving countable wages that SSA examines when making SGA determinations • Example – Joe is earning $1,300 gross/month, and has $150/month in allowable IRWE expenses. SSA would look at his wages like this: • $1,300 - $150 = $1,150 in countable wages (< 2019 SGA level of $1,220/month) • This would allow continued receipt of cash benefits For SSI Recipients: • IRWE can be used to reduce the amount of gross wages SSA examines when determining monthly SSI cash benefits • IRWE can, in some cases, allow SSI Recipients to recoup ½ of their expenses through an increased SSI cash benefit

29. Subsidies Subsidy Exists When an Employer: • Willingly pays more in wages than the value of services performed by an employee (Employer Subsidy); or • Receives full value only because some agency provides extra services to the employee (Special Conditions) How Does it Help? • Subsidy can be used to reduce gross wages, leaving countable wages that SSA examines when making SGA determinations • Example – Jane is earning $1,300 gross/month, and has $150/month in subsidized wages. SSA would look at her wages like this: • $1,300 - $150 = $1,150 in countable wages (below SGA after application of Subsidy) Note: can be used with SSDI beneficiaries only

30. Potential Indicators of Subsidy:Wage Employment Sheltered employment Childhood disability involved Mental impairment involved Marked discrepancy between amount of pay and value of services (i.e., fewer or easier duties when compared to non-disabled peers) Nature and severity of disability indicates that the employee receives help from others in performing work Government-sponsored job training or employment programs (i.e., Special Conditions)

31. Expedited reinstatement of benefits (EXR) • EXR - Effective January 1, 2001 WHO IS ELIGIBLE? • SSDI beneficiaries can be reinstated without a new application if you are an SSDI or SSI beneficiary who: • Stopped receiving benefits because of earnings from work, • Are unable to work or perform substantial gainful activity, • Are disabled because of an impairment(s) that is the same as or related to the impairment(s) that allowed you to get benefits earlier, and • Make the request within 5 years from the month your benefits ended NOTE: EXR may now be requested the same month a beneficiary stops earning SGA level wages, and provisional benefits may start the following month

32. Additional EXR Benefits • SSDI dependent’s benefits may be reinstated if the dependent satisfies all of the requirements for entitlement to the benefit • Provisional benefits may be received for up to 6 months pending the reinstatement application (only for wage earner) • Medicare and Medicaid will also continue for this period as well, although if EXR is NOT approved, this coverage will end • Once the individual receives EXR benefits for 24 months (called the Initial Reinstatement Period, or IRP), not necessarily continuously, he or she will be eligible for a new Trial Work Period, Extended Period of Eligibility and Expedited Reinstatement period (This is called a new period of disability) • Additionally, this would allow the beneficiary to access Ticket services again

33. Extended Medicare Eligibility(effective October 1, 2000) • An SSDI beneficiary is entitled to continued Medicare coverage during the Trial Work Period, and for at least 93 months following the ninth (last) Trial Work month. • During this entire period, hospital coverage is automatic (Part A) and cost-free. Outpatient coverage (Part B) continues to be optional and subject to premium payment. • The standard Part B premium will be $135.50/month for 2019. Most people will pay the standard Part B premium amount. This means that SSDI beneficiaries that go to work can keep Medicare insurance for at least 102 months! More about 2019 premiums: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4809

34. Work Incentives for SSI Recipients

35. General Income Exclusion (GIE) - The first $20 of any kind of income, earned or unearned, is excluded. Earned Income Exclusion (EIE) – SSA excludes the first $65 of earnings after any applicable Student Earned Income Exclusion (SEIE) or GIE are subtracted. Impairment-Related Work Expense (IRWE) – Reduces countable income further and is deducted prior to the ½ earnings exclusion. The ½ Earnings Exclusion – Only one half of the remaining earned income is counted (2 for 1 rule). Blind Work Expense (BWE) – If disabled due to statutory blindness, counted after the ½ earnings exclusion to further reduce countable wages. Plan to Achieve Self Support (PASS) – Allows for full recoupment of money saved in PASS account through increased SSI check in some cases. Work Incentives for SSI Recipients

36. SEIE allows an individual who is under age 22, and regularly attending school, to have earnings excluded from income as shown below: For Year Monthly Exclusion Maximum exclusion for calendar year 2019 $1,870 $7,550 Effective 4/01/05 To qualify for this exclusion, an individual must be: under age 22; and a student regularly attending school per SI 00501.020D Student Earned Income Exclusion (SEIE)

37. The Federal Benefit Rate (FBR) is the established rate of pay an individual is eligible for, or maximum SSI check allowed For 2019, the current FBR for single individuals is $771/month, and for married couples (both eligible for SSI) is $1,157/month In addition to the Federal portion of an SSI check, almost all states offer a State Supplement, which is added to the Federal amount provided under the SSI program The best way to determine the State Supplement amount is to talk with your local SSA Field Office in your state For more information, see: http://www.socialsecurity.gov/ssi/text-benefits-ussi.htm Federal Benefit Rate (FBR)

38. SSA determines the FBR using a variety of factors, such as: Living situation: Living in the Household of Another – This means the individual is living in a home they don’t own, and are NOT paying their fair share of the household expenses, which can reduce the SSI FBR by 1/3 Living with Others – This means that meals are bought and prepared collectively, which can reduce the State Supplement provided To learn more, see: http://www.ssa.gov/ssi/text-living-ussi.htm Marital status: Married couples that both receive SSI have a reduced FBR Married couples, where only one individual receives SSI, may encounter “Deeming” of spousal income which can impact cash benefit amounts Determining Federal Benefit Rate (FBR)

39. Income:Anything received in cash or in-kind that can be used to meet needs for food, clothing or shelter Earnings count in the month the pay check is dated Two types of income: Earned and Unearned Income Earned income:Typically, gross wages - salaries, commissions, bonuses, self-employment, sheltered workshop earnings Unearned income: All income that is not earned income - unearned income is counted when it is actually or constructively received SSI: what counts as Income

40. Resources:Cash or other liquid assets, or real or personal property that an individual owns and could convert to cash, which can be used to provide for food, shelter or clothing The general rule is that an item received in a month is income and, unless spent, becomes a resource in the following month(there are exceptions to this rule, for example, tax refunds) General resource limit in 2019 is $2,000 for an individual, $3,000 for an eligible couple (Note: This rate was established on 1/1/89) Achieving a Better Life Experience (ABLE) Act – Signed into law, December 2014. Will allow individuals who experience a disability per SSA standards, prior to age 26, to have savings up to $100,000 that will not count as a resource ABLE National Resource Center: http://www.ablenrc.org/ SSI: Resources

41. Examining the ssi formula – calculating adjusted ssi cash benefits based on earned and unearned income

42. Ted receives SSI and lives alone Ted also receives $385/month in Social Security Disability Insurance (SSDI) benefits The SSI program will disregard or not count the first $20 each month of any unearned income, in this case, Ted’s SSDI benefits SSI Budget Example #1- unearned income $ 385 Social Security Disability - 20 Disregarded $ 365 Countable income $771 SSI base rate (2019) -365 Countable income $406 Adjusted SSI Amount $385 SSDI benefit $791 Total SSI/SSDI for month

43. In this example, the Federal Benefit Rate (FBR) = $771 (this is the single living alone rate for 2019) Gross wages in this example = $1,120/month This example shows the impact of working on SSI, and the difference in the total monthly income available before and after work This example demonstrates how Work Incentives assist beneficiaries in increasing their financial well being through work SSI Budget Example #2 – Earned Income Only SSI Budget - PASS

44. In this example, the Federal Benefit Rate (FBR) = $771 (this is the single living alone rate for 2019) Gross wages in this example = $1,700/month This example shows that eventually, when wages are high enough, SSI will be reduced to a zero cash benefit, or to the “break-even point” Medicaid will still be available in this example, even though this individual would not be eligible for a cash benefits! How? Through a provision we will examine called 1619(b) SSI Budget Example #2 – Earnings Exceed Break-Even Point SSI Budget - PASS

45. Good News – Even if you earn enough to exceed the “break-even point,” (out of pay for SSI cash benefits), there is another work incentive to help you maintain your Medicaid 1619(b) provides protections for SSI recipients who earn enough through working, to reduce benefits to the “break-even point,” to maintain a connection to SSI eligibility AND Medicaid Let’s review eligibility for 1619(b) SSI & Medicaid

46. Under Section 1619(b), SSI recipients can still maintain Medicaid, if they: Have been eligible for an SSI cash payment for at least 1 month; Still meet the disability requirement; and Still meet all other non-disability SSI requirements; and Need Medicaid benefits to continue to work; and Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services. Each state has a different income threshold. To find out what your state’s 1619(b) threshold amount is, visit: https://secure.ssa.gov/poms.nsf/lnx/0502302200 SSI & Section 1619(b) Medicaid

47. The purpose of PASS is to allow SSI recipients to set aside income and/or resources to be used to assist in achieving a viable work goals A PASS can be used to assist in the costs of education, starting a business or purchasing support services that will result in SGA level employment (i.e., the reduction /cessation of benefits) By utilizing PASS, SSI recipients can help to offset the costs associated with the vocational goal in the PASS by reducing countable income and potentially increasing the amount of SSI cash benefits due, which can support living expenses during the timeframe outlined in the PASS Plan to Achieve Self-Support (PASS)

48. Beth is interested in purchasing a vehicle, as she is working 2nd shift, and there is no public transportation available. She has been getting rides from her co-workers, but knows this is not a long-term solution. Beth is working full-time, is making $1,800/month, and is single and living alone. Beth would like to save for a car of her own, save for insurance and initial expenses to get the car on the road. Because she is working already and earning above SGA, and has plans to continue working at or above SGA, Beth will be a good candidate for PASS. She will be saving $700/month for the next 10 months or longer depending on actual total costs of proposed expenses. Example of how PASS and Work effect SSI payments SSI Budget - PASS

49. Report new work activity, changes in work activity, or increases in wages to your local SSA field office Provide wage data to SSA regularly by providing a copy of paycheck stubs Wage data may be FAXED, hand delivered or mailed Be sure to write your S.S. # on paycheck stubs, and your name if not already printed on check stubs It is recommended, whenever reporting wage data to SSA, that you request a receipt showing you have provided such data SSA is required to do this, but it is not always provided…please remember to ask for a receipt Remember – reporting protects you! See ADEN Wage Reporting Fact Sheet: https://americandreamen.org/wage-reporting-social-security Your responsibilities when returning to work

50. Medicaid Buy-In Programs (or MBI) exists currently in 42 states as a result of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) This allowed states to expand Medicaid coverage for working-age individuals with disabilities If MBI is available in your state (see your local ADEN Specialist), it can assist individuals with disabilities who return to work in maintaining vital health insurance, with substantially increased income guidelines Prior to MBI, individuals with disabilities only had access to Medicaid through a “spend-down,” a work disincentive which MBI programs have eliminated To find out more about Medicaid in your state, visit: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html State Work Incentive - MBI