Judith M. Holt, Ph.D. Jeff Sheen, MSW April 11, 2008

1. What do transition-age youth with disabilities and their families need to know about work incentives? Judith M. Holt, Ph.D. Jeff Sheen, MSW April 11, 2008

2. What are the Benefits of Work?

3. What are the Barriers to Work? • Fear of loss of cash benefits • Fear of loss of health benefits. • Concerns about workplace discrimination. • Concerns about trying to work and then losing their job. • Concerns about getting back on Social Security if they need to.

4. 1999 GAO Report • Reported that fewer than .5% of Social Security Disability (SSDI and SSI) recipients left the rolls because they were working.

5. Statistics from Cornell University • Employment Rate 2004 People without disabilities 77.8% People with disabilities 37.5% Difference 40.3% • Poverty Rate 2004 People without disabilities 9.1% People with disabilities 24.1% Difference 15.0%

6. Workforce Shortages • Bureau of Labor Statistics projects that by the year 2010 the U.S. labor force will be short 10 million workers

7. Key Federal Legislation Ticket to Work and Work Incentives Improvement Act of 1999

8. Supports for transition-age youth with disabilities and families • Benefits Planning Assistance & Outreach • Social Security work incentives (for SSI / SSDI) • Health care access while working (Medicaid Work Incentive) • Personal assistance for ADL/IADL assistance while working (E-PAS) • “Ticket to Work” • Legal rights and responsibilities (PABSS)

9. The OLD Paradigm • DO NO HARM • PROTECT BENEFITS • LIMIT WORK TO PRESERVE EXISTING BENEFITS • ONCE YOU HAVE A DISABILITY YOU WILL NEVER WORK AGAIN • INFORMATION BASED ON HEARSAY, RUMOR AND UNVERIFIED INFORMATION

10. The NEW Paradigm • DO NO HARM • CONSUMER CHOICE THROUGH FULL DISCLOSURE • EXPLORE WORK OPPORTUNITIES THAT ALLOW A PERSON TO WORK W/O FEAR OF LOSING BENEFITS • INDIVIDUALS MAY BE ABLE TO WORK WITH ACCURATE INFORMATION, GUIDANCE, AND SUPPORT • INFORMATION IS CONSISTENT, DOCUMENTED AND VERIFIED

11. 1. Benefits Planning Assistance and Outreach (BPAO) • What is a Benefits Specialist? • Selected staff who have been highly trained to assist individuals in determining the impact of working on their benefits, including transportation, Medicaid, housing, food stamps, etc. • The staff have received intensive training and follow-up from Social Security. • Benefits Specialists do NOT assist consumers in applying for Social Security benefits

12. What do Benefit Specialist do? • Verify types and amounts of benefits person receives, including Social Security, Medicaid & Medicare, Housing subsidies, food stamps, etc. • Analyze information on entire public benefits picture. • Prepare a written benefits analysis for consumer on impact of employment on the consumer’s benefits. • Advise consumer to manage reporting responsibilities, including: periodic updates on consumer’s situation.

13. Two Disability Programs • Social Security Disability Insurance (SSDI) • Supplemental Security Income (SSI)

14. How Does SSA Define Disability The inability to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s): • That can be expected to result in death, or • That has lasted or that we can expect to last for a continuous period of not less than 12 months. • Note:  There is a separate definition of disability for children (under age 18) who are applying for the SSI program.

15. Social Security Disability Insurance (SSDI) • Pays workers under age 65, who are disabled or blind and their dependents • Worker must have contributed to Social Security to become insured. • Eligible for Medicare after 24 months

16. Supplemental Security Income(SSI) • Pays people who are aged, blind or disabled – including minor children with disabilities • Income and resource limits • No benefits paid to dependents • Benefits paid from general tax fund, not the Social Security Trust Fund • Eligible for Medicaid

17. SGA as a Factor • Important part of the eligibility process • Used in determining initial disability (other than blindness) • $940 for 2008; $1,570 for blind • Claim is denied at initial application if current SGA is established • After SSI benefits start, SGA is not a consideration • Income is used only to determine SSI benefit amount

18. Federal Benefit Rate (FBR) • Maximum monthly SSI cash benefit payable • 2008 • Individual $637 • Couple $956 • FBR is a national amount – same in all states • States have option to supplement the federal amount

19. Are We Having Fun Yet?

20. What are Work Incentives? • Special rules for employment support that help preserve benefit eligibility, including health insurance • Serve as a safety net to make the transition from benefits to work • Are available under SSDI and SSI – but are applied differently

21. SSDI work incentives: Trial Work Period, Extended Period of Eligibility, expedited reinstatement of benefits, etc. • SSI work incentives: $1 for $2 benefit reduction; extended Medicaid benefits, etc. • Need a “score card” to figure out.

22. Impairment-Related Work Expenses (IRWE) • Items or services, related to the disability, that are necessary for an individual to work • Must be paid for by the individual with no reimbursement expected • Be of reasonable cost • Cost can be used to reduce countable income

23. Examples of IRWE • Medications prescribed to treat the impairment • Attendant care services • Work-related assistance devices • Modifications to vehicle • Some transportation costs

24. Example – with IRWE • Wages: $400 • IRWE: $50 • Countable income: $400 minus $85 (auto exclusions) = $315 minus $50 = $265; divided by 2 = $132.50 • New SSI payment: $637 - $132.50 = $504.50

25. Healthcare Options

26. 3. Access to Health Care Medicaid Work Incentive (Buy-in) started July 2001 Sec. 1619(b) allows SSI recipients to continue Medicaid if they exceed amount for SSI cash benefit PCN can benefit some who need primary care and prescriptions

27. Medicaid Myths.... • Medicaid is the same in all 50 states… • If you move to another state you can transfer your Medicaid case… • You cannot be eligible for Medicaid if you have other health insurance… • Medicaid will cover all medical needs… • Medicaid is only for people who are poor and don’t work…

28. Medicare vs. Medicaid • Medicare: administered by the Social Security Administration • Age 65 • Received Social Security disability 2+ years • End-stage renal failure • Medicaid: administered by the State. • Medical assistance for low income families, senior citizens and disabled persons. • Must meet specific program criteria.

29. PROGRAMS • Utah Medicaid has over 30 different programs and each has different guidelines regarding: • Who is served by the program • The asset and income limits

30. Disability Medicaid (DM) The Aged, Blind or Disabled Programs are medical assistance programs for individuals aged 65 years or older, blind or disabled.   • Who can determine Disability? • Social Security (SS) • Medicaid Medical Review Board (MMRB) • Income • Assets $2,000/$3,000

31. Medicaid Work Incentive Premium (MWI) • A Medicaid Program for individuals with disabilities who have earned income • Household income limit is 250% of Federal Poverty Limit ($2,167 per month/individual) 2008 • Allows higher asset limits $15,000 • MWI premium is usually less than a Medicaid Spenddown. Premium ranges from 5 to 15% of your countable income

32. 4. Personal assistance services for people who work • Employment-related personal assistance (EPAS) started July, 2002 in Utah • Medicaid state plan service (not a waiver) • Need assistance with ADL/IADL in order to work at home or at work • Must be employed, have a disability, and Medicaid eligible

33. Employment Personal Assistance Services • Must be working at least 40 hours per month • Must have a disability (according to Social Security or Medicaid) • Must need assistance in order to work. • The assistance can be provided at home or at work • May hire their own personal assistant or go through an agency EPAS is for people who are eligible for Medicaid and working:

34. Employment Personal Assistance Services The assistant could: • Help with personal tasks to get ready for work, like bathing or eating. • Remind individuals to take their medicine. • Help with household tasks like housework or shopping that they need so they can work. • Help individuals get to work if they need personal help with transportation. • Help with personal tasks at the job.

35. 5. Ticket to Work • Purpose is to increase “choice” of service providers • “Employment Networks” will accept Ticket and provide necessary services that will lead to employment within 1-3 years. • Youth with disabilities (over 18) are eligible for Ticket if they have disability under “adult” criteria.

36. A Word About the Ticket to Work Program • VOLUNTARY-ALL MAY USE • Age 18-64 in current pay status for SSDI or SSI will receive Ticket • Ticket can be used to receive employment, vocational or other services to help in going to work • Services are provided by approved Employment Networks (EN) • Goal of the program is to help individuals earn enough money to no longer need Social Security cash benefits

37. 6. Legal Rights and Responsibilities • Disability Law Center has new program to assist job seekers and employees with disabilities re: discrimination. • Protection and Advocacy for Beneficiaries of Social Security (PABSS) • Can work with employers on ADA accommodations.

38. Protection and Advocacy(PABSS) • Receiving SSDI or SSI and has a work issue: • Provide advocacy and teach self-advocacy • Provide legal advice • Discuss ADA accommodations with employee and employer • Provide representation in overpayment cases • Services are free • Services through the Disability Law Center

39. 15 million people with disabilities are of working age-That’s about twice the population of New York City.That’s a HUGE talent pool!

40. Thin about the possibilities…