BENEFITS AND WORK INCENTIVES Supplemental Security Income and Social Security Disability Insurance

1. BENEFITS AND WORK INCENTIVESSupplemental Security Income andSocial Security Disability Insurance ADD NAME AND CONTACT INFO ADD DATE

2. You are not here merely to make a living. You are here to enable the world to live more amply, with greater vision, and with a finer spirit of hope and achievement. You are here to enrich the world. You impoverish yourself if you forget this errand. President Woodrow Wilson

3. Sound Familiar? • If I go to work I will lose my benefits. • I can only make $1,040 a month or I will lose my benefits. • I can’t get the skills and experience I need for a career without losing my benefits. • If I go to work and then stop working, I won’t be able to get back my cash benefits or Medicaid/Medicare back. • If I go to work Social Security will send me a letter asking for a lot of money back.

4. Let’s Bust Those Myths! • Reduce fear and misunderstanding about the effect of working on benefits. • Prevent crises that can result when change occurs. • Improve employment and economic outcomes through: • Increased employment rates; • Increased earnings; and • Decreased medical expenses.

5. SOME BASIC TERMS YOU WILL NEED TO KNOW • SSA: Social Security Administration • SSI: Supplemental Security Income • SSDI: Social Security Disability Insurance • SGA: Substantial Gainful Activity. $1,040 non-blind, $1,740 blind (2013). • WORK INCENTIVES: Both federal and state-specific programs that are available to people with disabilities in return to work efforts. • HUD: Department of Housing and Urban Development

6. LET’S START WITH SUPPLEMENTAL SECURITY INCOME!

7. SUPPLEMENTAL SECURITY INCOME How Does Supplemental Security Income Really Work?

8. SUPPLEMENTAL SECURITY INCOME • Supplemental Security Income = Title XVI (16) or SSI • Needs based program that provides a cash benefit and/or Medicaid. • To qualify: • Meet all five steps of the Social Security Administration’s (SSA) sequential evaluation; and • Have resources of $2,000 or less for an individual or $3,000 or less for a couple. Standard exclusions apply such as home you own and one car.

9. SUPPLEMENTAL SECURITY INCOME • SSA SEQUENTIAL EVALUATION • The Five Steps: • Is the consumer working at Substantial Gainful Activity (SGA) or above? If the answer is no, go to step two. • Does the consumer have a severe medically determinable physical or mental impairment that meets the duration requirement* or a combination of impairments that is severe and meets the duration requirement? If the answer is yes, go to step three. • Does the consumer have a disability that meets one of the listings in the SSA Blue Book(www.ssa.gov/disability/professionals/bluebook/)? If the answer is yes, the consumer gets benefits. If the answer is no, go to step four. • Is the consumer able to do the work that was at substantial gainful activity level done in the 15 year period prior to the disabling condition, and that lasted long enough for the person to learn to do that job? (This step may be skipped if evidence about past relevant work is not sufficient to make a finding.) If the answer is yes or no, go to step five. • Taking into account the consumer’s medical conditions, age, education, past work experience and any transferable skills, can the consumer do any other type of work? If the answer is no, the consumer qualifies for Social Security Disability Benefits (either SSI or SSDI). * DURATION REQUIREMENT = Unless condition is expected to result in death, it must have lasted or must be expected to last for a continuous period of at least 12 months

10. SUPPLEMENTAL SECURITY INCOME • BASIC WORK RELATED ACTIVITIES INCLUDE: • Ability to exert physically for various work-related activities (such as sitting, standing, walking, lifting, carrying, pushing, pulling). • Do manipulative and postural activities (such as reaching, handling large objects, using fingers, feeling, stooping, balancing, climbing stairs or ladders, kneeling, crouching, crawling). • Tolerate certain environmental conditions (such as temperature extremes, wetness, humidity, noise, hazardous working conditions like moving machinery or heights, dust, fumes, odors, gases, poor ventilation, vibrations). • See, hear, and speak. • Maintain concentration and attention at work. • Understand, remember and carry out instructions. • Respond appropriately to supervisors, co-workers, and usual work situations. • Cope with changes in the work setting.

11. SSI MYTH NUMBER ONE I WILL LOSE MY SSI IF I GO TO WORK FACT: WORK INCENTIVES LET CONSUMERS KEEP SSI CASH CHECK OR STATUS WHEN THEY WORK! • Plan to Achieve Self Support (PASS) • Impairment Related Work Expense (IRWE) • Blind Work Expense (BWE) • Student Earned Income Exclusion (SEIE) • 1619(b) Medicaid SUPPLEMENTAL SECURITY INCOME

12. SUPPLEMENTAL SECURITY INCOME IMMEDIATE SSI WORK INCENTIVES • Cash benefit of up to $710 a month (individual) or $1,066 (couple) a month in 2013. • Medicaid health insurance. There is no waiting period for Medicaid. Once a consumer is determined eligible for SSI he/she receives Medicaid. Generally, Medicaid is now provided through Star + Plus managed care unless the consumer is in a Medicaid Rural Service Area. Consumers who receive Home and Community Based Waiver (Tx Hml, CLASS, HCS, DBMD, etc.) get their acute care (Medicaid) services from STAR managed care.

13. SUPPLEMENTAL SECURITY INCOME PLAN TO ACHIEVE SELF SUPPORT (PASS) • Designed to help consumer reach an employment goal. • Time limited (48 months; can be extended). • Not a comparable benefit. • Must have earned or unearned (e.g. SSDI) income to create plan. • Must be able to live on amount left after putting money into PASS. • All purchases in plan must be related to employment goal. • Money in PASS must be spent on what is in plan or consumer will get overpayment notice. • SSA will review PASS once a year at a minimum. • Good DRS candidates: students and people who want to start business.

14. SUPPLEMENTAL SECURITY INCOME PLAN TO ACHIEVE SELF SUPPORT (PASS) continued • SSA Area Work Incentive Coordinator (AWIC) approves and reviews all PASS. • PASS form is located at: http://www.ssa.gov/online/ssa-545.htmlor on your cd. • Anyone may help consumer complete PASS form, but plan must be submitted by consumer. • Consumer is responsible for all expenditures and progress in PASS.

15. SUPPLEMENTAL SECURITY INCOME IMPAIRMENT RELATED WORK EXPENSE (IRWE) • A plan that has expenses for items or services which are directly related to enabling a consumer to work. • Services or items have to be things that cannot be paid through another source, and the cost must be reasonable. Any service or item an agency such as DSHS or DARS, or someone else pays for will not be approved as an expense in the IRWE. • Up to ½ the money put aside for expenses in an IRWE comes back to the consumer’s SSI check. • Helpful in reducing income to under SGA when applying for SSI.

16. SUPPLEMENTAL SECURITY INCOME IMPAIRMENT RELATED WORK EXPENSE (IRWE) • No SSA form. See cd for sample IRWE application. • Send application to the local SSA Work Incentive Liaison or SSA Area Work Incentive Coordinator. • May be asked for proof of need (e.g. medical records, doctor’s prescription). • Must provide proof on monthly basis that items or services were paid by filling out SSA Form 795 (http://www.ssa.gov/online/ssa-795.pdfor on your cd) and copies of cancelled check(s), or paid receipt(s). Must include statement on SSA-795 that no reimbursement was or will be received for the IRWE, and that no agency or other source is underwriting the expense for the consumer.

17. SUPPLEMENTAL SECURITY INCOME STUDENT EARNED INCOME EXCLUSION (SEIE) • Under age of 22. • Regularly attending school. • $1,730 a month or $6,960 maximum a year is forgiven from SSI check. • Must be requested. No student receiving SSI is automatically considered for this work incentive-not even someone in public high school! • No SSA form. See cd for template.

18. SUPPLEMENTAL SECURITY INCOME STUDENT EARNED INCOME EXCLUSION (SEIE) continued • Regularly Attending School means: • Grades 7-12: at least 12 hours a week or • College or university: at least 8 hours a week or • In a training course to prepare for employment for at least 12 hours a week (15 hours a week if the course involves shop practice); or • For less time than indicated above for reasons beyond the student’s control, such as illness. • GED counts if hours meet above guidelines! • Will have to provide proof of attendance. For high school: http://www.hslda.org/hs/state/tx/Verification_of_Enrollment.pdfor on your cd. (This is the form required by DPS for students in driver’s education or those trying to obtain a driving permit before the age of 18. )

19. SUPPLEMENTAL SECURITY INCOME STUDENT EARNED INCOME EXCLUSION (SEIE) continued • If consumer is home taught, he/she may be considered “regularly attending school” if: • Consumer is instructed in grades 7-12 for at least 12 hours a week, and • The instruction is in accordance with Texas home school regulations. • If consumer is home taught because of a disability, he/she may be considered “regularly attending school” by: • Studying a course or courses given by a school (grades 7-12), college, university or government agency, • Having a home visitor or tutor who directs the study, and • The instruction is in accordance with Texas home school regulations.

20. SSI MYTH NUMBER TWO IF I GO BACK TO WORK, I WILL LOSE MY MEDICAL FACT: CONSUMERS CAN KEEP MEDICAL WHEN THEY WORK! • SSI/Medicaid through1619(b) • Individualized Threshold • Texas Medicaid Buy-In after you “earn off” SUPPLEMENTAL SECURITY INCOME

21. SUPPLEMENTAL SECURITY INCOME 1619 (b) MEDICAID • When a consumer’s SSI cash check goes to $0 he/she will still receive Medicaid through 1619(b). • Receipt of Medicaid will continue until the consumer reaches the (2013) Texas “threshold” of $32,387.00. • Although transfer to 1619(b) is an automatic electronic ‘behind the scenes’ transfer, it is advisable that the consumer check with both the local SSA and HHSC or Your Texas Works benefits offices to ensure Medicaid coverage continues. There is no SSA form for 1619(b). • 1619(b) is required in Texas by federal and state regulations.

22. INDIVIDUALIZED THRESHOLD • After the consumer earns over the Texas state threshold of $32,387.00 gross (2013), he/she can request an Individualized Threshold from SSA. • The individualized threshold begins with the base amount from the state threshold and adds: • The higher of the consumer's actual Medicaid expenditures or the average per capita Medicaid expenditure shown (per capita Medicaid expenditures in 2012 for Texas were $14,327); • The higher of the State supplement rate for the consumer's actual living arrangement or a “living alone” rate; • Any IRWE or BWE the consumer has; • Amounts of income excluded under an approved PASS; and • The value of publicly-funded personal/attendant care which the consumer receives.  SUPPLEMENTAL SECURITY INCOME

23. SUPPLEMENTAL SECURITY INCOME MEDICAID BUY-IN • A great resource for consumers who received SSI, but have exceeded the state threshold (“earned off”1619(b)) and do not qualify for an individualized threshold. • Consumers who recently “earned off” SSI are presumptively eligible for Medicaid Buy-In! • For Buy-In application go to: http://www.dads.texas.gov/forms/H1200-MBI/ or on your cd.

24. SSI MYTH NUMBER THREE IF WAGES CAUSE SSI CASH BENEFIT TO STOP, THERE’S NO WAY TO GET THAT CASH BENEFIT BACK FACT: CONSUMERS CAN STAY IN ELIGIBILITY STATUS EVEN WHEN THEY DON’T GET A CASH CHECK! • 1619(b) • Expedited Reinstatement SUPPLEMENTAL SECURITY INCOME

25. 1619(b) • 1619(b) is a “stop payment status”, NOT a suspension status. • 1619(b) protects reinstatement rights under all SSI provisions including cash benefits. • Consumers eligible under section 1619(b) are reinstated to cash benefit status if countable income drops below the applicable breakeven point and all other eligibility criteria are met. • Reinstatement is possible at all times in all States, unless the consumer's eligibility is terminated.   SUPPLEMENTAL SECURITY INCOME

26. SUPPLEMENTAL SECURITY INCOME EXPEDITED REINSTATEMENT • A consumer ineligible for SSI payments due to work may be able to restart SSI cash payments again. • If the consumer has been ineligible for SSI and/or Medicaid for any reason other than work or medical recovery SSI cash payment and/or Medicaid coverage could resume within 12 months without a new application. • If cash payment and Medicaid benefits ended because of work and earnings, and the consumer stops work within 5 years of when benefits ceased, SSA may be able to start benefits again under Expedited Reinstatement. • There is no form for Expedited Reinstatement. Contact SSA office and request Expedited Reinstatement of SSI benefits. Consumer may receive six months of provisional cash benefits and/or Medicaid while SSA makes their determination.

27. SSI MYTH NUMBER FOUR Working always results in overpayments FACT: THERE ARE STRATEGIES TO PREVENT OVERPAYMENTS! • Report regularly. • Consumer should get a receipt from SSA to document that he/she reported. • Know the overpayment rules! If the overpayment is $1,000 or under it can be automatically waived. No matter what the amount is, the consumer should request reconsideration, a waiver, or negotiate a low, low re-payment plan. SUPPLEMENTAL SECURITY INCOME

28. SUPPLEMENTAL SECURITY INCOME • REPORTING EARNED INCOME • Find out how your SSA office wants earned income reported if you can. But, report every single time pay is received-no matter how little that pay is, and regardless of how often the SSA office has told the consumer to report! • Consumers receiving SSI can use telephone reporting by calling 1-866-772-0953, using Form SSA-821-BK (http://www.ssa.gov/online/ssa-821.pdfor on cd) or by taking or mailing in check stubs to the local SSA office. • Best ways to report? 1) Take pay stub in person. 2) Mail certified return receipt requested. 3) Mail in. If mailing be sure to include letter requesting receipt each time! REPORT! REPORT! REPORT! REPORT! REPORT!

29. SUPPLEMENTAL SECURITY INCOME • OVERPAYMENT NOTICES • Overpayment notices are almost a sure thing. Beneficiary does not have to pay entire amount by check, money order or credit card within thirty days. Do not ignore the letter! • Overpayments under $1,000 can be waived. • Over $1,000 file request for reconsideration using SSA Form SSA-561-U2 (http://www.ssa.gov/online/ssa-561.pdfor on your cd) or Request for Waiver of Overpayment Recovery Or Change In Repayment Rate using SSA Form 632 (http://www.ssa.gov/online/ssa-632.pdfor on your cd) or write letter. • In most cases repayment will never be more than 10% of monthly SSI check.

30. SSI MYTH NUMBER FIVE I lose my SSI cash benefit if I make over $1,040 a month FACT: CONSUMERS CAN MAKE MORE THAN $1,040 AND STILL GET AN SSI CASH CHECK! • SSI cash check does not go to $0 until consumer makes $1,505 in 2013 (with no other deductions from work incentive programs). SUPPLEMENTAL SECURITY INCOME

31. SUPPLEMENTAL SECURITY INCOME …AND NOW FOR THE MAGIC PORTION OF OUR PRESENTATION….

32. STEP ONE: COUNTABLE UNEARNED INCOME SUPPLEMENTAL SECURITY INCOME

33. STEP TWO: COUNTABLE EARNED INCOME SUPPLEMENTAL SECURITY INCOME

34. STEP THREE: TOTAL COUNTABLE INCOME SUPPLEMENTAL SECURITY INCOME

35. STEP FOUR: ADJUSTED SSI AMOUNT SUPPLEMENTAL SECURITY INCOME

36. SUPPLEMENTAL SECURITY INCOME

37. SUPPLEMENTAL SECURITY INCOME • Someone making Substantial Gainful Activity in gross earnings in 2013 ($1,040) would get an SSI check of $232.50, for a total of earned and unearned income of $1,272.50 • Take 25% away from earned income of $1,040.00 for FICA, etc. for an estimated take home (net) of $780.00 • Add the net earned income of $780.00 to the SSI check of $232.50 for a total monthly income of $1,012.50. • That’s $302.50 MORE than just the SSI check of $710! • And don’t forget that the consumer may qualify for the Earned Income Tax Credit (EITC) at tax time…. and get all, or a lot of the money taken out for taxes back in their pocket! • The only thing the person will lose entirely is SNAP. Almost everything else, including housing either reduces gradually or does not end.

38. And then you hear….. • If I go to work I am making $1,040 and only bringing home $1,012.50. I am really losing my SSI Cash benefit and that’s not fair… I am entitled to that! • And your answer is: Your Consumer Someone who works with your Consumer • Nets approximately $780 after taxes; • Gets free health comprehensive insurance, no dental (Medicaid); • Gets SSI cash benefit of $232.50; • Has work incentives available to access necessary items and services for work and get more money back in SSI cash benefit; • Has the ability to work enough and also get SSDI and Medicare; and • Gets all taxes done for free and paid back through EITC. • Nets approximately $780 after taxes; • Has no health insurance, no dental unless he/she purchases it at high cost; • Has to purchase everything necessary for doing the job and gets nothing in return; • Gets all taxes done for free and paid back through EITC.

39. SUPPLEMENTAL SECURITY INCOME THAT (UN) MAGIC NUMBER • When a consumer says to you “I can’t make over $1,040 a month because I don’t want to lose my SSI cash benefit", you can tell them that $1,040 is NOT the number they are looking for. • The “un-magic number” they are looking for in 2013 is $1,505.00 a month. Why is $1,505 “un-magic”?

40. THIS LOOKS LIKE $1,505 IS THE MAGIC NUMBER TO ME! SUPPLEMENTAL SECURITY INCOME

41. SUPPLEMENTAL SECURITY INCOME • If work incentive programs are used earnings can be much higher. • Even if work incentive program aren’t used, the consumer can earn up to $32,387 gross (2013) and still retain Medicaid health insurance through 1619(b) – and maybe more if he/she qualifies for an individualized threshold!

42. SUPPLEMENTAL SECURITY INCOME Now let’s see what happens when a consumer uses just one work incentive!

43. STUDENT EARNED INCOME EXCLUSION (SEIE) SUPPLEMENTAL SECURITY INCOME

44. STUDENT EARNED INCOME EXCLUSION (SEIE) SUPPLEMENTAL SECURITY INCOME • In this example, a student under the age of 22 regularly attending school earns gross $1,505.00 each month. • The student can deduct this amount until gross earnings reach $6,960 for the year. • For four months the student will get FULL SSI check plus earnings. • The fifth month the student will be able to deduct $940.00 from the gross earnings and get an adjusted SSI check of $470.00 • The sixth month, assuming the student still makes $1,505.00, his SSI cash check will be $0.

45. SUPPLEMENTAL SECURITY INCOME • WHY IS THAT A GOOD DEAL? • Using SEIE, the student will have gross annual earnings of $18,060.00, or an approximate net of $13,545.00. • For four of those months the student will get full SSI check of $710.00 for total of $16,385.00 (earned approximate net of $13,545.00 plus SSI total ($710 x 4) of $2,840.00). • The fifth month the student will get adjusted SSI check of $470.00 for a new grand total of $16,855.00. The student gets a $0 SSI check for the rest of the year. • If the student had just received an SSI check for the full year he would have gotten a total of $8,520.00 • We’re talking a difference of $8,335.00 and that’s some money! (and don’t forget about EITC!)

46. SUPPLEMENTAL SECURITY INCOME • WHAT’S THE CATCH? • For one thing, the resource limit has to be kept down to $2,000.00. • So then what good is that extra $8,335….The student could start a PASS…or Individual Development Account...or a 529 to save for college, and the money would be protected from SSI resource limits. • There are lots of possibilities that a Community Work Incentive Coordinator or DRS Benefits Subject Matter Resource Staff can help you think through.

47. SUPPLEMENTAL SECURITY INCOME THE HARSH REALITY 50 % towards rent $ 355.00 20 % towards food, essential household items 142.00 15 % Car Insurance, Gasoline, and repairs 106.50 15 % toward utilities 106.50 Total $ 710.00 This does not take into account that the consumer can get SNAP. This consumer will have to get Section 8 Housing Choice Voucher or Public Housing assistance and energy assistance to be able to afford the roof over his/her head and heat/air conditioning.

48. SOCIAL SECURITY DISABILTY INSURANCE SO WHAT DO I REALLY NEED TO KNOW ABOUT SSI? • Let the consumer that SSI is a formula: the more money a person makes in earned income will always result in more money in their pocket, even after taxes. • SSI has lots of different work incentive programs that allow a person to to work without losing Medicaid and/or cash benefits for a long time. • Encourage the consumer to consider working at the maximum number of hours and for the most money he/she is able to earn. • Make sure that any information you give is accurate. Check with your DRS SMR or other professionals before giving the answer! • If this is tough for you to understand, imagine how impossibly difficult it is for the consumer to understand. Patience, encouragement and commitment to finding out the right answer goes a really long way!

49. SUPPLEMENTAL SECURITY INCOME • Living on SSI is living in poverty. • The first step is to destroy the illusion. • It isn’t magic-or impossible, it’s just math and facts…and knowledge. • If you don’t bust those myths and assist the person in taking that first step, the journey can never begin.

50. NOW LET’S MOVE TO SOCIAL SECURITY DISABILITY INSURANCE!