Social Security Administration

1. Social Security Administration

2. SSA Disability Benefit Programs • Social SecuritySupplemental SecurityIncome (SSI) • Based on a No work requirement; worker’s earnings income, resources are factors • Family members Only for individual, possibly entitled not family

3. Definition of Disability Same for Both Programs • Physical/mental impairment expected to last (or has lasted) 12 months • & • Impairment prevents worker from engaging in “Substantial Gainful Activity” (SGA)

4. What is “SGA”? • “Gainful activity” is work • To be considered “substantial,” gross earnings must be at least $940* monthly • * $1,570 for blind

5. Disability “Onset Date” • Refers to earliest date condition meets medical requirements • & • Person was not working above SGA level ($940 monthly)

6. Who Qualifies for Social Security Disability Benefits? • Worker - filing on own work record • Disabled widow(er) -filing on deceased spouse’s record; minimum age 50 • Disabled Adult Child -filing on parent’s record; over age 18, disabled before 22

7. To be Insured, Workers need “Credits” • $1,050 earnings = one credit • Can earn maximum of four per year

8. For Worker, Age at Onset Dictates Credits Required • Age 31 or older: - 20 credits in 40-credit period pre-onset • Age 24 to 30 - credits for half the time from 21-onset • Under Age 24 - 6 credits in three-year period pre-onset

9. Who Qualifies for SSI Benefits? • Categories of recipients • - aged (65 and older) • - blind • - disabled adults and children • Receive cash benefits, Medicaid

10. SSI Income Limits • Federal maximum monthly payment, no other income: • - $637 for individual • - $956 for couple (both on SSI) • If other income, $20 exclusion applies- e.g., $500 Social Security results in $157 federal SSI

11. SSI State Supplement – Penna. • State adds up to $27.40 or $48.30 in separate check • exception: residents of Medicaid facility only due federal payment of $30

12. SSI - Resource Limits • Resources:cash, bank accounts, bonds, stocks, non-home property • Limits: $2,000 individual $3,000 couple

15. Filing Disability Application – Online at www.socialsecurity.gov • For Social Security disability, both medical and non-medical portions can be completed online • For SSI, only the medical portion can be completed online; non-medical must be completed in-person or by telephone

16. Filing Disability Application – By Telephone or In-Office • Call 1-800-772-1213, weekdays 7:00 a.m. to 7:00 p.m. • Set up telephone/in-office appointment; will be sent “Disability Starter Kit” in advance

17. Speeding Up Application • Average processing time: 92 days • Applicant can help by supplying: - names, dates, etc., of doctors, hospitals, clinics, & institutions - names of medications - medical records, lab tests - summary of jobs, type of work

18. Who Makes Decision? • Medical information sent to Disability Determination Services (DDS) • Disability evaluation specialist, physician review evidence, make determination

19. If Social Security Claim Approved… • Benefits due after 5-month waiting period e.g., onset date - March 10, 2008 entitlement begins - September 2008 paid - October 2008 • Medicare begins after 24 months of entitlement: September 2010

20. If SSI Claim Approved… • Benefits usually retroactive to effective date of application • Medicaid entitlement coincides with benefit entitlement

21. If Claim Denied… • Upon receipt of denial notice, 60 days to file hearing • If hearing denied, other appeals remain:- Appeals Council Review - Federal court review

22. Medicare • Federal health insurance program administered by Centers for Medicare & Medicaid Services (CMS) • SSA makes eligibility determinations, enrolls people, gets card issued

23. Medicare – Who Gets It? • 65 or older - eligible for Soc. Sec. benefits, or - worked 10 years for government entity, paid Medicare tax • Under 65 - entitled to Soc. Sec. disab. 24 months (no waiting period for ALS) or kidney failure (& insured for benefits)

24. Traditional Parts of Medicare • Part A - Hospital Insurance - covers inpatient care in hospital, skilled nursing facility, some home health care, hospice; but .... long-term care limited - length of in-patient stay dictates amount of coverage - no premium, but financed by worker’s 1.45% tax

25. Traditional Parts of Medicare • Part B - Medical Insurance - outpatient procedures, medical supplies - $96.40 standard monthly premium ... .... but, sliding-scale premium for singles with income $82K+, couples with $164K+; affects 4% of beneficiaries

26. Another “Part” of Medicare • Part C – Medicare Advantage Plan - health plan option, like Medigap plan; receive all health care services thru provider organization - includes HMOs, PPOs, special needs plans, private fee-for-service plans - pay Part B premium & plan premium; lower out-of-pocket costs, more covered services

27. Newest Part of Medicare – Part D Prescription Drug Plan • Began 2006, CMS responsible - open to all Medicare recipients - choose from plans of private companies - important: compare current plan - enroll soon after applying for Medicare; later, can only enroll Nov. 15 – Dec. 31

28. Part D “Extra Help” • SSA responsible • People of limited means can get help with:- premium, deductible, co-pays • Must apply, unless in “deemed” category • Apply online or use paper application

29. Work Incentives Social Security & Supplemental Security Income (SSI)

30. Social Security Beneficiary Returning to Work • Trial Work Period - can work in nine months - regardless of earnings, benefit paid - to count as TWP month, earnings at least $670 - nine months can be scattered over 60-month period

31. At conclusion of TWP, ongoing work evaluated • If work “not substantial” (under $940), benefit continues • If work “substantial” ($940+), benefit paid months 10-12, then suspended

32. Months #13 through #45 .... Extended Period of Eligibility • After 12-months TWP & grace months, “EPE” runs 33 months, to month 45 • Benefit unpaid for months #13-45 whenever SGA ($940+) performed • Likewise, benefit paid for EPE months under $940

33. Impairment-Related Work Expenses • After TWP completed, the costs of some impairment-related items, services needed to work can be deducted from earnings in determining SGA ... $1100 earnings - $165 IRWE $935 = no SGA • Individual must not be reimbursed for item, cost must be “reasonable,” and item paid for in a work month

34. What about Work after EPE? • Month #45 is last EPE month * SGA in month 46 or later terminates eligibility * But .....

35. “Expedited Reinstatement” * If earnings fall below SGA, benefit reinstated...no new application needed * Request must be made within 60 months of termination * Must have same disability * Can receive up to six months of benefits, including Medicare

36. Continuation of Medicare • All disability recipients are Medicare-eligible after 24 months of benefit entitlement • After TWP, Medicare can continue for 93 months regardless of SGA

37. SSI Recipient Returning to Work • No TWP, no EPE • SGA not an issue • Earnings reduce payments, but benefits continue as long as income, resource limits not exceeded

38. How Earnings Reduce SSI • Unlike unearned income, earnings don’t reduce SSI dollar-for-dollar • Subtract $65 ($85) from monthly gross earnings; half of remainder counts against SSI • $600 earnings Half of $515 = -$85 exclusion $515 remainder $257.50 SSI reduction

39. Monthly Earnings Cut-off • Earnings of $1,359+ results in no SSI payable • $1359 earnings Half of $1274 -$85 exclusion is $1274 remainder $637 • SSI limit: $637.00 - $606.40 countable income 0 = no SSI payable

40. Impairment-Related Work Expenses • Remember, SGA not an issue for SSI once on; but IRWE reduces countable earnings • $1267.80 earnings $1182.80 -$85.00 exclusion- $52.00 IRWE $1182.80 $1130.80 Half of $1130.80 = $565.40 countable earnings • SSI limit $637.00 - $565.40 countable income $71.60 SSI payable

41. Continuation of Medicaid • If earnings too high to allow SSI payment, Medicaid still continues if ... .... yearly earnings don’t exceed Pennsylvania threshold: $28,554

42. Work Exclusion for Students • Must be under age 22 and in regular school attendance • Up to $1,550 earnings excluded per month • Maximum $6,240 excluded yearly

43. Plan for Achieving Self-Support (PASS) • Use or setting aside of income, resources to achieve work goal, increase prospects for self-support * Excluded income, resources don’t count against SSI, thereby increasing payment * Must be in writing, estimate time period for attaining goal

44. Ticket to Work • Gives disabled choice in obtaining free rehabilitation & vocational services • Provides more incentives for disabled to work & lessen dependence on public benefits • Removes barriers that make people choose between medical coverage and work

45. The Ticket Itself • New disability recipients, age 18-64, will be sent Ticket, letter, & booklet • Ticket certificate can be “used” to obtain free vocational, employment services from organizations called “Employment Networks” - ENs are paid, but only if disabled individuals work • Ticket program is voluntary!

47. Upon Ticket receipt ... • Recipient not required to do anything; remember....voluntary program • But ....if interested in receiving services, call Program Manager (Maximus, Inc.) • Later ... take Ticket to an Employment Network (EN) to obtain services

48. Employment Network (EN) • Any agency or instrument of the state, or a private entity responsible for the coordination or actual delivery of services can become EN • Can be single entity, consortium, or association of organizations collaborating to combine resources to serve Ticket holders

49. Examples of ENs • State VR agencies • Any public/private entity providing appropriate services (job readiness, placement, voc. rehab., training, etc.) • Employers offering job training, voc. rehab., support, retention, or other types of job-related services and/or assistance for the disabled

50. ENs Serving Philadelphia • Currently, 34 ENs signed up • Seven are based in city