Understanding Social Security: Can It Be Done?

1. Understanding Social Security:Can It Be Done? February 18, 2004 Toni Bender-ERI Holly Johnson-ERI

2. Potential loss of benefits is one of the most persistent and pervasive fears among people with significant disabilities who are considering employment

3. Social Security Disability Insurance(Title II) • Entitlement programs • Disability • Medicare Coverage SSDI DAC

4. SSDI Work Incentives • TWP -Trial Work Period • SGA - Substantial Gainful Activity • EPE - Extended Period of Eligibility • Expedited Reinstatement • IRWE/Subsidy • EPMC

5. Trial Work Period (TWP) • 9 months of $580 or more (no limit) • as of January 1, 2004 • 2003 - $570 • 80 hours of self-employment activity per month • Don’t need to be consecutive • Only one TWP per disability entitlement • Review by SSA when completed

6. Trial Work Period

7. Substantial Gainful Activity(SGA) • Measure of ability to work • $810 per month-as of January 1, 2004 • In 2003, SGA was $800 per month • $1,350 per month for the blind (2004) If performing work that is “SGA” after the TWP cash SSDI benefits stop

8. Reducing Countable Income IRWE Subsidy

9. Impairment Related Work Expenses (IRWE) • Expenses that are necessary to work, related to the person’s disability and paid for by the worker • May be considered to reduce countable income below SGA

10. IRWE Example • John is working and earning $840 per month. He pays $40 each month for specialized transportation to drive him too and from work. • How does this expense help John? $840.00 Work Earnings -$ 40.00 IRWE $800.00 Countable Earned Income

11. Subsidy • Value of additional support to perform a job, or difference between actual wages received and value of work performed • May reduce income below SGA like IRWE EXAMPLES: more frequent breaks, more supervision/support, lower production requirements

12. Extended Period of Eligibility(EPE) • Consecutive 36 month period after TWP • Cash benefits reinstated for months under SGA ($810) without a new application • If at SGA at end of EPE, no more SSDI payments

13. Expedited Reinstatement (EXR) • Effective 1/1/01 • Reinstate without new application if: -Unable to work, because of medical impairments -Medical condition same or related, and -File request within 60 months of date last entitled. • After 24 months of EXR payments, receive a new TWP and EPE.

14. Reapplication • If unable to maintain working at SGA level after the completion of the EPE. • Reapplying within 60 months of last benefit payment, no waiting period. • Reapplying after 60 months of last benefit payment, 5 month waiting period. • New TWP and EPE

15. Medicare • Federal health insurance program • 24-month waiting period after SSDI benefits start • $66.60/month Part-B premium (year 2004); Part A is free

16. Extended Period of MedicareCoverage (EPMC) • Continued Medicare coverage even if no longer eligible to receive SSDI payment because of work • At least 93 months of coverage after TWP ends • Billed quarterly for months an SSDI payment isn’t received

17. Supplemental Security IncomeSSI- (Title XVI) • Needs based program • Elderly or Individuals with disabilities • Medicaid • State Supplements

18. Federal SSI Eligibility • Earnings must be below SGA at application only • Unearned income below $584 if single, living alone • Assets below $2,000 for single person, $3,000 for couple • Automatic Medicaid (Medical Assistance) • Maximum payment for a single person, living alone is $564/month (2004 amount, changes annually)

19. SSA Doesn’t Count All of Your Income... • General Income Exclusion of $20 Deducted first from unearned income • Earned Income Exclusion $65 per month plus 1/2 of the rest

20. Example: • Rich is working at the grocery store earning $775 a month. • What will his SSI payment be?

21. Example: $775 (earnings) - 20 (general income exclusion) - 65 (earned income exclusion) $690 ÷ 2 $345 (countable earned income) $564 (Federal Benefit Rate-2004) -345 (countable earned income) $219 (Federal SSI Payment)

22. Reducing Countable Income for SSI purposes • Impairment Related Work Expenses (IRWE) • PASS Plan • Student Earned Income Exclusion • Blind Work Expense

23. IRWE for SSI Recipients • Same expenses allowed as for SSDI • Can increase SSI payment $1 for $2 of expenses

24. IRWE Example • $775 (earnings) - 20 (general income exclusion) - 65 (earned income exclusion) $690 -$ 50 (IRWE-Specialized transportation) $640 ÷ 2 $320 (countable earned income) $564 (Federal Benefit Rate-2004) -320 (countable earned income) $244 (Federal SSI Payment) W/O IRWEW/ IRWE $219 $244

25. Plan for Achieving Self Support (PASS) • Sets aside income/resources (such as earnings or SSDI) for items or services needed for a vocational goal • Income/Resources set aside not considered countable income • Increases or establishes SSI payments for the length of the plan • Needs SSA approval

26. Student Earned Income Exclusion • A student under age 22 • Regularly attending school • Excludes up to $1,370 per month in 2004 (in addition to regular SSI disregards) • Excludes up to $5,520/yr (2004)

27. Blind Work Expenses • Only for SSI recipients • Used instead of IRWE Examples: Transportation Payroll taxes Union dues Adaptive equipment Lunches while working Service animal and expenses

28. Continued Medical Assistance Section 1619 (b) • Continued Medicaid when earnings are too high for an SSI payment • Income up to threshold of $ 27,645 (2004) • For SSI-E Eligible $29,948.48 (2004) • Can request individualized threshold if medical costs are higher than average and meet the needs test. • If lost due to excess assets or income, can re-qualify within 12 months

29. State SSI Supplements • Eligible if entitled to $1 of Federal SSI • WI State Supplement - $83.78 • Exceptional Expense Supplement - $95.99 • Caretaker Supplement-$250 1st child, $150 for each additional child

30. Medical Assistance MA Deductible • Medical Assistance for individuals with higher income - “medically needy” • 6-month re-certification period • Deductible amount increases with work • Do a financial comparison between county MA and MAPP

31. Medical Assistance

32. Individual Criteria for MAPP Applicant must: • Be considered to have a disability by the Disability Determination Bureau (DDB) without counting earnings • Have countable assets less than $15,000 • Adjusted gross income of 250% FPL • Be working, OR, enrolled in an approved Health and Employment Counseling Program

33. Medical Assistance Purchase Plan • Medicaid waiver services available to MAPP participants • Enrolling in MAPP could eliminate cost share or spend down • May have a MAPP premium • Applicant should do a financial comparison before enrolling

34. BPA & O Benefits Planning, Assistance and Outreach

35. What does BPA & O have to offer? • Benefits Planning Assistance & Outreach • Information and Referral • Benefit Problem Solving and Advocacy • Benefits Analysis and Advisement • Benefit Support Planning • Benefit Management

36. How to contact BPA&O? ERI –1-877-826-1752 or 1-877-242-1357 Riverfront –1-800-949-7380 Ext 401 Independence First – 1-414-291-7520