Work Incentives and Work Supports: The Ins And Outs Social Security, Medicaid Buy-In's And Other Community Supports

JOE ENTWISLENCHSD

NTW AgrAbility Conference

Grand Rapids, MI

OUTLINE

•SSI: Eligibility, Resources, Income, Work, Medical Assistance, PASS

•SSDI: Eligibility, Work, Medicare

•Self Employment

•Work Incentive Planning and Assistance

•Ticket to Work

•Employed Individuals with Disabilities MBI

RSDI/SSDIRetirement,Survivors,

Disability Insurance)

Medicare

SSI- Supplemental Security Income

Medicaid*

C

oncu

rren

t

Social Security’sBenefit Programs

• Social Security Disability Insurance(SSDI) provides benefits to disabled or blind people who are “insured” by workers’ contributions to the SSA trust fund.

• Supplemental Security Income makes cash assistance payments to the aged, blind and disabled who have limited income and assets.

Social Security Disability Insurance (SSDI, Title II)

Supplemental Security Income (SSI, Title XVI)

KEY CONCEPTS

“SGA” “COUNTABLE INCOME”

Definition of Disability for both SSDI and SSI

•“Assistance Program”

•Must have low income & resources•““Countable Income”Countable Income” = Key Concept

= $674 or less

•Resources = less than $2,000 •Cash payment + Medical Assistance

The maximum dollar amount a person can receive in federal SSI cash benefits on a monthly basis

$674 month for eligible individual

SSI pays the difference between the FBR and countable income

General Income Exclusion of $20Deducted first from unearned incomeEarned Income Exclusion

$65 per month plus1/2 of the rest

o These are expenses that one must pay for out-of pocket in order to work.

o They must be related to the primary disability or an established secondary disability.

o The individual must have an IRWE approved by SSA first and must show receipts.

o medical appointment paymentso prescription co-paymentso prosthetic devices o transportation costs for taxis o costs of adaptive devices for automobiles o special transportation used by persons

who cannot drive an unmodified automobile.  

IRWE’s deducted from countable income before we divide by 2.

Therefore, IRWE is not subtracted from countable income dollar for dollar (like it is with SSDI).

Mary pays $100 per month for specialized transportation to and from work. She is paid $500 per month from her job.

500 Earned Income- 20 General Disregard

- 65 Earned Income Disregard- 100 IRWE

=315/2=157.50 Countable Income

A person whose primary disability is a visual impairment can use BWE’s to deduct the cost of a large list of items.

Unlike IRWES, BWEs are deducted AFTER we divide by 2. The entire BWE is deducted from income dollar for dollar.

Because of this, BWEs can be used to deduct so much from countable income that often times the SSI check is not reduced at all!

:

IRWEs State and Federal Taxes Union Dues Mandatory Pension Cost of Uniforms Reader Services, Driver Services, and Cost of

Service Animal’s Care Childcare Transportation Meals Consumed at Work Adaptive Equipment

Mary earns $500 per month. She has $100 in various BWEs (taxes, etc.)

$500 Earned Income-20 General Disregard

-65 Earned Income Disregard=415/2=207.5

-100 BWE$107.5 Countable Income!

Must be under the age of 22 and regularly attending school.

Exclude up to $1550 of earned income per month when they figure the SSI monthly payment amount.

The maximum yearly exclusion is $6,240.

Mary earns $500 a month. But, she is also attending community college with enough hours to qualify for Student Earned Income Exclusion.

$500 Earnings minus $500 SEIE (out of the possible $1550 max per month)

NO SSI REDUCTION until she uses $6240!

When work earnings reduce SSI payments to zero, MA will continue if yearly wages below “Threshold” amount

Individual Thresholds can be higher based on an individual’s actual MA use

Entitlement programs Disability Medicare Coverage

SSDI DAC

Paid from Social Security Disability Insurance Trust Funds

Have worked in “covered” employment May be eligible on parents record if

disability began before age 22 Gateway to Medicare

1. Gross average earnings minus any: - impairment-related work expenses;& - special conditions or subsidy2. Consider the value of the work 3. Consider if work is an “unsuccessful

work attempt” ( lasted 6 mo or less)

TWP -Trial Work Period SGA - Substantial Gainful Activity EPE - Extended Period of Eligibility Expedited Reinstatement IRWE/Subsidy EPMC Medicare for people with disabilities

who work

9 months of $700 or more (no limit) 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

Measure of ability to work

$980 per month for 2009

$1,640 per month for the blind SGA

If performing work that is “SGA” after the TWP cash SSDI benefits stop

Subsidy

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

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:EXAMPLES: more frequent breaks, more supervision/support, lower production requirements

Consecutive 36 month period after TWP Cash benefits reinstated for months

under SGA ($980) without a new application

If at SGA at end of EPE, no more SSDI payments

When someone’s Social Security or SSI disability benefits have ended due to earnings from work, he/she is able to request reinstatement without filing a new application

Within 5 years of last benefits received

Beneficiaries must be unable to work due to their medical condition

They may receive temporary benefits (as well as Medicare/ Medicaid) for up to 6 months while SSA evaluates their medical condition

Federal health insurance program 24-month waiting period after SSDI benefits

start $96.40/month Part-B premium (2009); Part A

is free

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

After EPMC, Medicare can continue if beneficiary pays the monthly premiums

Must continue to have disabling condition

State may pay Medicare premium through the Medicare Buy-In program, if income guidelines are met

Programs designed to allow workers with disabilities to buy into Medicaid at higher income and asset levels◦ First and only Medicaid work incentive◦ Operating in 40 states

Program features:◦ Vary from state to state◦ Required to pay premiums◦ Eligible from 16-64 and above◦ Most offer ability to increase assets

35

◦ Must have a disability to participate◦ Must be working to participate◦ Provides wrap around coverage for private

insurance

More than 100,000 participants nationwide

Many offer participants the ability to retire while maintaining eligibility

Utilize net income for eligibility on self-employment

36

o 7.8% of the general population is self employed

o 12.2% of people with disabilities are self employed

o 90% of businesses started by people with disabilities are successful due to planning and pre-determined supports

o Provide greater flexibility and freedom to the owner

o Allow independence and autonomy

o Provide greater income potential

o Allow for building of assets

o Accommodate some disabilities more readily than wage employment

Determine if it is self employment.

Determine Net Earnings from Self Employment (NESE).

For SSDI, determine TWP

Determine countable earnings for SSDI and SSI (NESE minus any applicable deductions).

Adjust checks accordingly.

Is the beneficiary showing good faith intention of making a profit or producing income? AND

Is the beneficiary engaged in the activity on a regular basis? AND

Is the beneficiary presenting him/herself to others as ‘a business’?

SSA will calculate the Net Earnings from Self Employment (SSI and SSDI)

Utilize SSA deductions (IRWE, Unpaid help etc..)

Establish countable income

Determine impact on benefit

o Plan for Achieving Self Support

o Individual Development Accounts

o Vocational Rehabilitation Services

SSI recipients submit their business plan to SSA for approval as a PASS.

Expenses within the business plan may be approvable for a PASS.

A SSI recipient must have NESE or assets in order to fund the PASS!

May use SSDI as funds for PASS, making SSI eligible

Under the Rehab Act, VR agencies are allowed to support self-employment as a goal and can help to fund a business.

Rules vary from state to state and some states have strict requirements.

VR agencies can work with other workforce systems, such as the Small Business Development Centers, to support individuals.

o A matched savings account in cooperation with a local bank; goal can be small business.

o Individual Development Accounts may be used on their own, or in conjunction with a PASS or Family Self-Sufficiency Plan, to fund a business.

o Federal IDA programs are exempt from most public benefit programs like SSI. This means that what the individual deposits, matching deposits and interest earned will not count as a resource.

Pizza Restaurant Owner:

oDeveloped PASS to fund rent for restaurant ($35,000).

oState VR funded a Business Enterprise Program grant ($50,000).

o Individual Development Account containing wages from previous employment ($15,000)

$100,000 for the Business!!

www.start-up-usa.biz

http://www.worksupport.com/resources/listContent.cfm/5/2/0

http://digitalcommons.ilr.cornell.edu/edicollect/53/

www.griffinhammis.com

Self Employment For People with Disabilities http://www.brookespublishing.com/store/books/griffin-6520/index.htm

Work Incentive Planning and Assistance◦Information and Referral◦Benefit Problem Solving and Advocacy

◦Benefits Analysis and Advisement◦Benefit Support Planning◦Benefit Management

SSA’s Website

https://secure.ssa.gov/apps10/oesp/providers.nsf/bystate

Provides beneficiaries with more choices for receiving employment services

Provides greater incentives for entities providing employment services

• Employment Network (EN)– Any qualified State, local, or private

entity– Assumes responsibility for coordination

and delivery of employment services, vocational rehabilitation services, or other support services under the Ticket to Work program

– see www.yourtickettowork.com for list in our area

1-866-968-

7842(yourticket)

TDD 1-866-833-2967

INFORMATION

WWW.SSA.GOV

Red Book on Work Incentives

SSA Employment Support Programs -WWW.SSA.GOV/WORK

www.yourtickettowork.com

1-800-772-1213

Joe Entwisle312.401.3909www.nchsd.org

jentwisle@hdadvocates.org

55