1. Overview of the Work Incentives for Social Security Disability Benefits Ambassador Orientation April 9, 2010 Presented by: Karla Bell California Health Incentives Improvement Project San Diego State University Interwork Institute

2. Reasons to Work  More income  Independence  Learn New Skills  Meet New People  Build Assets  Increase Retirement  Tax Credits

3. Social Security Administration (SSA) 1300 local Field Offices 10 Regional Offices OESP (Office of Employment Support Programs) Oversees Ticket to Work and WIPA projects Over 60,000 employees

4. Local SSA Field Office  Hierarchy and Individuality of Field Offices (aka District Offices) Service Representative (SR)  Usually first point of contact when an individual visits SSA  Assesses situation, answer questions, investigates & resolves problems Claims Representative (CR)  Help to establish entitlement to Social Security benefits.  CR's can also be assigned as WIL's (not separate positions) Work Incentive Liaisons (WILs)  Primary contact on work incentive issues for CR's and SR's. Area Work Incentive Coordinator (AWIC)  Coordinate with WIL's, Public outreach

5. Disability Benefit Programs  Social Security Disability Insurance (SSDI)  Supplemental Security Income (SSI)  Both SSDI and SSI = Concurrent benefits

6. How do I find out what benefits I receive?  Benefits Planning Query (BPQY) Request from your local Social Security Office Call the Social Security Administration (SSA) at: 800-772-1213 (voice); 800- 325-0778 (TTY)  A Community Work Incentives Coordinator (WIPA projects) will request a BPQY for you as part of benefits counseling

7. Social Security Disability Insurance (SSDI)  AKA: DI, SSA, Social Security or Title II  Based on work, not financial need  Must have worked long enough & recently enough (FICA contributions) to become insured  Disabled or blind under Social Security rules  5 month waiting period  Medicare eligible after entitled for 24 months  Not affected by resources  3 Different Forms: SSDI, Childhood Disability Benefits (CDB), Disabled Widow(er)s Benefits (DWB)

8. Social Security Disability Insurance (SSDI)  Must have insured status on own work record  At least 20 credits in the 10 years prior to onset of disability  Those disabled prior to age 31 need fewer credits to qualify  Possible to earn up to four credits per year -one credit = $1,120 in 2010  The amount of disability benefits payable under title II is determined by the number holder’s work record. The maximum monthly payment for 2010 is $2,346

9. Childhood Disability Benefits (CDB)  To be eligible for Social Security as an adult child with a disability, individuals must be: 1. 18 years of age or older 2. Disabled by SSA’s definition before age 22; and, 3. Child of an insured worker who is either disabled, retired or deceased.  No 5-month waiting period required  Benefits not payable prior to the month in which the individual turns 18

10. Medicare Federally run program that has the same eligibility standards and coverage rules across all 50 states Medicare Part A:  Hospital Insurance (HI)  Helps pay for care in a hospital and skilled nursing facility, home health care and hospice care Medicare Part B:  Helps pay for doctors, outpatient hospital care and other medical services Medicare Part D:  Prescription Drug Program  Participants choose a drug plan

11. Supplemental Security Income (SSI)  Federal income program funded by general tax revenues (not Social Security taxes)  Aged, blind or disabled people with limited income and limited resources  U.S. Citizen or qualified alien  Income/resources of family members or living arrangements may affect eligibility  No waiting period  Automatic Medi-Cal eligibility in CA Medi-Cal is a state-run program designed primarily to help those with low income and little or no resources

12. 2010 California SSI payment rates SSI Payment= $674 Federal Benefit Rate + State Supplement Payment $845.00 (Individual-own household) $639.66 (Individual-household of another) $929.00 (Individual-no cooking facilities) $908.00 (Blind individual) $1407.00 (Couple) $1554.20 (Blind Couple) SSI Resource Limit: $2000 (individual) $3000 (couple)

13. SSDI Work Incentives  Trial Work Period  Extended Period of Eligibility  Expedited Reinstatement  Continuation of Medicare

14. Trial Work Period (TWP)  Allows you to test work for at least 9 months while receiving full SSDI benefits  No limit to earnings during TWP  2010: $720 gross earnings or 80 hours in self-employment = TWP month

15. Trial Work Period (TWP)  Lasts until you complete 9 months (not necessarily consecutive) of work within a rolling 60-consecutive month period  After TWP, there is a 3 month grace period with full SSDI benefits in addition to earned income (may occur during Extended Period of Eligibility (EPE) or after EPE has ended)  No other work incentives apply during the TWP  Only one TWP per period of entitlement

16. What happens after I use my Trial Work Period (TWP)?  Your Extended Period of Eligibility (EPE) starts the month after TWP ends  36 consecutive months  Once EPE starts, it cannot be stopped  Key concept: Substantial Gainful Activity (SGA)  2010: SGA is $1000 in countable earnings ($1640 for a Blind individual)

17. Extended Period of Eligibility (EPE)  First 36 months are Reinstatement Period If monthly countable earnings are over $1000 not entitled to cash benefits If monthly countable earnings are less than $1000 then entitled to cash benefits Benefits automatically reinstated without need for new application or disability determination  During the EPE, work activity over $1000 may not cause termination of benefits only suspension

18. Extended Period of Eligibility (EPE) There are work incentives that you can use during the EPE to lower your countable earnings:  Impairment Related Work Expenses (IRWE)  Subsidy or Special Conditions You require more supervision or help from coworkers Your performance is at a lower standard You are provided with special equipment for your job Your have irregular work hours and/or take frequent rest breaks You have a job coach

19. What happens once my 36 month Extended Period of Eligibility ends?  Your benefits will continue if you are not working or earning above SGA  Your benefits will end if you work above SGA after the 36-month reinstatement period  Expedited Reinstatement provides an additional 5 years of reinstatement if work stops and there is no medical improvement

20. Expedited Reinstatement (EXR)  Previous entitlement to benefits terminated due to SGA  Unable to work or perform SGA due to a disabling impairment  Eligible within 60 months of benefit termination date  Up to 6 months provisional benefits payable during EXR decision making process  Medical decision needed

21. Example of TWP & EPE: (2010 Amounts) *Trial Work Amount = $720 total gross monthly earnings *SGA = $1000 total countable monthly earnings ($1,640 if Blind) (These amounts are likely to increase each year in January, but for this example the amounts remain the same each year for simplicity.) JanFebMarAprMayJunJulAugSepOctNov.Dec $800 T1 *Start TWP $600$800 T2 $900 T3 $700$1500 T4 $800 T5 $0$800 T6 $550 $825 T7 $1000 T8 $1000 T9 *End TWP $900 * Start EPE $950$825$1200 *Grace & Ces- sation $1100 Grace $1200 Grace $1200 Not Eligible $1050 Not Eligible $950 Eligible $875 Eligible $1200 Not Eligible $1500 Not Eligible $1075 Not Eligible $850 Eligible $1200 Not Eligible $2000 Not Eligible $875 Eligible $1250 Not Eligible $980 Eligible $1025 Not Eligible $850 Eligible $120 Eligible $450 Eligible $1500 Not Eligible $1600 Not Eligible $865 Eligible $995 Eligible $1300 Not Eligible $1500 Not Eligible $1700 Not Eligible $875 Eligible $1400 Not Eligible $1250 Not Eligible $0 Eligible $1250 Not Eligible $800 *End EPE $850 Eligible $875 Eligible $1200 *Termi nation Due to the complexity of the SSDI work incentives it is helpful to see a WIPA Community Work Incentives Coordinator for benefits counseling

22. What happens to Medicare if SSDI benefits stop?  Medicare coverage uninterrupted during Trial Work Period  Continues for at least 93 months after the 9 month Trial Work Period  After that you may be able to purchase Medicare coverage

23. SSI and Work  Going to work can increase overall income  Medi-Cal can continue even if working  Reinstatement

24. How earnings affect SSI payments  SSA counts less than half of your earned income For example: $885 in wages $400 counts against SSI  Certain Impairment Related Work Expenses and Blind Work Expenses can also be deducted from your gross wages

25. SSI Calculation Example-IRWE $885 Gross Wages -$20 General Income Exclusion $865 Remainder -$65 Earned Income Exclusion $800 Remainder -$100 Impairment Related Work Expense $700 ÷ 2 $350.00 Total Countable Earned Income $845.00 Maximum SSI Rate -$350.00 Total Countable Income $495.00 Adjusted SSI Payment $885.00 Gross Wages +$495.00 SSI -$100 IRWE $1280.00 Total Financial Outcome

26. Blind Work Expenses (BWE)  For SSI beneficiaries whose primary diagnosis is blindness  Allows the exclusion of any work related items that are paid out of pocket and not reimbursed  BWEs do not need to be related to blindness or any impairment  Examples: Service animal expenses, fees, State, Federal & local taxes, visual & sensory aids, driver services, transportation to and from work, childcare, meals consumed at work, union dues, uniforms, reader services, vehicle modification, mandatory pension contributions, training to use an impairment-related item, translation of materials into Braille

27. SSI Calculation Example-BWE $885 Gross Wages -$20 General Income Exclusion $865 Remainder -$65 Earned Income Exclusion $800 Remainder ÷ 2 $400 Remainder -$100 Blind Work Expense $300.00 Total Countable Earned Income $908.00 Maximum SSI Rate -$300.00 Total Countable Income $608.00 Adjusted SSI Payment $885.00 Gross Wages +$608.00 SSI -$100 BWE $1393.00 Total Financial Outcome

28. IRWE & BWE  All Blind and Impairment Related Work Expenses must be verified by your local Social Security field office  Provide them with original receipts or canceled checks of the expenses  SSA will determine if the expense may be deducted  Request in writing in order to use appeal rights (if necessary)

29. SSI Calculation Example-SSDI & SSI Benefits $520 Unearned Income (SSDI payment) -$20 General Income Exclusion $500 Countable Unearned Income $885 Gross Wages -$65 Earned Income Exclusion $820 Remainder ÷ 2 $410.00 Countable Earned Income $500.00 Countable Unearned Income +$410.00 Countable Earned Income $910.00 Total Countable Income $845.00 Maximum SSI Rate -$910.00 Total Countable Income $0.00 Adjusted SSI Payment

30. What happens if my earnings are so high that my SSI stops?  1619(b) is a work incentive that allows working SSI recipients to keep FREE Medi-Cal (No Share-of-Cost)  Medi-Cal retained when SSI payment is reduced to $0.00 per month due to earned income  Medi-Cal continues until you earn above a Threshold  2010 California 1619(b) Threshold Amounts: Disabled = $34,324.00 Blind = $37,252.00  People with high medical costs can earn even more (Individualized Threshold)  Benefits can start again if you stop working or your earnings decrease (Reinstatement)

31. 1619(b) To qualify:  Have been eligible for an SSI cash payment for at least 1 month;  Would be eligible for cash payment except for earnings;  Still be disabled or blind;  Still meet all other eligibility rules, including the resources test;  Need Medi-Cal in order to work;  Have gross earned income that is insufficient to replace SSI, Medi-Cal, and any publicly funded attendant care.

32. 1619(b)  Individualized Threshold: threshold can be adjusted on a case-by-case basis  Higher Individualized Threshold if:  Blind Work Expenses (BWE)  Impairment Related Work Expenses (IRWE)  Plan to Achieve Self-Support (PASS Plan)  Publicly Funded Personal Attendant  (i.e. In-Home Supportive Services)  Medical Expenses above State Average

33. 1619(b)  All Blind and Impairment Related Work Expenses must be verified by your local Social Security field office  Provide them with original receipts or canceled checks of the expenses

34. Section 301  SSI/SSDI benefits may continue in spite of determination that medical improvement has occurred if enrolled in an appropriate program that increases likelihood of not returning to disability benefit rolls: Department of Rehabilitation (using an IPE) Individualized Education Plan (IEP) if under age 22 PASS Plan Ticket to Work Support Services using an individualized written employment plan  Benefits continue until you complete the program, stop participation in the program or if your continued participation in the program no longer increases likelihood that you remain off the rolls

35. Ticket to Work A ticket all SSI and SSDI recipients, ages 18- 64, can use to get free employment services 866-968-7842 (voice), 866-833-2967 (TTY) http://www.yourtickettowork.com/

36. Ticket to Work  Help you access vocational rehabilitation services, training, education and placement services  Ticket can be used with: Department of Rehabilitation or Employment Network  Your choice to use your Ticket or not and who you take it to  Protection from continuing disability review when Ticket is assigned and in use

37. Work Incentives Seminar Events (WISE)  Community Events  FREE information about Ticket to Work and other work incentives for SSDI and SSI recipients  Meet local Employment Networks and Work Incentives Planning and Assistance (WIPA) representatives  Upcoming San Diego WISE (see flier): May 25, 2010, 10 am – 2:00 pm Goodwill Industries

38. Medi-Cal Working Disabled Program  An individual with a disability who is working full or part time may qualify  Individuals can earn up to $55,188 ($73,884 for a couple) gross per year and still qualify for Medi-Cal Higher gross wages possible when there are Impairment Related Work Expenses (IRWEs)  Affordable premiums: $20 - $250 (Single Person) $30 - $375 (Couples)

39. Medi-Cal Working Disabled Program  Asset Limit ($2000 individual, $3000 couple)  Retirement Plans allowed and not counted towards asset limit  All disability income is exempt in determining eligibility and premium (Social Security Disability Insurance-SSDI, State Disability Insurance, Workers Comp., Childhood Disability Benefits, private disability insurance, etc.)  Maintain In-Home Supportive Services at home and in the workplace

40. Local Resources  Area Work Incentives Coordinator (AWIC)  Public outreach on work incentives  Norma Richey  Covers California South Coast (714) 966-2410 ext. 246 17075 Newhope St., Ste. B Fountain Valley, CA 92708

41. Local Resources Work Incentives Planning and Assistance (WIPA)-San Diego County  One on one benefits planning  Steve Stover, Community Work Incentives Coordinator  619-840-6616  Email: Sstover@proindependence.org

42. Local Resources Disability Rights California  advocacy, appeal rights & assistance  PABSS: Protection & Advocacy for Beneficiaries of Social Security http://www.disabilityrightsca.org/  800-776-5746  TTY 800-719-5798

43. Resources  Talent Knows No Limits http://www.talentknowsnolimits.info/  Disability Benefits 101 http://www.disabilitybenefits101.org/  SSA Red Book-Guide to Work Incentives http://www.ssa.gov/redbook/  WISE Events http://www.cessi.net/WISE/

44. Resources  Area Work Incentives Coordinators (AWIC) http://www.ssa.gov/sf/awic.htm  Ticket to Work http://www.yourtickettowork.org/  Ticket to Work FAQS http://www.cessi.net/ttw/faqs/beneficiaries.html

45. Questions You are welcome to contact Karla Bell at 619-594-5381 (office) 760-579-3474 (cell) karlabella@disabilityskunkworks.com