WIPA Training for AWICs Session 2 April 29,

Challenging Issues for CWICs  Title II A Title II beneficiary is not affected by asset limits. Unearned income and resources do not matter and do not need to be reported. The BPQY reflects Social Security’s records. The CWIC must examine it and investigate situations that appear to need action. The concept of SGA is often misunderstood - it is a decision involving more than the gross wage amount. There are two types of Title II work incentives –Those that affect the cessation/SGA decision –Those that offer safety nets (i.e. protection from either loss of cash benefits or from termination) for periods of time. 2

Reading the BPQY: Issues to Explore Why is the individual not receiving the full Title II amount? –Is Social Security withholding either the Part B or Part D premium? –Is Social Security recovering an overpayment? –Is there child support being withheld? Some people may have one BPQY on their own SSN and one on another SSN –If so, are there different TWP/EPE periods? Have all of the earnings been adjudicated? –Does the individual need to have an SSA-820 or SSA-821 completed? Is the beneficiary involved in Benefits Offset National Demonstration (BOND) project. How to get questions answered. 3

Factors to Verify Beyond BPQY Medicare Part D, Low Income Subsidy Type of Medicare Savings Program (QMB, etc.) Status of Medicaid – confirm with Medicaid agency if not an SSI beneficiary in a 1634 state Ticket assignment Veteran’s Benefits, Worker’s Compensation, etc. – verify with each individual agency 4

Recognizing and Reconciling Issues Beneficiary’s blindness status not noted on BPQY –Contact Social Security and request medical CDR to establish blindness TWP information not up to date –Request a work review. Furnish documentation. Work incentives not applied to determine countable wages –Assist beneficiary to gather required documentation and request review Earnings discrepancies between Social Security records and beneficiary information –Request review 5

Work CDR Documentation CWICs can assist beneficiary to provide documentation for a work review, including helping with forms. CWICs should support beneficiary to follow-up with Social Security when possible SGA-level work is occurring. CWICs may download 820 or 821 and assist the beneficiary to complete and submit it (we encourage them to ask CRs if this would be helpful). CWICs can help beneficiaries understand how to report work in the future. 6

Documenting Work Incentives CWICs help beneficiaries understand the importance of reporting work –They assist beneficiaries to complete Work Activity Report (SSA-820 or SSA-821) Records to document work incentives –Create folder to maintain IRWE receipts, paystubs, and Social Security letters –Submit request for IRWE/subsidy with documentation and at appropriate times 7

Challenging Concepts for CWICs  Title II Disability Benefits Title II programs count income when it is EARNED, not when it is PAID! Title II benefits are not reduced due to work – Benefits are paid in full or not at all. The SGA test remains in effect indefinitely—it is part of the disability definition for the Title II disability programs. People who work but never engage in SGA will NOT lose cash benefits or Medicare unless medically recovered. Work incentives in the Title II program operate in phases. 8

Supports Related to Specific Work Incentives Work CDRs and SGA Determination –CWICs assist beneficiaries to make sure beneficiary understands SGA and is prepared –Help beneficiary deal with an adverse SGA determination –Help with subsidy/special condition development Ask probing question early in employment Meet with employer or employment specialist, if needed Use subsidy template (attached) –Help with IRWE development (attached) Think out of the box Help with documentation Review often; changes happen! (see attached form for reporting changes) 9

IRWE Issues that Occur Assisting the beneficiary to document prorated IRWE in the manner that benefits the beneficiary most. Assisting the beneficiary to document IRWE for approval for driving unmodified vehicle when the beneficiary is unable to use public transportation due to disability. Documenting IRWE as part of residential support expenses as IRWE when person lives in a group home. Denial of approval of expense when proof of payment is a check written by a spouse from a joint account. 10

TRANSPORTATION AS IRWE FLOWCHART PUBLIC TRANSPORTATION AVAILABLE IN COMMUNITY? YES NO Can individual use Public Transportation ? Can individual drive unmodified vehicle? Yes NO Yes NO The individual’s expense Is reason individual Transportation expense When need and payment of driving an unmodified unable to drive is NOT deducted as IRWE verified – cost of cab driver, vehicle cannot be deducted themselves to work special bus or driving a as IRWE. This would NOT due to impairment vehicle IS IRWE be deductible YES NO When need payment verified – Individual’s expenses Special travel expenses cab driver or special ARE deductible as IRWE. bus are NOT deductible as IRWE 11

Subsidy Issues that CWICs Often Encounter Employer often does not return the form. Form was sent to HR and it was completed incorrectly, due to lack of knowledge of subsidy. Beneficiary has disclosed disability to supervisor and receives accommodation but does not want SSA to send form to anyone else, as he doesn’t want them to know. Efforts by CWIC to assist the employer to complete the form is view differently by different Field Offices. 12

Averaging Policies that CWICs Must Understand Social Security does not average income across time periods when the SGA levels changed. Social Security does not average together periods of work activity that are significantly different in terms of earnings or work activity. “Significantly different” is not well defined in POMS and CWICs are encouraged to ask questions about this when in doubt. Averaging is not performed on an annual basis, but from the point at which a work effort begins to where it ends or changes. Averaging is performed on “countable” earnings, not gross earnings and it cannot be used after cessation. Months without earnings are never included in the average. 13

UWA Policies that CWICs Must Understand There must be a significant break in continuity of work for work attempt to be considered unsuccessful. Language in POMS about the break before and after the work is complex. The break must be caused by the disability or the removal of “special conditions” related to the disability SGA level work lasting more than 6 months cannot be UWA and it cannot be used after cessation. 14

Supports CWICs Provide Related to Specific Work Incentives Ticket Use Support Medical Benefits Support –Medicaid Buy-In, EPMC, Extra-help and Medicare Savings Program (QMB, SLMB, QI) Expedited Reinstatement (EXR) –Education Difference between EXR vs. new application Completing the process –Support Tracking the 24 months of cash benefit receipt in the EXR Initial Reinstatement Period Refreshing beneficiary’s understanding of TWP, EPE, etc. 15

Main Points for CWICs Work incentives are only considered if gross earnings are over the applicable SGA level (except TWP). All work incentives are deducted before a final SGA determination is made. SGA determinations are based on pattern of work in past. SGA determinations may only be made by Social Security. CWIC role is to help identify and document use of work incentives. 16

17 SSI Benefits

Important Concepts for CWICs in SSI Benefits To receive SSI the beneficiary has to be poor. It is a needs based program & is intended to assist with basic needs. Unearned & earned income as well as resources do matter and beneficiaries must report changes. CWICs must understand: –Deeming and in-kind support (ISM) –Living arrangements—When beneficiary receives the full Federal Benefit Rate, and when in-kind support reaches the Presumed Maximum Value (PMV), or the Value of the 1/3 Reduction (VTR) CWICs must understand how the work incentives affect SSI calculations, including what Social Security deducts, where the deduction occurs in the calculation, and what documentation beneficiaries need. 18

Reading the BPQY: Issues to Explore Why is the individual not receiving the full SSI amount? –Is there unearned or earned income? –Is Social Security recovering an overpayment? –Is there deeming or ISM? –Excess income and/or resources Have all of the earnings been reported? –How to recognize Estimated vs. Verified earnings Work incentive usage Medicaid – may say State determination or Eligible for Medicaid (SSI) How to get questions answered 19

Factors that BPQY Does Not Address and CWICs Must Verify in Other Ways Status of Medicaid – confirm with Medicaid agency if not SSI in a 1634 state 1619(b) status, including transition to 1619(b) at the appropriate point Ticket assignment Type & amount of unearned income (Deemed, PMV, Veteran’s Benefits, Worker’s Compensation, etc.) 20

CWICs Must Recognize and Assist to Resolve Existing Benefit Problems Beneficiary’s blindness status not noted on BPQY –Contact Social Security and request medical CDR to establish blindness –Earnings information not up to date –Ask for review and furnish documentation. Work incentives not applied to determine countable wages –Ask for review and furnish documentation 21

CWICs Must Understand How Work Affects SSI Benefits SSI counts income when it is PAID, not when it is EARNED! It’s possible to receive a partial SSI payment. –Beneficiaries who work are almost ALWAYS better off financially working than not working and receiving SSI alone. People who work and no longer receive a cash payment can usually keep Medicaid unless medically recovered or they have excess resources. Retrospective Monthly Accounting 22

SSI Benefits and Work Incentives Reporting earnings –Contact Social Security to report earnings from new job –Report monthly via phone, mobile app or in person Documenting work incentives –Create folder to maintain IRWE/BWE receipts, paystubs, and Social Security letters –Submit request for IRWE/BWE with documentation monthly. 23

Supports Related to Specific Work Incentives SEIE –Identify SSI beneficiaries who are eligible for SEIE –Help with documentation IRWE development (attached) –Think out of the box –Help with documentation –Review often; changes happen! (see attached form for reporting changes) BWE development (attached) –Remember that BWEs are anything required for work and don’t have to be related to the impairment –Help with documentation 24

CWICs Assist with PASS Development Assist in the writing of PASS Assist with communication with the PASS Specialist Check-in with beneficiary to ensure milestones are being met Assist with PASS amendments 25

Supports Related to Specific Work Incentives Ticket Use Support –Explaining current Ticket Status –Providing list of ENs in the area Medical Benefits Support –1619(b) & Medicaid Buy-in EXR Support –Deciding to use EXR vs. new application –Completing process 26

Errors We Teach CWICs to Avoid When Calculating SSI Payment When estimating an SSI payment, income is never reduced below zero Unused earned income exclusions are never applied to unearned income The General Income Exclusion and the Earned Income Exclusion apply only once to an eligible couple. Do not combine the GIE & EIE for one $85 exclusion Never enter the beneficiary’s current SSI payment on the unearned income line Use all of the exclusions that apply to the beneficiary’s situation Do not change the order of the calculation steps Make sure the beneficiary knows that Social Security has the final say in the calculation and application of exclusions. 27

Main Points for CWICs Work incentives are considered as soon as the beneficiary has earned income. Special considerations for eligible couples: –Work incentives are combined –Total countable income subtracted from the couple FBR –Half of the adjusted check is given to each member of the couple –1619(b) only applies to the member of the couple who is working—so both have to work for both to have 1619(b) CWIC role is to help identify and document use of work incentives. 28

29 Concurrent Beneficiaries

Teaching/TA Points for Concurrent Beneficiaries The Title II payment takes precedence since SSI is the payer of last resort. The Title II payment is considered unearned income for SSI purposes. All work incentives potentially apply and can be used in combination. Concurrent beneficiaries are natural PASS candidates. IRWEs can be applied simultaneously in both the SSI & Title II disability program. The same expense may be claimed as an IRWE for Title II disability and included as a PASS for SSI if it meets the criteria. Blind Work Expenses only apply to the SSI program, but Title II IRWE may be included as BWE on the SSI record. Beneficiaries should report earnings to BOTH the Title II & SSI programs. 30

Self-Employment 31

Teaching/TA Points for Self-Employment Hobby vs. Business Importance of Business Structure Determining Net Earnings from Self-Employment (NESE) Title II & Self-employment –TWP (attached) –SGA determination Countable Income Test vs. Three-Step Test Unincurred business expenses & unpaid help (attached) SSI & Self-employment –Calculation of NESE –PESS CWICs role with Self-Employment cases (attached) 32

CWICs Must Understand NESE Annual gross business income minus annual business expenses multiplied by.9235 Annual NESE is divided by 12 for SSI determinations Annual NESE is divided by number of months of operation for Title II SGA determinations In both SSI and Title II determinations, applicable work incentives are subtracted from NESE to determine countable NESE 33

Calculating NESE for Title II TWP –NESE over the TWP limits or –The beneficiary spends more than 80 hours in that month performing the work activity for the business SGA determination –Methods for determining SGA Countable Income Test vs. Three-Step Test –Work Incentives available Unincurred business expenses Unpaid help 34

CWICs Must Understand the Difference When Calculating NESE for SSI Use Annual NESE to determine monthly NESE NESE is always divided by 12 months, even if the business: –Did not operate for the entire year –Is seasonal –Ceased operation prior to the SSI application Monthly NESE is then the starting point for the basic SSI countable income calculation 35

Property Essential for Self-Support (PESS) PESS considerations: Applies to business that are sole proprietorships or partnerships ONLY. Applies to assets that are in current use in the trade or business –Current use applies on a monthly basis –If not in use, can be excluded if it was in use and is reasonably expected to be used again within 12 months –If not used within 12 months, additional 12 months extension can be allowed if nonuse is due to disability. 36

Main Points for CWICs Be clear with the beneficiary what is and what is not the CWIC’s role. Identify role in both the business and benefits domains. Know the local resources for business development. Clarify that Social Security counts income the same way as the IRS does. It does not matter how much money the beneficiary takes out of the business as “owner’s draw”. 37