1. MISSION STATEMENT The Agency Supports Persons with Developmental Disabilities in Living, Learning, and Working in their Communities. Governor Rick Scott Director Barbara Palmer

2. KATRINA WASHINGTON State Office Operations Review Specialist Phone: 850-595-8329 Cell: 850-556-5859 Fax: 850-595-8020 Katrina.Washington@apdcares.org

3. Knowledge Is Power! You are here to learn exciting new ways to help others or yourself!

4. Acronyms SSA Social Security Administration SSDI Social Security Disability Insurance SSI Supplemental Security Income

5. Barriers High unemployment rate for people with disabilities o Up to 80% unemployed Unemployment and under-employment among working-age Americans with disabilities continues to be a problem Fear of losing benefits is a significant barrier o SSA benefits and attached health care

6. (of the System) (of the System) What if…? I earn too much money? I don’t earn enough money? I get sick again? I can’t get my benefits back?

7. 7 RULES OF ENGAGEMENT “Before any rules are discussed, all parties must be clear what benefits a persons is receiving from all sources, private and public, before information is exchanged.

8. ALWAYS CONSIDER THE FOLLOWING: o Age o SSI o SSDI o dual eligible o Married / Single o Live in HUD housing o Receiving food stamps o Over 18 and living at home o Any other information pertinent to their financial situation 8

9. Expert? You do NOT need to be the expert! o You do need to know how valuable this information is o You do need to educate people o You do need to know about the tools at your disposal 9

10. 10 Overview SSDI (Title II) (Social Security Disability Insurance) FICA Medicare Federal Rules SSI (Title XVI) (Supplemental Security Income) General Revenue Medicaid State Rules VERSUSVERSUS

11. 11 Florida is a 1634(d) State Social Security Act Section 1634(d) allows Florida to use the same eligibility criteria for SSI eligibility as for the state’s Medicaid Program

12. 12 SSDI: Eligibility for Benefits Required Work Credits in F.I.C.A. 5-month Waiting Period Medical Eligibility Medical eligibility defined Disabled Adult Child (DAC) Disability prior to age 22 Never legally married to non-Title II person Insufficient F.I.C.A. or higher parent amount Parent F.I.C.A. opens (parent dies, retires, becomes disabled) Possible continuation of Medicaid Pickle Amendment Medicare (Medical Insurance) 24 months upon eligibility Part A – Free in most cases Part B/D – Premium

13. Medicare Federal Health Insurance Program For people 65+ People <65 with certain disabilities People with end-stage Renal Disease 13

14. Continuing Disability Review (CDR) – SSI and SSDI Continuing Disability Review (CDR) – SSI and SSDI Periodic eligibility redetermination Answers the Question: Does the beneficiary continue to be disabled? 14

15. CDR Process 15 Interview at the Local SSA Office Complete a Form about Current Medical Information SSA Forwards Form to DDS for Review and Medical Determination Occurs every 3, 5, or 7 years. If you have a condition not expected to improve, SSA will review your case, but not as often as every 3 years.

16. 16 F.I.C.A. Waiting Period SGA Eligibility DAC/CDB Medicare (1960’s) SSDI – Title II

17. 17 SSDI You may receive this benefit if: You have a work history and are disabled You were disabled before age 22 and receiving childhood disability CDB or DAC* *Disabled Adult Child Medicare is usually associated with SSDI

18. 18 Medicare Components Part A - Hospital Insurance Part B - Medical Services Part C - Private Insurance Part D - Prescription Drug Coverage Page 28 - 29

19. SSI Title XVI (1974) General Revenue Needs-based No Waiting Period Looks at Earned and Unearned Income Resources Count Medicaid 19

20. SSI: Eligibility for Benefits 20 Unearned Income (Not Wages) SSDI, VA, Annuities Income (Earned Wages) 12 months no SGA income SGA factor during initial eligibility Once eligible, SGA is non-issue Resources (NOT Wages or Unearned Income) $2,000/month/individual $3,000/month/couple Medical Eligibility (DDS) Department of Health (FL) Medical eligibility defined Medical Insurance SSI connected State Administered

21. HOW TO FIND BENEFIT CHANGES Social Security www.socialsecurity.gov www.socialsecurity.gov/disability www.ssa.gov Medicaid http://www.Medicaid.gov/ Federal Poverty Guidelines http://obamacarefacts.com/federal-poverty-level.php 21 Page 38

22. 22 Requires states to consider Title II Childhood Disability Beneficiaries (CDBs) who lose SSI eligibility as if they were still SSI recipients for Medicaid purposes – keep Medicaid – o As long as they would have remained otherwise eligible for SSI benefits but for their entitlement to (or increase in) their SSDI (Title II) payment (CDB = DAC or Disabled Adult Child) Childhood Disability Beneficiary (CDB)

23. Childhood Disability Beneficiary A DAC or CDB may also be an adopted child a step-child a grandchild or a step-grandchild 23

24. 24 Work Incentives Comparison Chart Social Security Disability Insurance (SSDI) Supplemental Security Income (SSI) Trial Work Period (TWP) Continuation of SSI Extended Period of Eligibility (EPE) Student Earned Income Exclusion (SEIE) Continuation of Medicare Blind Work Expense (BWE) Special Rules for the Blind (SGA) 1619(a) 1619(b) Property Essential for Self Support (PESS) Plan for Achieving Self Support (PASS) Impairment Related Work Expense (IRWE) Section 301 (Not Ticket Rules) Expedited Reinstatement Ticket to Work

25. SSDI Work Incentives SSDI Work Incentives Trial Work Period – 9 months with monthly gross earnings of $810.00 or more within a 60-month rolling window of time Extended Period of Eligibility (EPE) – 36 consecutive months Grace Period is a 3-month period which runs once upon first earning SGA during or after EPE Extension of Medicare Coverage – minimum of 93 months 25 Page 51

26. Student Earned Income Exclusion, SEIE SSI Only Must be under the age of 22 and regularly attending school Can exclude earned income up to a certain amount, which changes annually Amount earned is reviewed monthly, with a yearly maximum of $7,180.00 This exclusion applies before any other exclusion Can carry the balance over the following month 26 Can make up to $1,780.00 per month.

27. SEIE – SSI $1,780/mo. $7,180/yr.

28. Report the following to the SSI claims representative: Proof of regularly attending school at least one month during the current calendar quarter or expectation to attend school at least one month in the next quarter Pay stubs showing the amount of earned income while considered a student and under the age of 22 28 SEIE – SSI

29. Enables a person to continue receiving an SSI cash payment when earnings exceed SGA 29 Section 1619(a) – SSI

30. Eligibility for SSI will continue as long as requirements are met SSA will continue to calculate income as before A person continues being eligible for Medicaid This happens automatically when wages are reported to SSI monthly. 30 Section 1619(a) – SSI

31. When a beneficiary earns enough income to no longer receive an SSI monthly cash payment, 1619(b) provides for the continuation of Medicaid There are qualifications: Eligibility Disability Need Medicaid Under State Income Threshold 31 1619(b) – SSI

32. An income/resource exclusion Allows a person to set aside income and/or resources for purposes of achieving an occupational objective Helps an individual to establish or maintain SSI eligibility 32 Plan for Achieving Self-Support (PASS) – SSI Plan for Achieving Self-Support (PASS) – SSI

33. SSI will not count certain resources that are essential to a person’s means of self-sufficiency Utilized when initially applying for SSI Maintains resource eligibility for SSI/Medicaid Property Essential for Self-Support (PESS) – SSI

34. 34 IRWE – SSI and SSDI Page 83

35. SSI Beneficiaries: IRWE is used to reduce gross income – Why? SSDI Beneficiaries: IRWE is used to reduce countable earnings below SGA – Why? What is the difference between “gross income” and “countable earnings”? 35 Impairment Related Work Expense (IRWE) – SSI and SSDI

36. Examples Transportation Medications Medical Devices PCA 36 IRWE – SSI and SSDI

37. 37 Thanks!