1. “Do the best you can until you know better
“Do the best you can until you know better. Then when you know better, do better.” Maya Angelou

2. BENEFITS AND WORK INCENTIVES
10/12/2013
BENEFITS AND WORK INCENTIVES
Essential Supports for Employment Success!
February 2017

3. How Often Have You Heard….
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How Often Have You Heard….
If I go to work I will lose my benefits.
I can only make a certain amount each month or only work a certain number of hours or I will lose my benefits.
I can’t get the skills and experience I need for a career without losing my benefits.
If I go to work and then stop working, I won’t be able to get back my cash benefits or Medicaid/Medicare back.
If I go to work Social Security will send me a letter asking for a lot of money back.

4. The Basic Terms SSA: Social Security Administration
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The Basic Terms
SSA: Social Security Administration
SSI: Supplemental Security Income
Title II: Covers Social Security Disability Insurance, Childhood Disability Beneficiary and Disabled Widow/Widower.
SGA: Substantial Gainful Activity: $1,170 (2017) monthly gross earned income non-blind, $1,950 (2017) blind.
Work Incentives: Both federal and state-specific programs that are available to Individuals with disabilities in their return to work efforts.
Audience members may be familiar with these terms already, but it is good to remind them.
It is also good to say “Supplemental Security Income, or SSI” and “Social Security Disability Insurance, or Title II” several times before you start referring to them as just SSI and Title II.

5. SSI and Title II
Supplemental Security Income (SSI) and Title II (Title II, Childhood Disability Beneficiary and Disabled Widow/Widower) adult benefits are not “disability only” benefit programs.
SSI and Title II are “benefits based on your inability to do substantial gainful activity due to your disability” benefit programs.
Substantial Gainful Activity is only important if the individual receives Title II, and even then only at a specific point in their work activity. SGA has nothing to do with SSI work activity at all!

6. Childhood SSI versus Adult SSI (1 of 5)
Very basically, eligibility for childhood SSI looks at functional limitations the individual has at home and in school in comparison to children of the same age without a disability.
Adult SSI looks at whether the disability impacts the ability to make SGA in an employment situation, and, often, whether the individual can obtain a job at SGA with current skills and abilities anywhere in the country.

7. Childhood SSI versus Adult SSI (2 of 5)
Individuals are not automatically eligible for adult SSI just because they received childhood SSI. However, the process is typically an “ex parte” determination.
Individuals transitioning from childhood to adult SSI can be proactive by calling and requesting an appointment with the Title XVI (16) Claims Representative at their local SSA office a few months before they turn 18.
We will only be talking about Adult SSI today with a few exceptions.

8. Childhood SSI versus Adult SSI (3 of 5)
Any factor impacting an individual’s income/resources (who they live with, how much they earn, how much they have, marriage, etc.) may impact SSI regardless of the age of the individual.
Family earned/unearned income or resources can affect eligibility for SSI.

9. Childhood SSI versus Adult SSI (4 of 5)
Deeming: Income of someone with a legal obligation to provide food and shelter can impact a individual’s eligibility and/or SSI amount. SSA considers three groups when looking at legal obligation for food and shelter:
Parent to Minor Child
Spouse to Spouse
Sponsor to Immigrant

10. Childhood SSI versus Adult SSI (5 of 5)
After the individual turns 18 and becomes an “Adult on His Own” as per SSA, deeming no longer applies.
"In-Kind Support and Maintenance” takes over for adults and can reduce the SSI monthly cash benefit by 1/3 if the individual is getting room and board, or assistance with room and board from someone.
In-Kind Support and Maintenance can be avoided by setting up a rental agreement with the individual and figuring what his fare share of groceries is per month and providing this information to SSA.

11. Title II and Individuals Under Age 18
Some individuals under age 18 can draw a monthly cash benefit from their parent’s Retirement, Survivor or Disability Insurance (RSDI) benefit.
If the child is not disabled, when he or she turns 18 the Title II cash benefit will most likely be terminated.
The benefit can continue up to age 19 if the child without a disability is attending elementary or secondary school full time.
For those who are disabled over age 18 there is a Title II program called Childhood Disability Beneficiary we will talk about.

12. SSI: The Basics CASH BENEFIT Disabled by SSA definition.
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SSI: The Basics
CASH BENEFIT
Disabled by SSA definition.
Little to no assets or income.
Monthly benefit amount for 2017 is $735 for an individual, $1,103 for a couple, reduced by other income. This amount is known as the Federal Benefit Rate (FBR).
HEALTH CARE BENEFIT
Medicaid (no waiting period and no cost). Provided mainly through Managed Care organizations.

13. SSI: Purpose and Eligibility
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SSI: Purpose and Eligibility
The main objective of the SSI program is to provide the basic cash support of needy aged, blind, or disabled individuals. Basically the SSI program provides cash assistance to help an individual obtain food and shelter.
To qualify:
Meet all five steps of the Social Security Administration’s (SSA) sequential evaluation;
and
Meet resource limit of $2,000 for an individual or $3,000 for a couple (2017) minus standard exclusions.

14. Title II: The Basics CASH BENEFIT Be disabled by SSA definition.
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Title II: The Basics
CASH BENEFIT
Be disabled by SSA definition.
Be “insured”, or draw off “insured” worker who is disabled, retired, deceased. Amount varies based on work history.
No asset/resource test (no limit to the amount you can have that is not earned income).
HEALTH CARE BENEFIT
Medicare (after 24 month waiting period and costs associated with all Parts (A, B and D).

15. Title II: Purpose and Eligibility
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Title II: Purpose and Eligibility
An individual pays into the program in order to draw benefits, or someone who qualifies can “draw off” the qualified individual’s record.
The younger someone is, the quicker they can become a Title II beneficiary if they are working.
To qualify:
Meet all five steps of the Social Security Administration’s (SSA) sequential evaluation;
and
Meet “recent work” and “duration of work” tests.

16. SSI Myth #1: Individuals lose their SSI if they go to work
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SSI Myth #1: Individuals lose their SSI if they go to work
FACT: Work Incentives Lets Individuals Keep SSI Cash Benefit or Status When Working!
Basic Deductions: SSI reduced $1 for every $2 after first $20/$65.
Additional Work Incentives let Individuals keep more cash:
Impairment Related Work Expense
Blind Work Expense
Student Earned Income Exclusion
Plan to Achieve Self Support

17. Example of SSI Formula in Action

18. The Facts Behind The SSI Formula
As the individual earns more, the amount of SSI monthly cash benefit goes down. The more money the individual earns the more money he/she has in pocket, even after taxes - always, every single time, regardless of amount of earnings.

19. SSI Myth #2: There is No Incentive for Students to Try Working
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SSI Myth #2: There is No Incentive for Students to Try Working
Fact: Students Have a Special Rule That Lets Them Keep More of their SSI When They Work!
Student Earned Income Exclusion (SEIE)

20. SSI: Student Earned Income Exclusion (SEIE) Eligibility
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SSI: Student Earned Income Exclusion (SEIE) Eligibility
Under age of 22.
Regularly attending school.
$1,790 (2017) a month or $7,200 (2017) maximum a year is forgiven from SSI check.
Must be requested. No individual is automatically considered for this work incentive-not even someone in public high school!
No formal SSA form, write a letter requesting SEIE and include proof of attendance.

21. SEIE: Attendance Requirement
Regularly Attending School means:
Grades 7-12: at least 12 hours a week or
College or university: at least 8 hours a week or
In a training course to prepare for employment for at least 12 hours a week (15 hours a week if the course involves shop practice); or
For less time than indicated above for reasons beyond the student’s control, such as illness.
Home schooling counts as long as hourly requirements are met; and instruction is under Texas Home Schooling regulations.

22. Example: SEIE in Action

23. SEIE Financial Benefit (1 of 2)
Under SEIE the student can deduct up to $1,790 month until annual gross earnings reach $7,200 (2017). Therefore, the student will get a full SSI check ($735 in 2017) plus earnings for six months ($1,170 gross earned income x 6 months = $7,020).
The seventh month the student has $180 left in SEIE and will get adjusted SSI cash benefit of $ The student has reached the maximum SEIE deduction of $7,200 for 2017.
The last five months of the year the student uses the regular SSI calculation with no work incentive and gets an adjusted cash benefit of $192.50

24. SEIE Financial Benefit (2 of 2)
Using SEIE the student grosses $14,040 in earnings and $5,655 in SSI monthly cash benefits.
Approximate net on earnings would be $10,530.
Total take home would be $16,185 as opposed to $8,820 if the student did not work and just received SSI cash benefits.

25. SEIE: Keeping the Full Cash Benefit All Year

26. SEIE: Financial Benefit even with Lower Earnings!
The student works 16 hours a week at $7.25 an hour.
The SEIE is good for the entire year since the student’s gross annual income is $6, and does not reach the maximum deductible for 2017.
Therefore, the student gets the full SSI cash benefit every month of the year and their (approximate) net earned income for a total approximate take home of $13,

27. Combining SEIE with other Work Incentives
What happens if the student reaches the maximum yearly SEIE deduction of $7,200 before the year has ended?
Move from SEIE to an “IRWE” to ensure continuation of some cash benefit!
Wondering what an “IRWE” is? Stay tuned…
Does the student need to get a monthly cash benefit?
Not necessarily. Medicaid continues even if there is no SSI cash benefit for a long time! More good news to come!

28. SSI Myth #3: Individuals Who Need Services or Items Related to Their Disability to Work Can’t Lose Any of Their SSI Cash Benefit
Fact: There are SSI work incentives that will return up to half of out of pocket expenses or more to the monthly cash benefit!
Impairment Related Work Expense (IRWE)
Blind Work Expense

29. Impairment Related Work Expense (IRWE)
Expenses for items or services directly related to enabling a individual with a disability to remain working. Individual has to be working to get an IRWE.
Services or items cannot be paid through any other source (e.g. An individual such as a parent or agency such as HHSC). The cost must be reasonable. Services or items someone else pays for will not be approved as an IRWE
Up to ½ the money put aside for expenses in an IRWE comes back to the individual’s SSI check.

30. Common IRWEs Cost of prescription drugs related to disability.
Paratransit.
Job coaching.
Mileage to and from work when driven by someone else-and can not get to work any other way.
Durable equipment such as wheelchair.
Assistive Technology if necessary for job.
Medical services not covered by insurance (e.g. personal attendant care).

31. Example: Without an IRWE

32. Example: With an IRWE

33. Impairment Related Work Expense (IRWE): Financial Benefit
The individual works 20 hours a week at $7.25 hour, grossing approximately $628 a month.
The individual spends $150 a month for paratransit services to get to and from work.
The individual’s adjusted SSI monthly cash benefit is $538.50, or $75 more than without an IRWE.
This is $900 more than without an IRWE. Paratransit costs $1,800 a year, so ½ of the cost is covered!

34. Blind Work Expense (BWE)
Much like an IRWE but many more exclusions allowed and comes off dollar for dollar, such as:
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

35. 10/12/2013
SSI Myth #4: There Aren’t Any Resources to Help Individuals Reach Self-sufficiency
Fact: There are work incentives that will match funds set aside to pay for expenses related to a vocational goal!
Plan to Achieve Self Support (PASS)
Individual Development Accounts (IDA) CFED to find an IDA.

36. Plan To Achieve Self Support (PASS) (1 of 2)
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Plan To Achieve Self Support (PASS) (1 of 2)
Can be working or not working, but must have an employment goal.
If working, PASS goal has to help maintain or advance current employment, or for an entirely different position.
Must have earned or unearned (e.g. Title II) income to create plan; cannot use SSI cash benefit. Must be able to prove ability to live on amount left after putting money into PASS.
Income and resources that would normally reduce SSI cash benefit will not be counted.

37. Plan To Achieve Self Support (PASS) (2 of 2)
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Plan To Achieve Self Support (PASS) (2 of 2)
All PASS savings must be spent on what has bee approved by SSA, and purchased on time line submitted or individual will get overpayment notice.
SSA will review PASS once a year at a minimum.
Excellent tool for someone organized, and/or has a strong stable support system. Never use paid staff to assist with monitoring a PASS!
Students and individuals saving for their own business can be good candidates for a PASS.

38. 10/12/2013
SSI Myth #5: Earning Income Causes Individuals to Lose Medical Coverage
Fact: Individuals on SSI can keep medical when they work!
1619(b) Medicaid
Individualized Threshold
Texas Medicaid Buy-In program

39. SSI: 1619(b)
1619(b) is a federal Social Security program that allows individuals to continue to receive Medicaid after their SSI cash benefit goes to “$0” a month due to earned income, and until they reach the state “threshold”.
The Texas State Threshold for 2016 was $34,670 Gross Annual Income A Year. (2017 amount not released at time of submission of this presentation)

40. Medicaid Buy-In
A great resource for individuals who received SSI, but have exceeded the state threshold (“earned off”1619(b)) and do not qualify for an individualized threshold.
Individual must be working to get MBI.
Individuals who recently “earned off” SSI are presumptively eligible for Medicaid Buy-In!
Individuals on Title II who are working can “buy-in” at any time.
For Buy-In application Google H1200-MBI.

41. 10/12/2013
Myth #6: If Wages Cause SSI Cash Benefit To Stop, There’s No Way To Get It Back
FACT: Individuals stay in eligibility status even when they don’t get a cash check!
1619(b)
Expedited Reinstatement
Individualized Threshold

42. Individualized Threshold
After the individual earns over the state threshold he/she can request an Individualized Threshold from SSA.
Must need Medicaid to maintain employment and cannot cover cost of Medicaid services through earned income.
Typically approved for those using personal attendant services or taking the new generation of psychotropics.

43. Some of the Major Differences Between Title II and SSI (1 of 2)
Title II is an “all or nothing” program, meaning a participant either gets the Title II monthly cash benefit or doesn’t get any cash benefit at all depending on which Title II stage of work is happening and the amount of earned income.
Title II comes with Medicare. Individuals receiving Title II are not eligible for Medicaid unless they also get some SSI cash benefit.

44. Some of the Major Differences Between Title II and SSI (2 of 2)
There is a waiting period for the first cash benefit (5 months) and Medicare (24 months).
Medicare has costs associated with all parts (A, B and D).
Title II is a more complex program in some ways than SSI, with shifting dollar amounts that trigger different stages when an individual works.

45. Title II Myth #7: Individuals Who Work Lose Title II
FACT: Work Incentives Let Individuals Keep Title II Cash Benefit or Status When They Work!
Trial Work Period (time limited)
Impairment Related Work Expenses (IRWE)
Subsidy/Unincurred Business Expense
Extended Period of Eligibility
And more!

46. TRIAL WORK PERIOD
Nine months in a ‘rolling 60 month’ period where the individual can make any amount of money above $840 (2017) and still receive Title II cash benefit.
Months do not have to be consecutive.

47. Extended Period of Eligibility
36 consecutive month period beginning the first month after the completion of a Trial Work Period.
During EPE the individual either gets an Title II check or does not get a cash benefit depending on amount of earned income: Over Substantial Gainful Activity (SGA), no cash benefit; under SGA, cash benefit.

48. IRWE and Subsidy
Impairment Related Work Expense (IRWE) or Subsidy are the two work incentive programs used in SSDI.
IRWE and Subsidy are used only after completion of Trial Work Period.
During and after Extended Period of Eliglibity if individual earns above Substantial Gainful Activity use IRWE and/or Subsidy to reduce income to below SGA and continue to receive monthly Title II cash benefit.
Can use IRWE and/or Subsidy throughout lifetime of Title II benefits.

49. Title II Myth #8: If Wages Cause Title II Cash Benefit To Stop, There’s No Way to Get It Back
FACT: Individuals stay in Title II eligibility status even when they don’t get a cash benefit!
Extended Period of Eligibility
Expedited Reinstatement

50. SSI and Title II Semi-Myth #9: Working Always Results in Overpayments
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SSI and Title II Semi-Myth #9: Working Always Results in Overpayments
Fact: There are strategies to prevent overpayments!
REPORT REGULARLY.
Get, or request in writing, a receipt from SSA and keep copies of everything.
Know the rules - negotiate!
Overpayments under $1,000 must be automatically waived.
Don’t ignore the letter, no matter how scary it sounds

51. SSI And Title II Myth #10: If I Retire My Child Loses Medicaid and Their Home and Community Based Waiver
Fact: Individuals Who Were on SSI Keep Medicaid When They Become a Title II Beneficiary Through a Parent’s Account!
Childhood Disability Beneficiary (CDB: formerly Disabled Adult Child or DAC) is over age of 18 with disability occurring prior to age 22 and received, or did not receive, SSI.
Mom and/or Dad retires, passes away or becomes disabled.

52. CDB
Adult over age 18 whose disability occurred prior to age 22 will begin drawing cash benefit (and get Medicare after 24 month waiting period) from parent’s Retirement, Survivor or Disability Insurance (RSDI).
Individual who was on SSI retains Medicaid regardless of the amount of the Title II CDB cash benefit. Must apply using H-1200.
Individuals who were not on SSI will only receive Title II cash benefit and Medicare. Exception: dollar amount from parent’s RSDI is lower than required Title II amount. In these cases, individual will receive some SSI cash benefit, Medicaid, Medicare and Title II cash benefit.

53. How am I Supposed to Figure All This Out?
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How am I Supposed to Figure All This Out?
Good News! There are folks right here in Texas and around the nation who can help.

54. 10/12/2013
Community Work Incentive Coordinators (CWICS) at Work Incentive Planning And Assistance Programs (WIPA)
‘CWIC’s are highly trained staff certified by the Social Security Administration under a ‘WIPA’ grant.
Services are free to any consumer who receives SSI and/or Title II and is actively looking for a job, or has a job.
Find your Texas WIPA program at Choose Work.

55. SSA’S Ticket to Work Help Line
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SSA’S Ticket to Work Help Line
Individuals can contact a representative at SSA’s Ticket to Work Help Line at (voice) or (TDD)
Representatives give individuals basic information on SSI and Title II programs, and the effects of earnings from work on cash benefits and health care coverage.

56. Protection and Advocacy for Beneficiaries of Social Security (PABSS)
PABSS assists individuals with SSI or Title II overpayments that are work related. They also assist those dissatisfied with services provided by an Employment Network under the Ticket to Work.
PABSS also provides information to individuals on a variety of work-related subjects, including accessible housing!
Call Disability Rights Texas’ Intake Line at to reach a PABSS staff.

57. Health Information Counseling and Advocacy Program (HICAP)
Housed in the 28 Texas Area Agencies on Aging (AAA).
Has certified Regional Benefits Counselors and trained volunteers who assist Medicare-eligible individuals with disabilities of any age with information, counseling, assistance and advocacy regarding Medicare and Medicaid, entitlements and legal rights.
Can assist individuals to obtain certain Medicare- related benefits and assist with appeals.
Find your HICAP program at: AAA

58. Community Center (MHMR) Consumer Benefits Officers (CBO)
In general, (CBOs) assist Individuals with serious and persistent mental illness and intellectual and developmental disabilities who are receiving services through a Community Center in applying and getting qualified for SSI, Title II and/or various Texas Health and Human Services Commission benefits.
Contact your local Community Center/MHMR CBO to find out exactly what your CBO offers. Find yours at TXCouncilofCommunityCenters.

59. SSI in a Nutshell… SSI cash amount is determined by a formula.
Individuals always have more money if they work under SSI.
SSI Medicaid continues until earnings of $34,670 (2016) or higher each year!

60. Title II in a Nutshell… Title II cash works in stages.
There are lots of safety nets and many years the individual can try work and still be attached to the system.
Title II has provisions for getting back onto the system quickly even if someone is terminated from cash and health care benefits.
Medicare continues as long as someone gets a cash benefit and continues even after that for many years!

61. Dive in, the water’s great!
“Give a man a fish and you feed him for a day. Teach him to fish and you feed him for a lifetime” Lao Tzu
Dive in, the water’s great!