Work Incentives: Part 3 Operations Support Manager Social Security’s Ticket to Work Program

Work Incentives Covered in Part 1 of This Training SSI and SSDI or concurrent o Impairment-Related Work Expenses (IRWEs) SSDI only o Trial Work Period (TWP) o Extended Period of Eligibility (EPE) o Continuation of Medicare Coverage SSI only o Blind Work Expenses (BWEs)

Work Incentives Covered in Part 2 of This Training SSI and SSDI or concurrent o Expedited Reinstatement of Benefits (EXR) o Section 301 – Continued Payment under Vocational Rehabilitation or Similar Program o Ticket to Work Program SSI only o Earned Income Exclusion o Student Earned Income Exclusion (SEIE) o Plan to Achieve Self-Support (PASS)

Learning Objectives Introduce five additional Work Incentives designed to encourage beneficiaries with disabilities to try work Provide a basic understanding of these Work Incentives for appropriate referrals to Community Work Incentives Coordinators (CWICs) Ensure familiarity with community resources providing detailed information on Work Incentives and individualized assistance with benefits planning

Work Incentives Covered in This Training SSI and SSDI or concurrent o Subsidies and Special Conditions SSDI only o Unincurred Business Expenses SSI only o Special SSI Payments - Section 1619(a) o Medicaid While Working - Section 1619(b) o Property Essential for Self-Support (PESS) 5

Subsidies and Special Conditions SSDI and SSI eligible Considered when Social Security is making a decision about Substantial Gainful Activity (SGA) A subsidy is support provided by a person’s employer that may result in the person being paid more than the actual value of the work being performed or service being provided 6

Subsidies and Special Conditions (continued) A special condition is defined as support and/or on the job assistance provided by the person’s employer, or by someone other than the employer, that results in the person being paid more than the actual value of the work or service(s) being performed 7

Subsidies and Special Conditions (continued) Social Security uses a series of questions to determine if a subsidy or a special condition applies to a beneficiary’s personal situation Questions are found in the Social Security Program Operations Manual System: POMS DI

Subsidies and Special Conditions (continued) Social Security only considers earnings that represent the real value of the work performed to decide if the person is working at the SGA level o Exceptions: Not considered in determining eligibility for SSI or when Social Security figures a person’s SSI monthly benefit amount If a beneficiary is receiving this type of assistance, he or she should notify the local Social Security field office o Subsidies and special conditions are usually reported to Social Security on Form SSA-3033, the Work Activity Questionnaire, available online at o Employer must complete and sign the form 9

Progress Check Social Security may consider the following as subsidies or special conditions when making a determination about SGA level earnings. Indicate all that apply. a)A State VR agency pays for a job coach to accompany a person with an intellectual disability for part of the work day to ensure that he or she is able to organize and complete the tasks that need to be accomplished each day as a requirement of the position. b)An employer gives a person with a disability time off without pay to attend a computer training workshop. c)An employer gives a person with a disability extra breaks during the day to accommodate the person’s physical limitations, but the person is paid the same as others who work the entire 8 hour day. d)A and C e)All of the above 10

Section 1619(a) – Special SSI Payments for Persons Who Work SSI eligible only A person can receive SSI cash payments even when his or her earned income is at the SGA level but remains lower than their break-even point o For 1619(a), earned income is defined as gross wages and/or net earnings from self-employment Eliminates need for a TWP or an EPE for SSI recipients 11

Section 1619(a) (continued) To qualify for 1619(a), a person must o Be eligible for a SSI payment for at least one month before beginning work at the SGA level; o Still be disabled; and o Meet all other eligibility rules for SSI, including the income and resources tests No need to file a special application - Simply keep Social Security up to date on work activity 12

Progress Check There is no observable difference in the SSI payment or statement on the SSI benefit that indicates that the beneficiary has been moved from the regular SSI payment status to a special 1619(a) payment status. a)True b)False 13

Medicaid While Working Section 1619(b) SSI eligible only After returning to work, a beneficiary’s Medicaid coverage can continue, even if earnings become too high to qualify for a SSI cash payment o Earnings may be alone or in combination with the person’s other income o The beneficiary must need Medicaid in order to work o The beneficiary must respond “yes” to at least one of three questions to qualify for continued Medicaid coverage under 1619(b) 14

Transition to 1619(b): Break-even Point Reduction in SSI cash payments will occur as earnings increase SSI recipients will continue receiving cash payments until their total countable income increases to the point where the SSI cash benefit is reduced to zero o Referred to the break-even point of BEP The BEP is the exact amount of monthly gross earnings that will reduce a person’s SSI cash benefit to zero. 15

Eligibility for Section 1619(b) To qualify, a beneficiary must meet all of the following criteria. o Has been eligible for a SSI cash benefits for at least one month; o Would otherwise be eligible for SSI cash payments except for earnings; o Is still disabled; o Still meets all other SSI eligibility rules, including the resources test o Needs Medicaid in order to work; and o Has gross earned income that is insufficient to replace the value of the SSI benefit, Medicaid, and any publicly-funded attendant care services - Referred to as the person’s threshold amount 16

Threshold Amount Amount Social Security uses to decide whether a beneficiary’s earnings are high enough to replace his or her SSI and Medicaid benefits, as well as any publicly-funded attendant care services the person is receiving A person’s threshold amount is based on the: o Amount of earnings that would result in SSI cash payments stopping in the person’s state; and o Average annual per capita Medicaid expenditure for the person’s state Certain Work Incentives and related expenses may come into play if gross earnings are higher than the state’s threshold amount 17

Applicable Work Incentives and Related Expenses The following Work Incentives and related expenses are taken into consideration when determining whether a person has met the “threshold amount” for 1619(b) o Impairment-Related Wok Expenses (covered in Part 1 of this training series) o Blind Work Expenses (covered in Part 1) o Plan to Achieve Self-Support (covered in Part 2) o Publicly funded attendant or personal assistance services o Medical expenses above the state’s per capita amount 18

SSI and Medicaid Eligibility Rules Most states use Social Security’s SSI eligibility rules to determine Medicaid eligibility However, a number of states use their own eligibility rules for Medicaid o Those states are: CT, HI, IL, MN, MO, NH, ND, OH, OK, VA o In these states, continued eligibility for Medicaid under 1619(a) or 1619(b) depends on the person being eligible for Medicaid in the month before he or she became eligible for Section

Progress Check The “break-even point” or BEP is the earnings level that a person must reach to result in his or her SSI cash benefit being zero. a)True b)False 20

Property Essential for Self-Support (PESS) SSI eligible Social Security does not count some resources (e.g., goods, inventory and property) when deciding on continuing eligibility for SSI benefits o Resources considered essential to a person’s self-support o Beneficiary must be using the resources for the purpose of self-support, or if not being used due to circumstances beyond the person’s control, must expect to start using them again within a reasonable period of time - usually within 12 months Liquid resources (stocks, bonds, notes) are not considered essential unless used as part of a trade or business 21

PESS (continued) Property (e.g., inventory or goods) used in a trade or business and personal property (e.g., tools or equipment) if used for work as an employee are not counted towards the SSI resource limit o As long as used for these purposes, property and items can also be used for other purposes Social Security will not count up to $6,000 of equity value o Non-business property used to produce goods or services essential to daily activities (e.g., land to produce vegetables or support live stock solely for consumption by person’s household) o Non-business income-producing property (e.g., rental property) if it yields an annual rate of return of at least 6 percent 22

Unincurred Business Expenses (Self-Employment) SSDI eligible Contributions made by others to a person’s self- employment business effort o State VR agency provides computer or tools to assist a beneficiary who is setting up a small business operation o A family member volunteers as unpaid help in a beneficiary’s business enterprise Must be an item or service that the IRS would allow as a legitimate business expense if purchased by the person 23

Unincurred Business Expenses (continued) Social Security generally follows the IRS rules to figure a person’s net earnings from self-employment IRS limits deductions to expenses the person actually paid or incurred as a debt When making a SGA determination, Social Security deducts unincurred business expenses from the person’s net earnings in an effort to make an accurate assessment of the value of the person’s work 24

Progress Check In looking at Property Essential for Self-Support, Social Security does not count resources such as goods, inventory and property or liquid resources such as stocks, bonds and notes towards a person’s resource limit when deciding on continuing eligibility for SSI. a)True b)False 25

Sherman W. Gifford, MS, CRC, CRP, LPC Vice President The Choice Group Richmond, Virginia , Ext

EN Practices & Approaches The Choice Group provides Ticket to Work services to beneficiaries and Supported Employment services to VR clients throughout most of Virginia Six (6) Certified Work Incentive Specialists on staff – also serve as the primary liaison for explaining the Ticket program and completing the Individual Work Plan (IWP) Benefits and Work Incentives are discussed in the initial conversations with Ticket to Work applicants Consents obtained during intake and IWP process, and Benefits Planning Query (BPQY) is requested 27

EN Practices & Approaches (continued) Social Security provides a very useful BPQY Handbook which can be downloaded at: Handbook_Version%205.2_ pdf Handbook_Version%205.2_ pdf We are very fortunate in Virginia to have access to WorkWORLD (decision support software) which will soon be available online and customized for Virginia Work Incentive Specialists must be certified (Cornell or VCU programs) to provide these services to VR clients, so these Specialists also work with our Ticket Holders 28

EN Practices & Approaches (continued) A thorough written report is provided to the beneficiary, discussed with him or her, and referred to throughout the service provision process We use a counseling approach to address fears, perceived obstacles, build rapport/trust, and generate commitment – reduces later dropouts and recidivism VA State VR agency has determined that if a client has a thorough understanding of his/her benefits and Work Incentives, the chances of a successful outcome are almost doubled 29

EN Practices & Approaches (continued) The Red Book provides an excellent review of the SSI and SSDI programs, the effects of earned income on benefits, and the eligibility rules for the different Work Incentives Social Security offers Another excellent resource is Social Security’s Program Operations Manual System (POMS), which can be accessed at: o A good general understanding of SSI and SSDI is helpful in navigating this system 30

More Information on Work Incentives Key resource for every EN staff member: The Red Book- A Guide to Work Incentives ( As appropriate, refer beneficiaries to the local Work Incentives Planning and Assistance (WIPA) project for individualized benefits planning assistance – Find your local WIPA at Seeking comprehensive training on Work Incentives? Check out Work Incentives Part 1 (slide 21) for information on Virginia Commonwealth University National Training Institute and Cornell University’s Employment & Disability Institute Access Parts 1 and 2 of this training series by visiting and looking under “Working with Beneficiaries” 31

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