BENEFIT OVERVIEW

BENEFIT PROGRAMS Supplemental Security Income (SSI – Title XVI) Needs-based Benefits Entitlement-based Benefits Supplemental Security Income (SSI – Title XVI) Social Security (RIB, DIB, SIB, CDB) – Title II) Medicaid (Title XIX) Medicare (Title XVIII) Cash Assistance (Income) Medical Assistance

DISABILITY Physical or mental impairment 12 months or result in death Prevents engaging in SGA

SSDI/MEDICARE ELIGIBILITY Disability under SS SSD 5 months after disability Medicare 24 months after SSD Prior earnings and payment of SS taxes Benefits based on parent’s earning history if Child disabled prior to age 22, and Parent retired, disabled or deceased

SSDI Eligibility depends upon Sufficient work credits to be insured Relationship to worker Disability of Worker Dependent

SSDI ELIGIBILITY Necessary work credits range From 20 for age 42 > To 40 for age 62 < Fewer work credits necessary if age 31 > 20/40 rule: 20 credits in last 10 years 10 years = 40 credits Hence: “20/40” rule

RELATIONSHIP FOR SSDI Disabled insured person entitled On own account if Worked enough quarters Earned enough Children entitled If minors or disabled adult children On parent’s account if Eligible parent disabled, retired, deceased Adult child disabled before age 22 (CDB)

DISABILITY CRITERIA Determination delegated to State DDS 2 criteria of physical or mental impairment(s) Expected to last (or lasted) 12 mos or result in death Prevents worker from doing “substantial gainful work” existing in national economy considering Age Education Work experience Disability types Listed impairment Functional test (claimant to prove disability) Seriousness (no substantial gainful work activity) >$940/month

SSDI WORK ABILITY TESTS First test: can worker do former job Worker has burden to prove that can’t do former job Second test: hold any job earning >$940 SSA has burden to prove gainful work alternative Available in the national (not area) economy Vocational expert often used in hearings Test is relative to Age (50 < presumed less able for other work) Education Work history

SSDI BENEFITS Primary Insurance Amount (PIA) Cap on total worker/family benefit “Family Maintenance Amount” Worker’s family not to do as well as when working Range from few dollars to about $2000 per month Lose if earn >$940 (less work-related expenses) 5-month waiting period For benefits after disability onset Medicare eligibility 24 months after eligible for SSDI benefits

RECOVERY FROM DISABILITY Periodic reviews Frequency based on recovery likelihood 5-7 years 3 years if recovery theoretically possible 6 to 18 months if recovery expected Regular income > $940 Benefits conditioned upon treatment compliance

RETURN TO WORK Trial work period (TWP) Test ability to work For 9 months & continue benefits Earnings >$670/mo Once per lifetime Work performance considered evidence that not disabled Reinstatement if becomes disabled within 15 mos.

SSI/MEDICAID ELIGIBILITY Disability under SS standards Countable resources < $1,500 Medicaid, $2,000 for SSI Income levels

SSI Federal income program for persons with a disability who do not have Social Security coverage SSI is intended to pay for the beneficiary's food, clothing, and shelter and nothing more

INCOME Disregard $20 unearned income Disregard $65 plus one-half earned income IRWEs Deeming In-kind support and maintenance (charge room & board)

EFFECTS OF INCOME ON SSI Unearned Income Earned Income In-Kind Support & Maintenance Gifts, payments from annuities, pensions, alimony, support , SNT distributions, dividends, interest, rents, awards, and other benefit programs (e.g., SSA but not welfare). Wages, royalties, net earnings from self-employment, and any honoraria for services rendered. Actual receipt of food or shelter, or something used to get one of these from any source or imputed. Acronym is “ISM.” Reduces benefits dollar-for-dollar after first $20 Reduces benefits $1 for each $2 after first $85 ($65 + $20) earned monthly Reduces benefits dollar-for-dollar up to max. of $20 + 1/3 ($232.33 in 2005)

EXAMPLE Earnings = $585/month Less $85 disregards = $500 Less ½ = $250 SSI reduced to $387 ($637 – 250)

RESOURCES Owned by the individual Available to the individual and can be converted to cash Not “exempt” Deeming

EXEMPT RESOURCES Household goods (collectibles are not exempt) Residence Vehicle Irrevocable funeral contract Burial plots Whole life insurance w/ total face value < $1500 Back payments of SS (for 9 months) Special needs or pooled trusts

INCOME v. RESOURCES Receipt of assets is income in the month received 10 day reporting requirement If still owned next month, counted as resource

VALUE OF BENEFITS SSI - $637/month Medicaid medical/hospital care prescriptions rudimentary dental/vision residential/institutional Waiver - up to $14,000/month

SSI TRANSFER RULES Gifts within last 36 months disqualify Gifts from current beneficiary disqualify Disqualification determined by Dividing the value of the gift by SSI rates involved Maximum disqualification is 36 months Exceptions for transfers to special needs trust 42 U.S.C. § 1396p(d)(4)(A) – Payback Trust 42 U.S.C. § 1396p(d)(4)(C ) – Pooled Trust

SSI & DIB BENEFITS COLLIDE Example: Helen disabled since age 20 Receives $579 in SSI monthly Helen’s father, Earl, retires Receives $1,000 RIB monthly Helen then Receives $500 CDB monthly Receipt of DIB unearned income Reduces Helen’s SSI by $480 Helen then receives total of $599 $99 SSI + $500 CDB

SSI BENEFITS LOST Example Cont’d: Earl dies Helen receives $750 DCB per month Helen’s $579 SSI eliminated Helen may lose eligibility for Non-vendor Medicaid in some states Unless does “spend down”

SS & SSI BENEFITS KNOWLEDGE IMPORTANT Understanding of benefits Essential To estate planning To special needs trust administration To avoid jeopardizing eligibility when Beneficiaries have mental illnesses Families want benefits to continue Source www.ssa.gov

REPRESENTATIVE PAYEE SSA procedures & standard Refuse to honor DPOA Refuse to honor guardian/conservator Appointment & reporting requirements Not burdensome Funds Requirements All to be used for beneficiary No commingling with other funds (e.g., trust) However, could use joint tenancy to avoid probate