Understanding Social Security: Can It Be Done? February 18, 2004 Toni Bender-ERI Holly Johnson-ERI

Potential loss of benefits is one of the most persistent and pervasive fears among people with significant disabilities who are considering employment

Social Security Disability Insurance (Title II) Entitlement programs Entitlement programs Disability Disability Medicare Coverage Medicare Coverage SSDIDAC

SSDI Work Incentives TWP -Trial Work Period TWP -Trial Work Period SGA - Substantial Gainful Activity SGA - Substantial Gainful Activity EPE - Extended Period of Eligibility EPE - Extended Period of Eligibility Expedited Reinstatement Expedited Reinstatement IRWE/Subsidy IRWE/Subsidy EPMC EPMC

Trial Work Period (TWP) 9 months of $580 or more (no limit) 9 months of $580 or more (no limit) –as of January 1, $ $ hours of self-employment activity per month 80 hours of self-employment activity per month Don’t need to be consecutive Don’t need to be consecutive Only one TWP per disability entitlement Only one TWP per disability entitlement Review by SSA when completed Review by SSA when completed

Trial Work Period Jan$600Feb$400Mar$1,000April$0 May$1,200June$570July$590Aug$810 Sept$560Oct$700Nov$700Dec$700

Substantial Gainful Activity (SGA) Measure of ability to work Measure of ability to work $810 per month-as of January 1, 2004 $810 per month-as of January 1, 2004 In 2003, SGA was $800 per month In 2003, SGA was $800 per month $1,350 per month for the blind (2004) $1,350 per month for the blind (2004) If performing work that is “SGA” after the TWP cash SSDI benefits stop

Reducing Countable Income Subsidy IRWE

Impairment Related Work Expenses (IRWE) Expenses that are necessary to work, related to the person’s disability and paid for by the worker Expenses that are necessary to work, related to the person’s disability and paid for by the worker May be considered to reduce countable income below SGA May be considered to reduce countable income below SGA

IRWE Example John is working and earning $840 per month. He pays $40 each month for specialized transportation to drive him too and from work. John is working and earning $840 per month. He pays $40 each month for specialized transportation to drive him too and from work. How does this expense help John? How does this expense help John? $840.00Work Earnings -$ 40.00IRWE $800.00Countable Earned Income

Subsidy Value of additional support to perform a job, or difference between actual wages received and value of work performed Value of additional support to perform a job, or difference between actual wages received and value of work performed May reduce income below SGA like IRWE May reduce income below SGA like IRWE EXAMPLES: more frequent breaks, more supervision/support, lower production requirements

Extended Period of Eligibility (EPE) Consecutive 36 month period after TWP Consecutive 36 month period after TWP Cash benefits reinstated for months under SGA ($810) without a new application Cash benefits reinstated for months under SGA ($810) without a new application If at SGA at end of EPE, no more SSDI payments If at SGA at end of EPE, no more SSDI payments

Expedited Reinstatement (EXR) Effective 1/1/01 Effective 1/1/01 Reinstate without new application if: Reinstate without new application if: -Unable to work, because of medical impairments -Medical condition same or related, and -File request within 60 months of date last entitled. After 24 months of EXR payments, receive a new TWP and EPE. After 24 months of EXR payments, receive a new TWP and EPE.

Reapplication If unable to maintain working at SGA level after the completion of the EPE. If unable to maintain working at SGA level after the completion of the EPE. Reapplying within 60 months of last benefit payment, no waiting period. Reapplying within 60 months of last benefit payment, no waiting period. Reapplying after 60 months of last benefit payment, 5 month waiting period. Reapplying after 60 months of last benefit payment, 5 month waiting period. New TWP and EPE New TWP and EPE

Medicare Federal health insurance program Federal health insurance program 24-month waiting period after SSDI benefits start 24-month waiting period after SSDI benefits start $66.60/month Part-B premium (year 2004); Part A is free $66.60/month Part-B premium (year 2004); Part A is free

Extended Period of Medicare Coverage (EPMC) Continued Medicare coverage even if no longer eligible to receive SSDI payment because of work Continued Medicare coverage even if no longer eligible to receive SSDI payment because of work At least 93 months of coverage after TWP ends At least 93 months of coverage after TWP ends Billed quarterly for months an SSDI payment isn’t received Billed quarterly for months an SSDI payment isn’t received

Supplemental Security Income SSI- (Title XVI) Needs based program Needs based program Elderly or Individuals with disabilities Elderly or Individuals with disabilities Medicaid Medicaid State Supplements State Supplements

Federal SSI Eligibility Earnings must be below SGA at application only Earnings must be below SGA at application only Unearned income below $584 if single, living alone Unearned income below $584 if single, living alone Assets below $2,000 for single person, $3,000 for couple Assets below $2,000 for single person, $3,000 for couple Automatic Medicaid (Medical Assistance) Automatic Medicaid (Medical Assistance) Maximum payment for a single person, living alone is $564/month (2004 amount, changes annually) Maximum payment for a single person, living alone is $564/month (2004 amount, changes annually)

SSA Doesn’t Count All of Your Income... General Income Exclusion of $20 General Income Exclusion of $20 Deducted first from unearned income Earned Income Exclusion $65 per month plus 1/2 of the rest Earned Income Exclusion $65 per month plus 1/2 of the rest

Example: Example: Rich is working at the grocery store earning $775 a month. Rich is working at the grocery store earning $775 a month. What will his SSI payment be? What will his SSI payment be?

Example: $775 (earnings) - 20 (general income exclusion) - 65 (earned income exclusion) $690 ÷ 2 $345 (countable earned income) $564 (Federal Benefit Rate-2004) -345 (countable earned income) $219 (Federal SSI Payment)

Reducing Countable Income for SSI purposes Impairment Related Work Expenses (IRWE) Impairment Related Work Expenses (IRWE) PASS Plan PASS Plan Student Earned Income Exclusion Student Earned Income Exclusion Blind Work Expense Blind Work Expense

IRWE for SSI Recipients Same expenses allowed as for SSDI Same expenses allowed as for SSDI Can increase SSI payment $1 for $2 of expenses Can increase SSI payment $1 for $2 of expenses

IRWE Example $775 (earnings) $775 (earnings) - 20 (general income exclusion) - 65 (earned income exclusion) $690 -$ 50 (IRWE-Specialized transportation) -$ 50 (IRWE-Specialized transportation) $640 $640 ÷ 2 $320 (countable earned income) $564 (Federal Benefit Rate-2004) $564 (Federal Benefit Rate-2004) -320 (countable earned income) $244 (Federal SSI Payment) W/O IRWEW/ IRWE $219$244

Plan for Achieving Self Support (PASS) Sets aside income/resources (such as earnings or SSDI) for items or services needed for a vocational goal Sets aside income/resources (such as earnings or SSDI) for items or services needed for a vocational goal Income/Resources set aside not considered countable income Income/Resources set aside not considered countable income Increases or establishes SSI payments for the length of the plan Increases or establishes SSI payments for the length of the plan Needs SSA approval Needs SSA approval

Student Earned Income Exclusion A student under age 22 A student under age 22 Regularly attending school Regularly attending school Excludes up to $1,370 per month in 2004 (in addition to regular SSI disregards) Excludes up to $1,370 per month in 2004 (in addition to regular SSI disregards) Excludes up to $5,520/yr (2004) Excludes up to $5,520/yr (2004)

Blind Work Expenses Only for SSI recipients Only for SSI recipients Used instead of IRWE Used instead of IRWEExamples: Transportation Payroll taxes Union dues Adaptive equipment Lunches while working Service animal and expenses

Continued Medical Assistance Section 1619 (b) Continued Medicaid when earnings are too high for an SSI payment Continued Medicaid when earnings are too high for an SSI payment Income up to threshold of $ 27,645 (2004) Income up to threshold of $ 27,645 (2004) For SSI-E Eligible $29, (2004) For SSI-E Eligible $29, (2004) Can request individualized threshold if medical costs are higher than average and meet the needs test. Can request individualized threshold if medical costs are higher than average and meet the needs test. If lost due to excess assets or income, can re- qualify within 12 months If lost due to excess assets or income, can re- qualify within 12 months

State SSI Supplements Eligible if entitled to $1 of Federal SSI Eligible if entitled to $1 of Federal SSI WI State Supplement - $83.78 WI State Supplement - $83.78 Exceptional Expense Supplement - $95.99 Exceptional Expense Supplement - $95.99 Caretaker Supplement-$250 1 st child, $150 for each additional child Caretaker Supplement-$250 1 st child, $150 for each additional child

Medical Assistance MA Deductible Medical Assistance for individuals with higher income - “medically needy” Medical Assistance for individuals with higher income - “medically needy” 6-month re-certification period 6-month re-certification period Deductible amount increases with work Deductible amount increases with work Do a financial comparison between county MA and MAPP Do a financial comparison between county MA and MAPP

Medical Assistance

Individual Criteria for MAPP Applicant must: Be considered to have a disability by the Disability Determination Bureau (DDB) without counting earnings Be considered to have a disability by the Disability Determination Bureau (DDB) without counting earnings Have countable assets less than $15,000 Have countable assets less than $15,000 Adjusted gross income of 250% FPL Adjusted gross income of 250% FPL Be working, OR, enrolled in an approved Health and Employment Counseling Program Be working, OR, enrolled in an approved Health and Employment Counseling Program

Medical Assistance Purchase Plan Medicaid waiver services available to MAPP participants Medicaid waiver services available to MAPP participants Enrolling in MAPP could eliminate cost share or spend down Enrolling in MAPP could eliminate cost share or spend down May have a MAPP premium May have a MAPP premium Applicant should do a financial comparison before enrolling Applicant should do a financial comparison before enrolling

BPA & O Benefits Planning, Assistance and Outreach

What does BPA & O have to offer? Benefits Planning Assistance & Outreach Benefits Planning Assistance & Outreach –Information and Referral –Benefit Problem Solving and Advocacy –Benefits Analysis and Advisement –Benefit Support Planning –Benefit Management

How to contact BPA&O? ERI – or or Riverfront – Ext 401 Independence First –