1. Benefits & Transition Overview of SSI vs. SSDI & Medicaid vs. Medicare For transition aged beneficiaries

2. Title II Few different types of Title II benefits Few different types of Title II benefits Focus on SSDI: Social Security Disability Insurance Focus on SSDI: Social Security Disability Insurance

3. SSDI Our focus will be Child Disability Benefit (CDB, formerly DAC) Our focus will be Child Disability Benefit (CDB, formerly DAC) Based off work record that parent paid taxes on (fica taxes) Based off work record that parent paid taxes on (fica taxes) Disability that occurred before age 22 Disability that occurred before age 22 Must be older than 18 to receive this Must be older than 18 to receive this

4. SSDI Work Incentives Trial Work Period months (TWP) Trial Work Period months (TWP) 9 months: do not have to be consecutive! 9 months: do not have to be consecutive! TWP counted when someone earns $720 (in 2012) or more TWP counted when someone earns $720 (in 2012) or more Still receive full cash benefit Still receive full cash benefit Amount usually increases every year OR does not increase Amount usually increases every year OR does not increase

5. SSDI Work Incentives Substantial Gainful Activity (SGA) Substantial Gainful Activity (SGA) $1010 (this amount can increase annually) $1010 (this amount can increase annually) SSA uses this amount to determine eligibility for benefits SSA uses this amount to determine eligibility for benefits If person earns more than SGA: receives NO benefit and can be terminated If person earns more than SGA: receives NO benefit and can be terminated Does not come into affect until after Trial Work Period Months (TWP) are complete Does not come into affect until after Trial Work Period Months (TWP) are complete

6. SSDI Work Incentive Extended Period of Eligibility (EPE) Extended Period of Eligibility (EPE) 36 Consecutive months: happens regardless of earnings 36 Consecutive months: happens regardless of earnings Begins the month immediately following the TWP Begins the month immediately following the TWP If individual’s earnings are above SGA: no cash benefit; if below SGA: will receive cash benefit If individual’s earnings are above SGA: no cash benefit; if below SGA: will receive cash benefit

7. TWP Example Chris started to receive SSDI in January 2012 and March 1 st 2012 started working and is earning $800.00 a month Chris started to receive SSDI in January 2012 and March 1 st 2012 started working and is earning $800.00 a month What will happen to his benefits (if he continues to earn this amount) June 30 th 2012? What will happen to his benefits (if he continues to earn this amount) June 30 th 2012? What will happen to his benefits (if he continues to earn this amount) December 1st 2012? What will happen to his benefits (if he continues to earn this amount) December 1st 2012? What if Chris stopped working August 30 th 2012 and restarted in April of 2017? What if Chris stopped working August 30 th 2012 and restarted in April of 2017?

8. SSDI Work Incentives Incentives that can be used-especially if beneficiary is hovering around SGA! Incentives that can be used-especially if beneficiary is hovering around SGA! Impairment Related Work Experience (IRWE) Impairment Related Work Experience (IRWE) Subsidy/Special condition Subsidy/Special condition Averaging Averaging

9. SSDI IRWE and SGA Example Person is earning $9.00/hour and is working $30 hours a week for total monthly earnings of $1080 Person is earning $9.00/hour and is working $30 hours a week for total monthly earnings of $1080 Paying $160 a month in job coaching Paying $160 a month in job coaching SSA would calculate SGA: $1080- $160=$920 so this person would still receive full cash benefit. SSA would calculate SGA: $1080- $160=$920 so this person would still receive full cash benefit.

10. Why Bore you with all of the work incentive information? When you hear people say they can’t work or they will lose their benefits you will be able to tell them it’s not true! When you hear people say they can’t work or they will lose their benefits you will be able to tell them it’s not true! Many “safety nets” in place for people to “try” working Many “safety nets” in place for people to “try” working

11. Medicare Eligible for Medicare 24 months after eligibility for SSDI cash benefits Eligible for Medicare 24 months after eligibility for SSDI cash benefits Part A, Part B, Part D Part A, Part B, Part D

12. Medicare Extended Period of Medicare Coverage (EPMC) Extended Period of Medicare Coverage (EPMC) Up to 93 months of Medicare coverage after the completion of TWP Up to 93 months of Medicare coverage after the completion of TWP Healthcare coverage even if cash benefit gets reduced to $0! Healthcare coverage even if cash benefit gets reduced to $0!

13. Supplemental Security Income (SSI) Needs based Needs based Disability Determination from the Disability Determination Bureau (DDB) Disability Determination from the Disability Determination Bureau (DDB) Current Federal Benefit Rate (FBR): $698.00 Current Federal Benefit Rate (FBR): $698.00

14. SSI Income paid in 1 month affects the cash benefit 2 months later Income paid in 1 month affects the cash benefit 2 months later Full benefit rate: $698 Full benefit rate: $698 1/3 reduction rate: $465.33 1/3 reduction rate: $465.33 States might have their own supplements States might have their own supplements

15. SSI Work Incentives Student Earned Income Exclusion (SEIE) Student Earned Income Exclusion (SEIE) Exclusion of inform for individuals who are under the age of 22 and regularly attending school Exclusion of inform for individuals who are under the age of 22 and regularly attending school SSA will not count up to $1,700 monthly (max: $6,840 per year) SSA will not count up to $1,700 monthly (max: $6,840 per year) This work incentive is applied first! This work incentive is applied first!

16. SSI Work Incentives General Income Exclusion (GIE) General Income Exclusion (GIE) $20 disregard on unearned income; if not unearned income then applied to earned income $20 disregard on unearned income; if not unearned income then applied to earned income Earned Income Exclusion (EIE) Earned Income Exclusion (EIE) $65 and ½ disregard on earned income $65 and ½ disregard on earned income

17. SSI Work Incentives Impairment Related Work Expense (IRWE) Impairment Related Work Expense (IRWE) Related to disability, paid for out of pocket and the beneficiary needs it in order to work Related to disability, paid for out of pocket and the beneficiary needs it in order to work SSA will “repay” the individual $1 for every $2 spent out of pocket SSA will “repay” the individual $1 for every $2 spent out of pocket Any examples??? Any examples???

18. Plan for Achieving Self Support Set aside money (other than SSI) to meet vocational goal Set aside money (other than SSI) to meet vocational goal Money in the pass plan: does not count towards SSI eligibility Money in the pass plan: does not count towards SSI eligibility

19. SSI benefit Example Individual is receiving full benefit rate and is earning $373.00 a month Individual is receiving full benefit rate and is earning $373.00 a month Not a student Not a student No IRWE No IRWE Setting $100 a month away in a PASS plan for a training program Setting $100 a month away in a PASS plan for a training program

20. SSI Benefit Example $373.00 monthly earnings and subtract $373.00 monthly earnings and subtract $100.00 for the Pass Plan for a total of $100.00 for the Pass Plan for a total of $273.00 you would then apply the $273.00 you would then apply the GIE: $273.00-$20.00=$253.00 you would then GIE: $273.00-$20.00=$253.00 you would then Apply the EIE: $253-$65.00=$188 and then… Apply the EIE: $253-$65.00=$188 and then… $188/2=$94 and the final step: $188/2=$94 and the final step: $698-$94=$604 $698-$94=$604 $604 will be monthly cash benefit 2 months later $604 will be monthly cash benefit 2 months later

21. SSI Benefit Example Sarah earns $850.00 in September 2012 Sarah earns $850.00 in September 2012 Full time student; under the age 22 Full time student; under the age 22 No IRWE No IRWE Eligible for the SSI full cash benefit Eligible for the SSI full cash benefit No unearned income No unearned income What will her cash benefit be in November 2012? What will her cash benefit be in November 2012?

22. Answer… September earnings: $850.00 September earnings: $850.00 $850.00-$1700 (Student Earned Income Exclusion)=$0 $850.00-$1700 (Student Earned Income Exclusion)=$0 Sarah’s benefit in November will be the full benefit because of the SEIE: $698.00 Sarah’s benefit in November will be the full benefit because of the SEIE: $698.00 Sarah still has $5,990.00 of the SEIE for the remainder of the year Sarah still has $5,990.00 of the SEIE for the remainder of the year

23. Another One! Ben earns $552 a month Ben earns $552 a month Not a student Not a student Eligible for the 1/3 reduction rate Eligible for the 1/3 reduction rate Pays $80 a month for a job coach and has an approved IRWE for this Pays $80 a month for a job coach and has an approved IRWE for this What will his benefit be? What will his benefit be?

24. Answer… $552 Earnings-$20.00 (General Income Exclusion)=$532.00 $552 Earnings-$20.00 (General Income Exclusion)=$532.00 $532.00-$65.00 (Earned Income Exclusion)=$467.00 $532.00-$65.00 (Earned Income Exclusion)=$467.00 $467.00-$40.00 (Impairment Related Work Expense)=$427.00 $467.00-$40.00 (Impairment Related Work Expense)=$427.00 $427.00/2 (Earned Income Exclusion continued)=$213.50 $427.00/2 (Earned Income Exclusion continued)=$213.50 $465.33 (1/3 Reduction rate)-$213.50=Benefit amount of: $251.83 $465.33 (1/3 Reduction rate)-$213.50=Benefit amount of: $251.83

25. SSI/Medicaid States have different rules for Medicaid eligibility (i.e some states automatically approve SSI beneficiaries for Medicaid coverage, others have separate application Coverage: Coverage: medically necessary doctor visits medically necessary doctor visits hospitalizations hospitalizations prescription drugs prescription drugs mental health services mental health services dental care dental care vision care vision care alcohol and drug treatment alcohol and drug treatment equipment and supplies and equipment and supplies and transportation to medical appointments transportation to medical appointments

26. Medicaid “incentives” 1619b: Continued Medicaid coverage if cash benefit is $0 due to EARNED income 1619b: Continued Medicaid coverage if cash benefit is $0 due to EARNED income First 12 months of this: “Suspension Period” First 12 months of this: “Suspension Period”

27. Medicaid/Medicare When someone receives both Medicaid and Medicare: When someone receives both Medicaid and Medicare: Part B Premiums are covered Part B Premiums are covered All deductibles and co-pays are between $0- $6 All deductibles and co-pays are between $0- $6

28. Example: SSI/SSDI and earnings Receiving $607 in SSDI and receives $111.00 in SSI Receiving $607 in SSDI and receives $111.00 in SSI Calculation for SSI payment: Calculation for SSI payment: $607-$20 (GIE)=$587.00 $607-$20 (GIE)=$587.00 $698.00 current FBR-$587.00=$111.00 $698.00 current FBR-$587.00=$111.00

29. Example SSI/SSDI and earnings Receiving $607 in SSDI and receives $111.00 in SSI and earning $199.95 a month Receiving $607 in SSDI and receives $111.00 in SSI and earning $199.95 a month $199.95-$65 (EIE)=$134.95 then divide by 2 (EIE continued)=$67.48 (countable earned income) $199.95-$65 (EIE)=$134.95 then divide by 2 (EIE continued)=$67.48 (countable earned income) $587 (countable unearned income)+ $67.48 (countable earned income)=$654.48 $587 (countable unearned income)+ $67.48 (countable earned income)=$654.48 $698 (current FBR) - $654.48= $43.52 SSI cash benefit $698 (current FBR) - $654.48= $43.52 SSI cash benefit Total monthly earnings with work: $607+199.95+ $43.52 =$850.47 (and any other state specific supplements) Total monthly earnings with work: $607+199.95+ $43.52 =$850.47 (and any other state specific supplements)

30. Ticket to Work All person receiving SSI or SSDI have a “ticket” All person receiving SSI or SSDI have a “ticket” Can assign to local Employment Network to receive assistance obtaining employment Can assign to local Employment Network to receive assistance obtaining employment More information: http://ssa.gov/work/aboutticket.html More information: http://ssa.gov/work/aboutticket.html http://ssa.gov/work/aboutticket.html

31. Important Take Away Messages When beneficiaries work-they earn MORE money When beneficiaries work-they earn MORE money Big changes can occur Big changes can occur With change in earnings and/or living situation With change in earnings and/or living situation when beneficiary turns 18 when beneficiary turns 18 is no longer a student is no longer a student parent dies/retires or becomes disabled themselves or parent dies/retires or becomes disabled themselves or enough work credits are earned enough work credits are earned Refer ALL beneficiaries for Benefits Counseling prior to graduation Refer ALL beneficiaries for Benefits Counseling prior to graduation There are ways to maintain health insurance! There are ways to maintain health insurance!

32. Important Take Away Messages Invite Benefits Counselors to meetings with families who have transition aged youth! Invite Benefits Counselors to meetings with families who have transition aged youth! Encourage families to inform SSA that the individual is paying their fair share of room and board Encourage families to inform SSA that the individual is paying their fair share of room and board Earnings can affect other benefits: Food Stamps, Housing Earnings can affect other benefits: Food Stamps, Housing