1. Navigating SSA Work Incentives and Employment
Work Incentives Planning and Assistance (WIPA) Project and the Freedom to Work Project
Brooke Lusk
4/21/2017

2. Cash Benefits Programs for People with Disabilities
Social Security Disability Insurance
Supplemental Security Income
Same definition of disability used to qualify for both programs.
SSA determines what, if any, program a person qualifies for and how much the cash benefit will be.
4/21/2017

3. Definition of Disability
Inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
3 parts to definition
Not working – SGA
Disability criterion – medically determinable physical or mental impairment
Durational criterion – result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months
4/21/2017

4. SSA’s Adult Sequential Evaluation
Are you working at or above SGA?
Are your impairments severe?
Do you meet or equal a listing?
Can you do your past relevant work?
Can you do any other work?
4/21/2017

5. Social Security Disability Insurance
Insurance system
Individual must have relevant work history or be related to somebody (child, spouse, former spouse, parent) who is disabled, retired, or deceased with work history.
Benefit will vary depending on when relevant work income earned and the amount earned.
4/21/2017

6. More on the SSDI Benefit
Assets and amount of unearned income are irrelevant.
Can vary in amount enormously.
For SSDI on own account, first check begins on 6th month after entitlement and SSA can award benefits retroactively for up to 12 months prior to application.
Wages count when earned, not necessarily when paid.
4/21/2017

7. SSDI on Own Work Record Individual worked and paid into the system.
Individual earned sufficient amount in a sufficient amount of quarters at the relevant time.
Number of quarters of coverage needed differ depending on age.
Minor children or spouse can receive a dependent benefit.
4/21/2017

8. Disabled Adult Child/Childhood Disability Beneficiary
18 or older
Disabled by SSA’s definition before the age of 22.
Child of insured workers who are either disabled, retired, or deceased.
If adult child marries, benefits will cease unless marriage is to another Title II beneficiary.
4/21/2017

9. Disabled Widow/Widower
Must be widow/widower or surviving divorced spouse.
Must be found disabled before a prescribed period of time.
Payments are not payable prior to age 50.
4/21/2017

10. SSDI Beneficiary: Medicare
SSDI beneficiaries are eligible for Medicare after 24 month waiting period.
Waiting period begins with the first month in which person is eligible for check.
Many have already passed waiting period when they receive first check because case was pending for so long.
Some SSDI beneficiaries are eligible for Medicaid assistance in paying for the Medicare premiums.
4/21/2017

11. Supplemental Security Income
Needs based program.
Strict asset and resource guidelines.
Countable income includes both earned and unearned income. Any money coming in could count, even gifts!
Also considers the income of other relatives in certain cases (deeming).
4/21/2017

12. Why Two Cash Systems?
SSDI is only for people who paid into the system or related to somebody who paid.
What about those with same exact disability who were not able to pay into the system or do not have the “right” relative who is retired/disabled/deceased?
SSI system was created later and helps fill in this gap.
4/21/2017

13. SSI fills in this gap, but………..
SSI is very different from SSDI in key aspects.
SSI is best thought of as a “payer of last resort.”
So, everything you receive or have could potentially count against the SSI check.
4/21/2017

14. Supplemental Security Income
Federal Benefit Rate – standard amount of SSI in 2011 is $674 for individual and $1011 for couple.
The amount you actually receive may vary if there has been an overpayment or other income is being counted.
Usually received on the 1st of the month.
Can supplement a low SSDI check.
Both children’s SSI and adult SSI.
Talk about age 18 redetermination.
Slightly different definitions for disability.
4/21/2017

15. Supplemental Security Income – Resource Rules
Asset limit is $2000 for single, $3000 for couple.
Home in which person resides does not count.
One car does not count.
Long list of other exceptions in the Program Operating Manual System (POMS).
Discuss Special Needs Trusts
4/21/2017

16. Supplemental Security Income – Counting Other Income
Almost all unearned income counts against the check.
Less than ½ of earned income counts.
In-Kind Support and Maintenance can be considered.
Income of certain relatives can be considered.
4/21/2017

17. Supplemental Security Income - Medicaid
In South Dakota, Medicaid eligibility is automatic when SSI is approved.
This is not the case in all states.
4/21/2017

18. What is the Difference Between Medicare and Medicaid?
Medicare is run by feds, Medicaid is run by states within parameters set by federal.
They can cover different services or cover its cost sharing in different ways.
They have different rules for how they are impacted when a person has employment income.
Doctors may take one and not the other.
And on, and on, and on…………………
4/21/2017

19. Shifting Gears…..Work Incentives
Social Security’s definition of disability involves inability to engage in substantial gainful activity.
Once in the system, there are rules and policies called “work incentives” to encourage beneficiaries to work!
Some incentives have been around a long time and others were created through the Ticket to Work and Work Incentives Improvement Act of 1999.
4/21/2017

20. Work Incentives Policy
Term used for policies and procedures created to address barriers to employment caused by benefits eligibility.
Some remove the barrier, while others encourage working by rewarding employment activity.
Work incentives have changed and improved significantly over time.
The Ticket to Work and Work Incentives Improvement Act was the latest and largest work incentives policy shift.
4/21/2017

21. Program Rules are Different
Rules for SSDI and SSI when you go back to work are different.
Often, beneficiaries and their service providers get confused as to which rules apply.
If person receives both checks, one set of rules applies to one check and the other set of rules applies to the other check.
4/21/2017

22. Impact of Unearned Income on SSDI?
NONE!
Receiving alimony
Child support
Gifts
Dividends
Interest or
Even winning the lottery will not have ANY impact on receiving a SSDI check
4/21/2017

23. Impact of Earnings on SSDI
SSDI is an ALL or NOTHING program.
The amount of the check is not reduced – a person either gets their check or they do not get a check.
4/21/2017

24. Trial Work Period
An individual is eligible to receive a total of 9 Trial Work Period (TWP) months.
Over a rolling 60-month (five-year) period.
The Trial Work Period amount for 2010 and 2011 is $ or 80 hours of work in self-employment.
4/21/2017

25. Trial Work Period
An individual is not required to use these nine TWP months consecutively.
During the Trial Work Period phase, a beneficiary is entitled to keep their SSDI cash benefit regardless of how much is earned.
4/21/2017

26. Substantial Gainful Activity (SGA)
SSA determines the amount each year
2010 and 2011 SGA: $1,000 in countable earnings
2010 and 2011 SGA for people whose primary disability is statutory blindness: $1,640
Important to remember deductions such as IRWE and Subsidy!
4/21/2017

27. Extended Period of Eligibility
The Extended Period of Eligibility (EPE) is a 36-month continuous period following the Trial Work Period.
When in the EPE, an individual can receive a SSDI cash benefit when countable earnings are less than SGA (2010 and $1,000 a month or $1,640 Blind).
However, any month in which countable earnings are above SGA, an individual will not receive a SSDI cash benefit.
4/21/2017

28. Impairment Related Work Expenses (IRWE)
Enables SSDI beneficiaries to recover some of their out-of-pocket expenses incurred as a result of their disability to support their work.
IRWE’s expenses are subtracted from a person’s earnings.
By reducing countable income, IRWEs result in a decrease in the amount counted towards SGA; a beneficiary can use an IRWE to remain eligible for SSDI cash benefits.
4/21/2017

29. Possible IRWEs -- Examples
Medical appointment co-payments
Prescription co-payments
Prosthetic devices
Certain transportation costs
Costs of adaptive devices for motor vehicles by persons who cannot drive an unmodified vehicle
4/21/2017

30. Example of IRWE
Mary works and earns $1, per month. However, she pays co-pays on her medications of $80 per month. Mary’s countable income is:
$1,000 per month during TWP.
$920 per month after TWP.
Mary’s SSDI cash benefit will continue because she is earning under SGA!
4/21/2017

31. Subsidy & Special Conditions
Support received on the job that may result in you receiving more pay than the actual value of the services performed.
“Subsidy” is support provided by the employer (extra breaks, more time to finish work)
“Special conditions” are something provided by someone other than the employer (VR pays for a job coach)
4/21/2017

32. Example of a Subsidy
Bill has finished his TWP. He earns $8.00 per hour and works 30 hours per week ($1,039.20). He receives 16 hours a month of support on the job from the employer.
Step 1: Hours of job coach intervention on site
16 hours per month or number of hours of additional supervision
x $8.00 hourly wage of worker
=$128 monthly subsidy
Step 2: $1, Monthly Gross Earings
Monthly Subsidy
= $ Monthly Gross Wages Counted towards SGA
Bill had earnings over SGA but with a subsidy, his countable income of $911 is less than $1,000 (SGA). Bill would be entitled to an SSDI cash benefit.
4/21/2017

33. Expedited Reinstatement (EXR)
Must apply within 5 years of the last time eligible to receive a SSDI cash benefit or last month of the EPE, whichever is later.
Stopped receiving benefits because of work.
Must continue to meet the medical definition of disability and not be earning over SGA.
Use medical improvement standard.
Decision is made quickly.
Eligible for 6 months provisional benefits while a decision is pending.
4/21/2017

34. Remember! Report Income Every Month!!!!!
STOP
Remember! Report Income Every Month!!!!!
4/21/2017

35. Will Medicare Continue When Person Gets a Job?
Medicare continues as long as you get a disability check.
Even if the disability check stops, most individuals who work will continue to receive at least 93 consecutive months of Medicare after the Trial Work Period.
4/21/2017

36. Supplemental Security Income
Federal Benefit Rate – standard amount of SSI in 2011 is $674 for individual and $1011 for couple.
The amount you actually receive may vary if there has been an overpayment or other income is being counted.
Usually received on the 1st of the month.
Can supplement a low SSDI check.
Both children’s SSI and adult SSI.
4/21/2017

37. (Almost) Everything Matters
Purpose of SSI is to help you obtain food and shelter.
Any factor impacting this (who you live with, how much you make, how much you have, etc) may impact SSI.
Rules are complicated and complex. Always look at the Program Operating Manual (POMs).
4/21/2017

38. What is NOT income? Medical and social services Personal service
Income tax refund (resource after nine months)
Loan
Somebody pays a bill that is not food or shelter
Clothing
Others……….
4/21/2017

39. What is Income? Unearned income (SSDI check, Retirement check, etc.)
Earned income (earnings, self-employment)
In-kind support and maintenance (food and shelter provided by someone else)
Other – Check POMs
4/21/2017

40. What is the Resource Limit?
$2000 individual, $3000 couple
Exclude:
Home the person resides in
One automobile
Retro SSA benefits for 9 months
Certain trusts
Burial fund up to $1500
PASS funds
Income tax refund (up to 9 months)
Others
4/21/2017

41. When does Earned Income Count?
For SSI, earned income always counts in the month that it is RECEIVED.
Therefore, paychecks every two weeks can come up with months where 2 pay checks are issued and months where 3 paychecks are issued!
4/21/2017

42. Supplemental Security Income and Employment
SSI and earnings are calculated with a formula. These deductions are subtracted from the gross income to determine countable income:
General Income Exclusion $20.00
Earned Income Exclusion $65.00
Deductions/Exclusions
4/21/2017

43. Examples of Working @ $8.25/hr. Total Gross Earnings From Work
Part Time Full Time
$8.25 Hourly Wage $
x Hours/Week x
$ $330.00
x Avg Hours/Month x 4.33
$ Gross Monthly Earnings/Employment $1,428.90
4/21/2017

44. Calculating Total Monthly Countable Income From Employment
Part Time Full Time
$ Monthly Income $1,428.90
-$ General Income Exclusion $20
$ $1,408.90
-$ Earned Income Exclusion $65
$ Gross Monthly Earnings/Employment $1,343.90
/ Divide by /2
$ Total Monthly Countable Income $671.95
4/21/2017

45. Calculating SSI payment
Part Time Full Time
$ Federal Benefit Rate $
Total Countable Income
$ Adjusted SSI Benefit Check $
4/21/2017

46. Total Monthly Income Adjusted SSI Benefit + Monthly Income from Employment
Part Time Full Time $ Earnings from Employment $1, Adjusted SSI Benefit Check $ Total Monthly Income $
4/21/2017

47. SSI Work Incentives Impairment Related Work Expense (IRWE)
Blind Work Expense (BWE)
Student Earned Income Exclusion (SEIE)
Plan for Achieving Self-Support (PASS)
1619(b) – Medicaid ($32,991/year in SD for 2011)
4/21/2017

48. Impairment Related Work Expenses (IRWE)
These are expenses one must pay for out-of-pocket in order to work
They must be related to the primary disability or an established secondary disability
The individual must have an IRWE approved by SSA first and must show receipts
4/21/2017

49. Where Do IRWEs Fit In?
IRWEs deducted from countable income before dividing by 2 in the calculation
Therefore, IRWE is not subtracted from countable income dollar for dollar (like it is with SSDI)
4/21/2017

50. Sample IRWE Calculation
Mary pays $100 per month for specialized transportation to and from work. She is paid $500 per month from her job.
$500 Earned Income
$20 General Income Exclusion
$65 Earned Income Exclusion
$100 IRWE
=$315/2
= $ Countable Income
4/21/2017

51. Blind Work Expenses
A person whose primary disability is statutory blindness can use BWEs to deduct the cost of a large list of items
Unlike IRWEs, BWEs are deducted AFTER dividing by 2 on the calculation sheet. The entire BWE is deducted from income dollar for dollar
Because of this, BWEs can be used to deduct so much from countable income that often times the SSI check is not reduced at all!
4/21/2017

52. Types of BWEs IRWEs 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
4/21/2017

53. Blind Work Expense Example
Mary earns $500 per month. She has $100 in various BWEs (taxes, etc.)
$500 Earned Income
-$20 General Income Exclusion
-$65 Earned Income Exclusion
=$415/2
=$207.5
-$100 BWE
$107.5 Countable Income!
4/21/2017

54. Student Earned Income Exclusion (SEIE)
Must be under the age of 22 and regularly attending school
Exclude up to $1,640 (2011) of earned income per month when SSA figures the SSI monthly payment amount
The maximum yearly exclusion in 2011 is $6,600
4/21/2017

55. Student Earned Income Exclusion Examples
Mary earns $500 a month. But, she is also attending community college with enough hours to qualify for SEIE.
$500 earnings minus $500 SEIE (out of the possible $1,640 max per month)
NO SSI REDUCTION until she uses $6,600
4/21/2017

56. Plan for Achieving Self-Support
PASS excludes other income which normally would reduce Supplemental Security Income
With the exclusion, SSA asks the recipients to put this money into a PASS that is then spent on a vocational goal.
Most common income excluded is wages/SSDI/savings
PASS allows SSI eligibility or higher payments of SSI
4/21/2017

57. Allowable PASS Expenditures
A PASS can be used to save and pay for a variety of expenses necessary to reach the work goal:
Computers and assistive devices
Transportation and modifications
Education and vocational training
Tools/other items needed to start a business
4/21/2017

58. Elements of a PASS Must be in writing using form SSA-545
State a job goal, self-employment goal, or vocational rehabilitation evaluation
Contain a reasonable start and end date
List expenses that are necessary to achieve the work goal
Must be able to prove that costs of food and shelter can still be met by setting money aside in PASS
4/21/2017

59. How Does a PASS Work? Once the PASS is approved by the SSA PASS Cadre;
Recipient opens a special bank account for PASS funds
Recipient keeps an accounting of all money received and spent
Recipient will be required to show this report to the PASS Cadre, upon demand
4/21/2017

60. Medical Assistance for Workers with Disabilities (MAWD)
Meet modified definition of disability that allows for work income (SSDI beneficiaries do)
Working (paying FICA taxes)
Unearned income limit less than $694 per month
Income limit is 250% FPL ($2256 countable earnings per month for an individual)
Assets are $8,000
4/21/2017

61. How do people apply for MAWD?
They simply complete an enrollment form.
An interested person can contact:
Local Department of Social Services office
Local Division of Rehabilitation Services office
Local Service to the Blind and Visually Impaired office
Freedom to Work staff
4/21/2017