1. Going to Work with a Disability: Busting the Myths! Carol Ruddell, Work Ability Utah Utah Clubhouse Leaders November 13, 2009 Work Ability Utah Medicaid Infrastructure Grant # 1QACMS030319

2. Disability and Working Social Security Public Perceptions Taxes Housing Medicaid / Medicare Owning a home Having a car What do you believe about working? Employment for individuals with mental illness or substance abuse?

3. What’s your incentive to work? $$$$$ Satisfaction Socialization Insurance, other benefits Positive self esteem; mental health Like to help others, or it’s a job that let’s you do what you enjoy!

4. Scenario You have mental illness. You are receiving a check from Social Security. You have health care coverage through Medicaid. You’d like to work, but are afraid to jeopardize what you already have. Disincentives to work.

5. Myth #1 If I go to work, I’ll lose my Social Security!

6. Myth #1: If I go to work I’ll lose my Social Security! Social Security wants you to work! Two Programs: Social Security Disability Insurance Supplemental Security Income Rules for determining disability are the same under both programs Rules for working are different

7. And What Are the Rules?

8. SSA Work Incentives SSI Earned Income Exclusions Student Earned Income Exclusion Impairment-related Work Expenses PASS plans Expedited Reinstatement SSDI Trial Work Period Extended Period of Eligibility Subsidy Impairment-related Work Expenses Extended Medicare Expedited Reinstatement

9. Myth #1 – SSDI Social Security Disability Insurance A home: Yes, you can have a home! A car: Yes, you can have a car! Assets or Resources: Yes, you can! Work: Yes, you can! Just follow the rules!

10. What is SGA? (Substantial Gainful Activity) Important part of the eligibility process Amount of earnings SSA considers as a factor in initial determinations of disability and for Continuing Disability Reviews (CDR) 2009 level is $980/mo gross for disabilities other than blindness and $1,640 for blindness The SGA amount generally increases each year

11. Major SSDI Work Incentives Trial Work Period (TWP) Extended Period of Eligibility (EPE) Impairment-Related Work Expenses (IRWE) Subsidy/Special Conditions Expedited Reinstatement (EXR)

12. Continuation of Medicare  Two parts to Medicare: Part A hospitalization – free Part B supplemental – premium  In general, coverage will continue at least 93 months following the TWP  After extension expires, both Part A and Part B may be purchased  Individual must remain disabled by SSA rules

13. Myth – SSI Supplemental Security Income A Home: Yes, you can have a home! A car: Yes, you can have a car! Assets or Resources: Yes, you can! $2000 limit Work: Yes, you can! ~ $1 less SSI for each $2 earned

14. Supplemental Security Income (SSI) SSI is a needs-based program, geared to give a person enough money to meet basic needs, like food and shelter. If people have other income or food/shelter help coming in, they don’t need Social Security to supplement them as much SSI is based on what’s called the Federal Benefit Rate (FBR). For 2009, the FBR is $674. If you are a couple and both recipients of SSI, the FBR is $1011 in 2009.

15. Major SSI Work Incentives SGA not an issue for SSI after initial allowance but income is used to figure cash benefit amount Work incentives are used to reduce the countable income: Impairment Related Work Expenses (IRWE) Earned Income Exclusion and General Exclusion Blind Work Expenses (BWE) Plan for Achieving Self-Support (PASS) Continuation of Medicaid - 1619b

16. Countable Income for SSI Amount used to determine SSI benefit check amount Earned income (wages, self-employment) counts $1 for every $2 earned (one-half) Unearned income (e.g. SSDI, alimony, pension) counts dollar for dollar Work incentives are used to lower countable income

17. Earned Income Exclusion/ General Exclusion  $65 of gross earnings automatically excluded – count one-half of remainder  If there is unearned income, SSA will exclude $20 – count all remainder  If no unearned income, the $20 is excluded from the earnings for a total of $85

18. Plan for Achieving Self- Support (PASS)  Set aside income (other than SSI) and/or resources, for use in reaching a specific work goal  A Plan is written and submitted to SSA  The Plan is approved by SSA, and then progress is monitored

19. Continuation of Medicaid 1619b  Earnings too high for monthly benefit check (break- even point)  To qualify: Eligible for benefit check for at least one month Remain disabled Meet all non-medical eligibility rules Need Medicaid in order to work Earn under the Medicaid threshold amount ($28,860 for UT in 2009)  Medicaid eligibility continues

20. Myth #2 If I go to work, I’ll lose my Medicaid or Medicare!

21. Myth #2: If I go to work I’ll lose my Medicaid or Medicare! Medicare: A federal health insurance program Medicaid: A federally funded, state health insurance program

22. How Do You Get Disability Medicaid? Have a disability, as determined by Social Security or the State Medical Review Board (MRB), and Meet specific eligibility requirements, and Apply Online at https://utahhelps.utah.govhttps://utahhelps.utah.gov In person at the nearest DWS office Mail or fax application into DWS Centralized Imaging Unit

23. Income Eligible Spend Down Medicaid Work Incentive SSI Disability Medicaid Four Doors into Disability Medicaid

24. Income Eligible Disability Medicaid Four Doors into Disability Medicaid

25. Door One: Income Eligible for Medicaid A person can get on Disability Medicaid if they: Have a disability (per SSA or MRB) Have assets below $2000 for a single person, $3000 for married couple, and Have countable income below the poverty level for their household size

26. Door One: Income Eligible Asset Test Some of the assets they DON’T count: The house they live in One car (the one with the highest equity value is usually excluded) Most personal household items, like their clothes, shoes, wedding ring, TV, personal computer, kitchen table, etc. (unless there are more big ticket items, like a grand piano) Burial funds, or burial plots Medical equipment related to their disability (wheelchairs, prosthetics, etc.)

27. Door One: Income Eligible Asset Test Some of the assets they DO count: Most real or personal property Any money they have in checking and/or savings accounts, Retirement accounts (401k, IRA, etc), Most trust funds (except special needs trusts) More than one car, recreational vehicles, boats Second or third home Items collected or held for their investment value, like a coin or stamp collection

28. Door One: Income Eligible Income Test Must have countable income below the poverty level for their household size Countable income is what the State counts as the person’s income, after all of the various deductions are taken Income limit charts can be misleading because of all the deductions that might be taken Disability Medicaid counts earned and unearned income differently than some of the other Medicaid programs

29. Income Eligible Spend Down Disability Medicaid Four Doors into Disability Medicaid

30. Door Two: Pay a Spend Down If someone’s countable unearned income is over the poverty level, they can pay a spend down to get on Disability Medicaid They must have a disability They must also have assets below $2000 for a single person, $3000 for married couple They must pay the spend down, either in cash or through medical bills The spend down amount is the difference between the person’s countable income and the poverty level.

31. Door Two: When to Pay a Spend Down? When a person’s out of pocket costs are lower than their spend down amount, it is generally more cost effective to simply pay out of pocket. If Will currently pays about $50/mo for his prescription drugs and other medical expenses, should he pay the $113/mo spend down? But, what if Will wants to start going to weekly therapy at Weber Human Services/Mental Health? What if Will has a surgery coming up? Or needs some dental work done?

32. Income Eligible Spend Down Medicaid Work Incentive Disability Medicaid Four Doors into Disability Medicaid

33. Medicaid Work Incentive Expands work options for people with disabilities. Support mechanism so that individuals with disabilities do not continue to be segregated and isolated. Individuals with disabilities become more self-sufficient. http://www.workabilityutah.org/healthcare/mwi.php

34. Door Three: The Medicaid Work Incentive Program The Medicaid Work Incentive Program (MWI) allows people with disabilities to have a higher income and asset limit, and still be able to acquire Disability Medicaid Anybody on Disability Medicaid who has earned income is on the MWI program, even if they don’t know it.

35. Door Three: The Medicaid Work Incentive Program A person can get on Disability Medicaid through the Medicaid Work Incentive Program (MWI) if they: Have a disability (per SSA or MRB), Have some earned income, Have assets below $15,000, Have countable income below 250% of the poverty level for their household size, and Pay the monthly MWI premium, if applicable

36. Door Three: MWI Asset Test Aside from the asset limit being higher for MWI ($15,000), they apply the same asset rules for MWI as they do for the other doors into Medicaid, with two big exceptions:

37. Door Three: MWI Asset Test They do not count any retirement funds or accounts toward the $15,000 asset limit, including any 401k, IRA, employer pension plan, etc. People can continue to contribute to their retirement accounts while on MWI AND, the retirement account stays exempt even if the MWI person stops working and goes through another doorway to get in Medicaid.

38. Door Three: MWI Asset Test They do not count a second vehicle when it is used by the MWI person’s spouse or child to get to work. This vehicle stays exempt even if the MWI person stops working and goes through another doorway, so long as the spouse or child continues to use the second vehicle for work.

39. Door Three: MWI Income Test Must have countable income below 250% of the poverty level for their household size We already know how they treat unearned income, (dollar for dollar) And the good news is, they are more generous with earned income (they count a little less than half of it)

40. Income Eligible Spend Down Medicaid Work Incentive SSI Disability Medicaid Four Doors into Disability Medicaid

41. Door Four: Supplemental Security Income (SSI) SSI is Supplemental Security Income. It is also known as Title XVI. SSI is a needs-based benefit intended for those who are aged, blind or disabled who have little or no income and resources and no significant work history.

42. Door Four: Supplemental Security Income (SSI) People who are on SSI automatically qualify for free Disability Medicaid in Utah. To be eligible for SSI, you must: Have a disability (per SSA), Have assets below $2000 for a single person, $3000 for married couple, and Have countable earned income below the 1619(b) state threshold amount. Meet all other SSI requirements Complete application!

43. Door Four: Supplemental Security Income (SSI) Because SSI is a needs-based program, geared to give a person enough money to meet basic needs, like food and shelter, if people have other income or food/shelter help coming in they don’t need Social Security to supplement them as much

44. To Qualify for 1619 (b), Individuals Must: Have SSI cash benefit the month before 1619 (b) eligibility; Have gross earnings below state threshold amounts (<$28,860.00 per year in 2009); Under age 65, but still experience a disability or be blind; Meet all other requirements for SSI payments other than earnings; Asset test of < $2,000 remains; and Need Medicaid in order to work. 1619 (b) for SSI only

45. Income Eligible Spend Down Medicaid Work Incentive SSI Disability Medicaid Four Doors into Disability Medicaid

46. Myth #3 There’s no help for all the things I can’t do myself, like cleaning, cooking. What happens if my medications get all messed up?

47. Personal Assistance If having personal care or personal assistance will help you keep your job, Medicaid has a service specifically for assistance related to employment.

48. Income Eligible Spend Down Medicaid Work Incentive SSI Disability Medicaid Four Doors into Disability Medicaid EPAS

49. Employment Personal Assistance Services Have a disability Eligible for Medicaid Competitive, integrated employment 10 hours per week Require personal assistance to work Bathing Dressing Cooking Laundry Shopping Mobility Reminders Money Mgmt Rx Mgmt http://www.workabilityutah.org/healthcare/epas.php

50. EPAS Services The assistant, at home or at work could: Help with personal tasks to get ready for work Bathing, eating, dressing, mobility, transferring Reminders to take medications

51. EPAS Services The assistant, at home or at work could: Help with household tasks like Housework, shopping, laundry, money management Help with transportation to work

52. EPAS Services Hire individuals as personal assistants, and use a fiscal management service to complete all paperwork, OR Hire a home health care agency

53. Related Medicaid Myths You can’t have private insurance and Medicaid. Medicaid will pay for everything. All Medicaid programs have the same benefits. You can’t lose Medicaid once you have it. Medicaid is the same in every state.

54. Myth #4 There’s no one who can help me. Or Now you’ve confused me! HELP!

55. Benefits Planning Assistance and Outreach Explanation of Benefits (Social Security, Health Care, Housing, Food Stamps, others) Personalized analysis of benefits and how working affects them Work Incentives Information about additional programs and help http://www.workabilityutah.org/work/bpao.php

56. Myth #5 Getting job training and help finding a job is impossible.

57. Prepare, Search and Placement Department of Workforce Services Vocational Rehabilitation Choose to Work

58. To be eligible for VR: Have a disability, The disability causes difficulty in obtaining or maintaining a job Must require VR training or services to obtain or maintain a job To apply for VR, an individual must: Fill out an application Make an appointment to see a counselor at a local VR office Vocational Rehabilitation

59. Assists eligible individuals with disabilities to prepare for and obtain employment, and increase their independence Services can include: counseling and guidance, medical services and treatment, assistive technology, training and education, job placement, and follow up services. (801) 373-7724 or toll free (800) 662-6539 http://www.usor.utah.gov/

60. Department of Workforce Services Department of Workforce Services. Utah’s ‘one stop’ for information on finding a job, food stamps, financial services, health care, child care and more. Eligibility may include specific financial and nonfinancial criteria. (801) 526-WORK http://jobs.utah.gov/

61. Chose to Work Choose to Work is a program for ‘work ready’ people with disabilities. Services include job development, job placement, employer supports and on the job training. Matching a skilled individual with an employer. For further information contact a DWS or Rehab office or call (801) 538-7590

62. PWDNET Business opportunity Businesses receive training on disabilities, hiring and retention practices Post positions to recruit people with disabilities Job seeker opportunity Go to http://www.workabilityutah.orghttp://www.workabilityutah.org Bottom left “PWDNET Job Openings”

64. Sort by job title, location, salary, etc.

65. Myth #6 I’ll never have a home of my own or get out of poverty.

66. Individual Development Accounts Everyone needs to save Match your $1 with $3 to save even more IDAs for people with low income Save for home, education or small business Total up $6K in three years http://www.uidan.org/ Not related to a disability.

67. Technology Utah Center for Assistive Technology Utah Assistive Technology Program http://www.uatpat.org/ http://www.usor.utah.gov:81/ucat/

68. Utah Cares Utah Cares is a free, confidential tool that helps you find state and community services. Search for clothing, care for children, elderly or disabled, employment, financial, food, health or mental health care, housing, legal assistance, safety and abuse and transportation resources https://utahcares.utah.gov Not related to a disability.

71. Dial 2-1-1 http://www.informationandreferral.org/ http://www.informationandreferral.org/ United Way of Utah County (801) 377-6600 Other Resources 211 Info Bank, a program of Community Services Council, is a free information and referral line for health, human and community services. 211 provides information and referral on topics such as emergency food pantries, rental assistance, public health clinics, child care resources, support groups, legal aid, and a variety of non-profit and governmental agencies. Think Prescriptions! Not related to a disability.

72. Employment Choices about employment and lifestyle are often made without a full understanding of the many rules. Some of those very rules empower people to have increased earnings and improved quality of life.

73. Going to Work: Busting the Myths! What other myths or questions do you have?

74. No Single Solution Together - we can make a difference!

75. Thank you! Please complete your evaluation! Work Ability Utah Medicaid Infrastructure Grant # 1QACMS030319 Carol Ruddell Project Director (801) 887-9388 cruddell@utah.gov

76. Resources Social Security, http://ssa.gov/workhttp://ssa.gov/work Call your local office directly Vocational Rehabilitation toll free 1-800-473-7530 http://www.usor.utah.gov/ Department of Workforce Services (801) 526-WORK http://jobs.utah.gov/http://jobs.utah.gov/ Utah Individual Development Account Network (877) 787-0727 http://www.uidan.org/http://www.uidan.org/

77. Resources Medicaid Work Incentive Contact your local DWS office to participate http://www.workabilityutah.org/healthcare/mwi.php Employment Personal Assistance Services (a Medicaid service) (801) 538-6165 http://www.workabilityutah.org/healthcare/epas.php Utah Benefits Planning Assistance and Outreach For referrals: (801) 887-9530 http://www.workabilityutah.org/work/bpao.php http://www.workabilityutah.org/work/bpao.php

78. Resources Utah Center for Assistive Technology, USOR (801) 887-9380, http://www.usor.utah.gov/ucat/http://www.usor.utah.gov/ucat/ Disability Law Center (800) 662-9080, http://disabilitylawcenter.org/http://disabilitylawcenter.org/ Utah is served by six Centers for Independent Living http://usilc.org/ Division of Services for People with Disabilities 1-800-837-6811 http://www.dspd.utah.gov/http://www.dspd.utah.gov/

79. Resources Work Ability Utah (877) 246-9675 http://www.workabilityutah.orghttp://www.workabilityutah.org 2-1-1 Information and Referral Dial 2-1-1 http://www.informationandreferral.org/

82. Impairment-Related Work Expenses (IRWE) Any work expenses: That are related to the person’s disability; That enable them to work; That they pay for out of their own pocket; AND That they paid for in a month they were working Possible Examples: Prescriptions, medical equipment, co- pays or expenses for medical procedures, attendant care services, expenses of service animals, job coaches Note: Need proof of payment and sometimes a doctor’s note IRWE is the only SSDI work incentive that can also be used for people on SSI.

83. Subsidy or Special Conditions Sometimes a person’s disability results in the need for extra assistance, a reduced production rate, frequent breaks, or fewer job duties than coworkers in a similar job. When that happens, the individual’s earnings are not only pay for their work product, but also represents either direct help from someone else, like a supervisor or job coach, or full pay for lower productivity than other employees. SSA is only interested in assessing earnings that can be attributed directly to the individual and their earnings potential if those supports weren’t in place. Therefore, the SSA adjusts the value of the income by deducting the cost attributed to the extra help or special situation that each person experiences.

84. Subsidy or Special Conditions Continued… In other words, when SSA is trying to decide whether somebody is capable of performing SGA or not, they try to look at the “actual” value of the work, and not necessarily just what the person receives in earnings.

85. Subsidy Example Helen receives SSDI and has completed her Trial Work Period. Helen gets paid $1200/mo for her work assembling model airplane kits. Most employees make 100 kits a day. Helen makes 50 kits a day. Even though Helen makes half as many kits, she receives the same wage as other employees, so her company is subsidizing her 50%. That means that the actual value of her work is probably around $600/mo, not the $1200/mo that she actually receives. So, when SSA is trying to decide if Helen can perform SGA, they will count it as if she only earned $600/mo.

86. How is a Subsidy Established? Once SSA has some indication that a subsidy might be in place, they usually send a form to the employer asking them to outline how much the person is being subsidized and how they came to that calculation This form is sometimes confusing so the individual should give the employer a heads up on what subsidy is and what info the form is actually asking for. Or, the employer may initiate by sending a letter to SSA outlining the subsidy