SOCIAL SECURITY DISABILITY BENEFITS:
INFORMED DECISION MAKING
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Today’s Moderator
Elizabeth Jennings
Deputy Director
National Disability
Institute
Today’s Agenda
Welcome
Financial Wellness and Individuals with MS
Qualifying for Social Security Disability
Insurance (SSDI)
The Impact of Work on SSDI Benefits
Where to Turn for Assistance
Questions & Answers
Suggested Next Steps & Wrap Up
Special THANK YOU
to our sponsor
Acorda Therapeutics
National Disability Institute
A national research and development
organization with the mission to promote
income preservation and asset development for
persons with disabilities and to build a better
What is Financial Wellness?
•
We define financial wellness as the state of a
person’s finances with the intent of working
towards financial behaviors that limit stress
and the impact of stress on one’s daily life.
Financial Wellness
12 Being Financially Literate Accessing Available Healthcare Subsidies Budgeting Understanding work and long-term disability options Building and Maintaining Assets Understanding Public Benefit rulesUtilizing Favorable Tax Provisions
Accessing Affordable Financial Services
Individuals ages 18-64
For individuals without disabilities, 11.9% had
income below the poverty level over the past
12 months.
For individuals with disabilities, almost 3x
that rate –
30.9%
had income below the
poverty level.
Source: U.S. Census Bureau, 2012 American Community Survey
13
•
For millions of working age adults
with disabilities a dependence on
public benefits for income, health
care, food, and housing becomes a
trap that requires staying poor to
stay eligible
The Americans With Disabilities Act
•
The Nation’s proper goals regarding individuals with disabilities
are to assure equality of opportunity, full participation,
independent living, and economic self-sufficiency for such
individuals;
42 U.S.C.
§
1201(a)(8) (2005)
•
the continuing existence of unfair and unnecessary discrimination
and prejudice denies people with disabilities the opportunity to
compete on an equal basis and to pursue those opportunities for
which our free society is justifiably famous, and costs the United
States billions of dollars in unnecessary expenses resulting from
dependency and non-productivity.
42 U.S.C.
§
1201(a)(9) (2005)
Why is Financial Wellness Important?
•
Impacts mental and physical health.
•
Positively impacts self-concept.
•
Changes status with other community
stakeholders.
•
Directly impacts quality of life.
Financial Wellness and MS
•
A recent survey conducted by MSAA and NDI
involving individuals with MS indicated:
55.1% of households earn less than $35k annually, 16.4%
earn less than $50k but more than $35k annually.
When asked about the ability to pay all of their bills in a
typical month, 32% have a “very difficult” time paying
their bills in a typical month, 46.9% reported a “somewhat
difficult time”.
43% of respondents reported that their financial status
has affected their ability to access medical care at some
point.
Financial Wellness and MS
•
A recent survey conducted by MSAA and NDI
involving individuals with MS indicated
:
71.7% of respondents do not have enough savings to
cover 3 months expenses.
67.1% of respondents reported that their finances were
worse since their MS diagnosis.
73.7% of Respondents reported that they were not aware
of/have not used financial stability programs (EITC, IDA,
FSS, PASS – you will learn about these in subsequent
webinars)
Post-secondary Education Employment Self-employment Micro-Enterprise Home Ownership 19
Family Self-Sufficiency Programs Individual Development Accounts
Assistive Technology Loan Funds Student Loans
Retirement Accounts
Use of work incentives Use of tax incentives
Volunteer Income Tax Assistance Earned Income Tax Credit Financial Literacy Budgeting Credit Repair Getting Banked State Medicaid Buy-In Programs
Protection and Advocacy, Taxpayer Advocates, Credit Counseling Volunteer Income Tax Assistance, Work Incentive Planning & Assistance
Kevin Nickerson
Manager, Financial
Empowerment & Employment
National Disability
SSA Disability Benefits
• The Social Security Administration has two programs to support
individuals with disabilities with an inability to work at a substantial level. Social Security Disability Insurance (SSDI)
Supplemental Security Income (SSI)
• Many people with disabilities who receive SSDI and/or SSI, want to work or return to work but are unsure what will happen to their benefits when they do, or have been misinformed about the impact of work and
earnings.
• SSA policy includes work incentives that make it possible for individuals to test their ability to work and continue to receive some or all of their cash and health benefits.
SSA Eligibility
Individuals must prove the following to be eligible for SSDI:
1.
Prove that they have a documented medical disability that
will last 12 months or longer or result in death.
2.
Meet SSA
’
s definition of disability:
The inability to engage in Substantial Gainful Activity (SGA,
which is paid work) by reason of any documented medical
impairment (physical or mental) that will lasts 12 months or
longer and/or result in death.
Individuals who are blind do not have to prove that they are unable to work. They only have to prove that they meet SSA’s level of blindness.
Substantial Gainful Activity (SGA)
SGA is a basic test used by SSA to establish disability status,
and continued eligibility for cash benefits
•
SGA is the performance of significant mental and/or physical
duties for profit.
•
It is usually determined to be gross earnings (before taxes) of
a set amount of money determined each calendar year based
on the National Average Wage Index.
•
To meet this test a person must not be working, or if working,
earning less than the established SGA amount.
2014 SGA for non-blind individuals = $1070/month
2014 SGA for blind individuals = $1800/month
SSDI Eligibility
Required Work Credits in FICA
DAC –Disabled Adult Children
• Disability Prior to Age 22
• Not Legally Married to non Title II beneficiary • Insufficient FICA or higher parent amount
• Parent must be Retired, Disabled or Deceased Medical Insurance - MEDICARE
• 24 month wait upon eligibility for cash benefits • Part A-Free, Part B/D-Premium
5 Month Waiting Period for cash benefits to start
SSA pays close attention to SGA rule during and after eligibility
Continuing Disability Review Process
• The Social Security Administration (SSA) is required by law to periodically determine whether beneficiaries continue to be disabled and therefore continue to be eligible for either SSI and/or SSDI
• Under SSA’s medical improvement standard, generally, once individuals are receiving benefits, substantial evidence must show that medical
improvement related to the ability to work and perform SGA has occurred. This must be developed before SSA can determine that individuals are no longer eligible to receive benefits.
1. CDR’s involve an interview at the local SSA office
2. Filling out a form about current medical information (similar to initial
eligibility process)
3. SSA will forward form to Disability Determination Service (DDS) for
Important Points - SSDI
SGA continually monitored after eligibility
• $1070/month (non-blind individuals) • $1800/month (blind individuals)
As you work and earn SGA, SSA reviews your work effort and
will take a person off the roles if they show a pattern of
being able to work and earn at the Substantial Gainful
Activity level.
No asset limit
Chart pulled from The Benefits Planner, volume 2, Issue 4:
Work Incentives Comparison Chart
Social Security Disability Insurance
Trial Work Period
Extended Period of Eligibility
Impairment Related Work Expense
Subsidies
Unsuccessful work attempt
Unincurred Business Expenses (self-employed only)
Continuation of Medicare
Section 301
Expedited Reinstatement
Ticket to Work
Medicaid Buy-In
Supplemental Security Income
Student Earned Income Exclusion
Impairment Related Work Expense
Blind Work Expense
1619 (a)
1619 (b)
Property Essential For Self Support
Plan for Achieving Self-Support
Subsidies (only at time of application)
Section 301
Reinstatement without new application
Expedited Reinstatement
Ticket to Work
SSDI Work Incentives
•
Today we will discuss some of the SSDI work incentives SSA
offers:
Trial Work Period = $770/Month 2014
Extended Period of Eligibility
Impairment Related Work Expenses
Special Condition/Subsidies
Extended Medicare Coverage
Expedited Reinstatement
Trial Work Period - TWP
Once determined eligible, SSDI beneficiaries are entitled to a
9 month Trial Work Period (TWP) to test work skills while
maintaining monthly cash benefits. During the TWP your
full benefit checks will continue regardless of the amount of
money earned. The 9 months of Trial Work do not need to
be earned in a row.
• TWP months are counted when an individual earns a specific amount of income. (Determined January 1 each year by SSA)
In 2014, the TWP amount is $770 per month
• The TWP ends when an individual has accumulated 9 months of Trial Work within a 60 month consecutive period of time (5 years)
• Once 9 months of the TWP have been earned within the 60 month window a person enters Extended Period of Eligibility (EPE)
Benefits Planning Query - BPQY
•
A BPQY provides information about your
disability cash benefits
health insurance
scheduled continuing disability review cycle
representative payee, and
work history, including use of Trial Work Period months
•
SSA provides BPQYs to beneficiaries, their representative
payees and their authorized representatives of record upon
request.
Requesting a BPQY
• Beneficiaries can request a BPQY by contacting their local SSA office or by calling SSA’s toll free number, 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. People who are deaf or hard-of-hearing may call our toll-free TTY/TDD number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.
• If someone other than the beneficiary, representative payee, or appointed representative (a benefits counselor, for example) wishes to receive a
BPQY, they must submit two SSA-3288 forms (Consent for Release of Information) that have been signed by the beneficiary.
One is to authorize the release of Social Security records
The other is to authorize the release of Internal Revenue Service
earnings records.
Both releases must contain the beneficiary’s Social Security number
or the claim number. Copies of the SSA-3288 are available at
http://www.socialsecurity.gov/forms/index.html.
Benefits Summary Analysis
After requesting a BPQY, if you are working with a certified Work Incentive
counselor, they will typically assist you by preparing a written report about your plans and benefits
•
After the last Trial Work Period month has been used, the next
part of your Work Incentive will begin, called the Extended
Period of Eligibility (EPE)
•
The EPE is a 36 month period
•
Unlike the TWP, once the EPE begins, it will end in 36 months
•
The EPE is another protective period, to help you in the
transition to work, and protects your eligibility status, not
necessarily your monthly cash benefits
•
SSA evaluates your gross wages each month, and during the EPE
- If you are earning more than the SGA amount, you
may not
receive your cash benefit that month
Extended Period of Eligibility - EPE
• Cessation - When countable wages first exceed the SGA level (cessation month), the individual should remain eligible for a 3month grace period -the cessation month plus -the next 2 months (regardless of earnings).
Countable wages above SGA beyond the cessation month and grace period may result in loss of SSDI cash benefit eligibility
• Termination - When the EPE is complete, a person earning gross wages below SGA will continue to receive a benefit check as long as medical
eligibility continues. If a person has countable wages above SGA after the EPE is completed, benefits may terminate
• For self-employment, an individual determination of SGA will be
established during EPE. An SSDI claims representative will look at hours and income when making SGA determination
• Reminder - The 36 month EPE begins in the month following the 9 month TWP whether a person is working or not!
SSDI Timeline
9 Months of Trial Work available
Count if over $770/month Make any amount and
retain cash benefits!
TWP
36 Months for Extended Period of Eligibility Based on S.G.A. $1,070/month (non-blind
rate), or $1,800/month (blind rate)
EPE
Grace/Cessation Period – Can occur anytime
AFTER the TWP is completed
3 more months that act like TWP!
NOTE: 12 MONTHS TO EARN AS MUCH AS YOU CAN!
Overview
Impairment Related Work Expenses
(IRWE’s) for SSDI Beneficiaries
•
In order to account for the additional expenses workers with
disabilities might experience related to the return to work, SSA
has provided another Work Incentives called an IRWE
An IRWE exists when:
» You pay for the item or service out of pocket » The item or service is related to your disability
» You would NOT be able to work, if you did not purchase the item or service,
therefore, it is necessary to maintain employment
What does this do for you?
» The amount of an approved IRWE will be deducted from your GROSS wages, leaving
what SSA considers Countable Wages, which is used to determine either continued eligibility, and/or eligibility for cash benefits (if in EPE)
Examples of IRWEs
• Transportation Costs• Attendant Care Services
• Medical Devices
• Prosthesis
• Residential Modifications
• Drugs & Routine Medical Services
• Diagnostic Procedures
• Non-Medical Appliances & Devices
• Expendable medical supplies; for example, incontinence pads, elastic stockings, and catheters.
• The cost of a service animal including food, licenses, and veterinary services.
Example: Impact of IRWE on SGA
•
John is working, and is earning $1,200/month in gross wages,
and is currently in his EPE
•
John has some out of pocket expenses related to his disability,
and his ability to continue working, as follows:
John pays $150/month for paratransit transportation services (an alternate mode of
public transportation services, which requires eligibility based on disability)
•
How SSA would look at John’s wages that month:
•
Since Countable Wages are less than the current SGA amount,
John would receive his cash benefit this month
Gross Wages = $1,200/month
Minus IRWE - $150/month Equals “Countable Wages” = $1,050
Subsidies
• Subsidies allow you to deduct the value of extra support you receive at no cost. A Subsidy may exist when:
An employer…..
» provides accommodations, support, or extra supervision » customizes a job to meet your individual needs
» allows lower productivity for the same job at the same wage
An agency……
» assists you in securing employment
» provides you with accommodations you need on the job » supports you in getting to work
» provides you with on-the-job supports
Note: Subsidiesapply to SSDI only and may be used during the initial eligibility process as well as when an individual is working and earning income.
Employer Subsidy Example
Jake works for a restaurant, making $1,260/month, and is well liked by his employer. He has some physical limitations that prevent him from lifting the grills that are
cleaned daily, and one of his co-workers handles this task daily. While this is a normal part of Jake’s job requirements, the employer has accommodated Jake by having
another employee take on this task. Jake is also allowed to arrive later than normal, as a family member drives him to work since he can’t drive, and public transportation is not available. Jake has used his TWP, and a Grace Period has been established. He is mid-way through his EPE.
In this example, Jake’s $1,260/month is more than the
2014 SGA limit, based on his gross wages, he would not be
eligible for cash benefits
Employer Subsidy Example
• A Work Activity Questionnaire evaluates what percentage of work the employer subsidizes
• The following are areas that are examined in the Work Activity Questionnaire, that help SSA determine if a Subsidy exists:
• Using these categories helps an employer determine Jake’s productivity, compared to his “non-disabled” co-workers, in similar positions
• SSA will deduct this amount from Jake’s gross wages, to evaluate whether he is “gainfully employed”
•
In Jake’s case, let’s say it was determined that a 20% Subsidy
exists, here’s how SSA would look at his earnings:
•
Here’s a basic rule of thumb, for Work Incentives:
Gross wages – Work Incentives = Countable Wages
SSA makes determinations, after the Trial Work Period, based on Countable wages
Employer Subsidy Example
Monthly Wages = $1,260
Subtract Subsidy (20%, or, $252) = $1,008 (Countable Wages) Countable wages less than SGA = Jake eligible for cash benefits
Reporting IRWEs and Subsidies
1. Reminder – IRWE and Subsidy are used to reduce countable income for SSDI beneficiaries, and it is recommended that you work with a certified Benefits & Work Incentive Counselor to assist you
2. Both incentives will need to be reported to your local SSA field office and evidence will need to be submitted along with regular reporting of paystubs
1. IRWE – bring along with the receipts and the reason for the costs.
2. Subsidy – Documentation will be needed from the employer and/or agency supporting you.
3. The SSDI claims representative will review the earnings and work incentives and, if approved, adjust wages for SGA determinations accordingly.
4. The individual should discuss with the claims representative the frequency with which the claims rep wants the individual to report the IRWE expenses (Note: Subsidy determinations remain in place as long as the person remains at the same employer).
5. The individual should continue to report wages monthly and maintain documentation of IRWE expenses.
Extended Medicare Eligibility
(effective October 1, 2000)
•
An SSDI beneficiary is entitled to continued Medicare coverage
during the Trial Work Period and for at least 93 months
following the ninth Trial Work month.
•
During this entire period, hospital coverage is automatic and
cost-free. Outpatient coverage (Part B) continues to be
optional and subject to premium payment
NOTE: For 2014 Part B will be $104.90
•
This means that SSDI beneficiaries that go to work
can keep Medicare insurance for at least 102
Expedited Reinstatement Period “EXR”
•
EXR provides a significant level of protection to SSDI
beneficiaries who return to work, and have their benefits
terminated due to “gainful” work activity
•
Note that when you are receiving proper Benefits, and Work
Incentive advisement, benefits termination is a planned event
WHO IS ELIGIBLE?
•
SSDI beneficiaries can be reinstated without a new application if
the person:
Was eligible for SSDI; and
Lost SSDI due to performance of substantial gainful activity (SGA); and Requests EXR within the consecutive 60-month period beginning with
SSDI – When Wages are Counted
•
SSA counts wages for SSDI beneficiaries when the
wages were earned
•
This means you should NOT count wages in a month
based on your pay-date, but rather, look at what month
the wages were earned in
•
The following slide will show you an example of how
you can carefully track wages
•
Example – Joe earns $600 and is paid on a Friday, September
2
nd. This is for a two week pay period.
•
For SGA purposes, wages would be broken into both months as
follows:
Day rate = $600/10 days = $60/day August = 8 days = $480
September = 2 days = $120
End of
pay
period
Your Responsibilities when Returning to Work
•
You should report new work activity to your local SSA
Field Office, including the following:
Name of new employer
Number of hours/week you’ll be working, and hourly wage Date you started your new job, and end date (if applicable)
Your Social Security number (always, with any correspondence)
•
Provide wage data to SSA monthly by providing a copy of
pay check stubs (keep your originals!)
•
Wage data may be FAXED, hand delivered, or mailed
•
Be sure to write your S.S. # on pay check stubs, and your
name if not already printed on check stubs
Supplemental Security Income
(SSI)
SSI Resources
•
For more information about SSI benefits and Work Incentives
associated with this program, see the following archived
training:
•
Supplemental Security Income – The Impact of Work on
Benefits
Individuals who receive Supplemental Security Income (SSI) may want to return to work but are worried about the impact of work on public benefits. With good information you can make the choice to work and you may still keep some or all of your cash and health benefits.Medicaid Buy-In Programs
Purpose of the Program: To provide an opportunity to purchase Medicaid coverage for persons with disabilities who are working.
Sample Eligibility Criteria:
1. Between the ages of 16 and 65 2. Have a permanent disability 3. Be employed (full or part time)
4. Meet the income and asset guidelines
To learn more about Medicaid options in your state, visit:
http://www.medicaid.gov/medicaid-chip-program-information/by-state/by-state.html
Benefits & Work Incentive
Advisement
Work Incentive Planning and Assistance
• Provide benefit and work incentives planning and assistance, including:
Decision to Work
Effect of Employment on benefits
Work Incentives and provisions Referral services
• Provide services to:
SSDI/SSI Beneficiaries between the ages of 14 and 65 Parents/Guardian
Service Providers Other Supporters
List of Providers -http://choosework.net/resource/jsp/searchByState.jsp
• Work Incentive Networks
A number of states have chosen to train professionals to better understand SSA disability
benefits and work incentives
Protection & Advocacy for Beneficiaries of Social Security
(PABSS)
Advocates are available to provide assistance with the following at not cost: • Access to Community Services
• Special Education and Transition
• Transportation , Housing, Health Care • Disability Benefits and Work Incentives • Rights and Conditions of employment • Vocational Rehabilitation and preparation
• Rights, Responsibilities, and Reasonable Accommodations under the ADA • Wage and hour issues
Provider Search -http://choosework.net/resource/jsp/searchByState.jsp
TICKET TO WORK
• A voluntary program for people on SSDI (or SSI) who want to work.
• Participating in the Ticket program provides:
Greater Choice through an increased network of Vocational Service
Providers
Suspension of the Continuing Disability Review when actively using their
Ticket
• The National Program Manager for SSA is MAXIMUS
1-866-968-7842 / 866-833-2967 (TTY/TDD) http://www.chooseworkttw.net/
• Employment Networks are:
Contractors with SSA who are qualified to provide vocational services State Vocational Rehabilitation offices are also a required Employment
Network
Employment Network Locator:
State Vocational Rehabilitation (VR)
•
The VR program is a state-federal partnership that promotes
the employment of people with disabilities.
•
VR counselors have extensive specialized training, to work
with you to:
Identify your employment goals
Provide assessments to measure your skills and aptitude
Provide access to assistive technology and other
employment supports
•
State Agencies and contacts -
http://rsa.ed.gov/people.cfm
Click on Other Useful Contacts
Department of Labor –
American Job Centers
•
The Workforce Investment Act of 1998 (WIA), which became
effective July 1, 2000, established the One-Stop Career Center
system (now called American Job Centers)
•
Workforce Innovation and Opportunity Act (WIOA) signed into
law on July 22, 2014 which reaffirms ongoing role of American
Job Centers
•
American Job Centers are community centers that provide
employment, education and training services all in one place.
•
To learn more and/or locate an American Job Centers near
you use:
http://www.servicelocator.org/
Independent Living Resource Centers
•
Centers for Independent Living (CILs) are grassroots,
advocacy-driven organizations run by and for people with
disabilities.
•
Independent Living Centers have four core services,
1. Individual and Systems Advocacy 2. Information and Referral
3. Peer Support
4. Independent Living Skills Training
To locate an Independent Living Center near you:
http://www.ilru.org/html/publications/directory/index.html
Federal Hiring of People with Disabilities
•
The Federal government provides employment opportunities
for individuals with disabilities through Schedule A hiring.
•
Schedule A is a hiring authority available to federal agencies
to hire individuals with disabilities without competing for the
job.
To learn more:
http://www.opm.gov/disability/PeopleWithDisabilities.asp http://www.choosework.net/about/schedule-a/index.html
Suggested Next Steps
1. Register with one of the employment
support programs noted.
» Vocational Rehabilitation -http://rsa.ed.gov/people.cfm
» Department of Labor – One Stop Centers - http://www.servicelocator.org/ » SSA Ticket to Work Program -http://choosework.net/
2. Meet with a Benefits Planner to make an
informed choice about the impact of work on
your benefits.
http://www.choosework.net/resource/jsp/searchByState.jsp
Suggested Next Steps
3. Review the previous Financial Wellness
webinars to determine your earnings goal –
http://www.realeconomicimpact.org/FinancialWellness
4. Set a goal to complete items 1 and 2 and 3
over the next three months.
5. Share with us your experience.
» We will send out emails over the next few months to offer you a
chance to share your experience.
Special THANK YOU again
to our sponsor
Acorda Therapeutics
Contact Information
65
