Social Security Work Incentives

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Social Security Work Incentives

• Presented by Jana Tacl,
• Area Work Incentive Coordinator (AWIC)
• Denver Region

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• Social Security Disability Insurance (SSDI)
  provides benefits to individuals with
  disabilities who are insured by workers
  contributions to the Social Security trust fund
• Supplemental Security Income (SSI) provides cash
  assistance payments to the aged, blind disabled
  with limited income assets (resource limits are
  2000 for an individual and 3000 for a couple)
• Retirement and Survivors Insurance provides
  benefits to individuals and family members who
  are insured by workers contributions to the
  Social Security trust fund

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SSA Acronyms(can be found on page 66 of the Red
Book)
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Inability to engage in any substantial gainful
activity (SGA) due to a medically determinable
physical or mental impairment(s) that

• can be expected to result in death, or
• has lasted or can be expected to last for a
  continuous period not less than 12 months

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• Work activity either as an employee or
  self-employed person
• Used as a guideline to determine initial
  continuing disability entitlement for SSDI
  beneficiaries initial entitlement for SSI
  recipients

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2007 Amounts
Non-Blind 900/Month
Blind 1,500/Month
Consider impairment related work expenses
subsidies/special conditions to determine
countable income for SGA
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• SSDI beneficiaries for initial continuing
  disability
• SSI Disability recipients for initial
  eligibility only
• Does not apply to SSI blind recipients

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Health Insurance Coverage

• You will receive Medicare coverage if you are
  eligible for SSDI benefits. Generally, Medicare
  eligibility begins 24 months after the month of
  entitlement to SSDI. Exceptions include chronic
  kidney disease requiring regular dialysis or a
  transplant, and Amyotrophic Lateral Sclerosis
  (ALS).
• Medicaid eligibility starts the same month as SSI
  eligibility. In some situations, retroactive
  eligibility for Medicaid to cover unpaid expenses
  may be possible.

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Impairment Related Work Expenses(IRWE)
Cost of certain disability-related items
services a person needs in order to work can be
deducted from earnings in determining SGA for
SSDI under title II excluded from earned
income in determining SSI monthly payment amount
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IRWE Requirements

• Costs for items services must be paid by
  individual with disability
• Item or services must be disability related
• Expenses must be reasonable

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IRWE EXAMPLES

• Attendant care services performed in the work
  setting
• Transportation cost of driver assistance or
  taxicabs required because of disability,
  rather than lack of public transportation
• Medical devices such as wheelchairs,
  hemodialysis equipment, pacemakers, respirators,
  and braces
• All impairment-related work-assistive devices,
  services, methods, or systems, including
  service animals
• Prosthetics such as artificial hip, artificial
  replacement of an
• arm, leg, or other parts of the body

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IRWE EXAMPLES (continued)

• Regularly prescribed medical treatment or
  therapy necessary
• to control the disabling condition, even if
  control is not
• achieved
• Diagnostic procedures related to the control,
  treatment, or
• evaluation of the disabling condition
• Expendable medical supplies, such as
  incontinence pads, elastic
• stockings, and catheters
• The cost of a service animal including food,
  licenses, and
• veterinary services
• If self-employed at home, modifications made
  inside the home
• in order to create a workspace to accommodate
  the impairment.

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• Employer may subsidize an employee with
  disability earnings by paying more in wages
  than reasonable value of actual services
  performed
• Excess regarded as a subsidy rather than
  earnings when making SGA determination

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Special conditions are generally provided by
someone other than an employer for example, a
third-party job coach paid for by a vocational
rehabilitation agency
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IRWE/Subsidy/Special Consideration Example

• John Doe works for ABC Company as a stocker/order
  puller.
• John works 40 hours a week at 12.00/hr. His
  gross wages per month are 1920.
• John requires a job coach to assist him in his
  job. The job coach performs 25 of Johns work.
  In addition, John often relies on his co-workers
  to assist him in his job duties.

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IRWE/Subsidy/Special Consideration Example

• SSA verifies with Johns employer that he works
  at 80 capacity compared to unimpaired workers
  doing the same type of work.
• In addition, John must take an anti-seizure
  medication that he pays 200/month out of pocket.

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Determining Countable Wages

• 1920 (gross monthly wages)
• - 480 (25 work performed by job coach)
• 1440
• - 384 (20 employer subsidy)
• 1056
• - 200 (IRWE Medication)
• 856 Countable Earnings
• It is determined that John is not performing SGA.

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Continued Payment Under Vocational Rehabilitation
Plan (Section 301)

• Continuation of SSDI SSI payments after a
  person is determined no longer disabled on basis
  of medical recovery

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Section 301 Requirements

• The ceased SSDI or SSI beneficiary with
  disability or blindness must be participating in
  the Ticket to Work Program or another program of
  vocational rehabilitation services, employment
  services, or other support services approved by
  the Commissioner of Social Security.
• Effective March 1, 2006, a PASS qualifies as an
  appropriate program.

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• Section 301 Requirements (Continued)
• Person must have begun participating in program
  before date his/her disability ceased.
• Social Security determines whether a persons
  completion of program, or continuation in
  program for a specified period of time, will
  increase likelihood that person will not have to
  return to disability or blindness benefit rolls.

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TRIAL WORK PERIOD
Allows SSDI beneficiary to work in nine calendar
months (not necessarily consecutively) during
which work will not be used to determine if
disability has ceased.
Continues until 9 months of servicesare
accumulated within a rolling 60-month period.
Work is consideredto be services if more than
640/month(2007 rate) is earned or more than 80
self-employed hours are worked in a month.
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EXTENDED PERIOD OF ELIGIBILITY (EPE)

• EPE re-entitlement period - consecutive period
  of 36 months after last month of trial work
  period (TWP)
• SSDI cash benefits are not paid if earnings
  are above SGA level (over 900 in 2007) except
  during
• Grace Period
• SSDI cash benefits will be reinstated for any
  month person does not work at SGA
• SSDI benefits can be reinstated during EPE
  without new application, new disability
  determination, or waiting period

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• The first month of SGA in the EPE is the
  cessation month. If SSDI beneficiary works at
  SGA level, benefits will be paid for month of SGA
  cessation plus next 2 months.

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TWP/EPE Example

• Sally Jones began work for XYZ Company in May
  2006. She was working 40 hours a week and earned
  approximately 2000 a month. She stopped working
  in June 2007.
• Sally did not receive subsidy or special
  considerations and she did not have IRWE.

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TWP/EPE Example

• Sallys TWP would be May 2006 thru January 2007.
  (She would continue to receive her SSDI benefits
  during the TWP.)
• Sallys EPE would begin in February. Since she
  was performing SGA, February would also be her
  cessation month. Because of the grace period,
  Sally will receive benefits for the months of
  February, March and April.
• Sallys benefits will be suspended effective with
  the month of May and reinstated with June, the
  month she stopped working.

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TWP/EPE Example
Grace Period
TWP May 2006 Jan 2007
EPE begins Feb 2007
EPE ends Feb 2010
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If a beneficiary performs SGA in the EPE,
Medicare coverage continues for at least 93
months after TWP is completed. Hospital
Insurance is free however, a premium is required
for Supplemental Medical Insurance (SMI) unless
premium is being paid by State.
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SSI EARNED INCOME EXCLUSION
We exclude 65 plus one-half of remaining monthly
earned income (wages or self-employment) to
provide incentive for SSI recipients to work
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ExampleSSI Recipient Earns 385/Month

• 385 - 20 (general income exclusion) 365
• 365 - 65 (earned income exclusion) 300
• 300 - 150 (1/2 remaining earnings) 150
• countable earned income
• 623 (SSI full benefit rate) - 150 473 SSI
  payment/month

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Example of Earned Income Exclusion

• Available Income
• 385 in earned income
• 473 in SSI benefits
• Total 858 income/month

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• Section 1619(a) Allows SSI recipients with
  disabilities to work above SGA level continue
  to receive cash payments.
• Section 1619(b) Allows SSI recipients who are
  blind or disabled to continue to be eligible for
  Medicaid when their earned income is only reason
  for termination of cash payment

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1619(b) Threshold Rates
The 1619(b) threshold level varies from State to
State. (If an individuals earnings exceed the
threshold amount, in some circumstances, we can
figure an individual threshold amount).
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2007 State Threshold Rates

• Alabama 22,728
• Alaska50,685
• Arizona 27,401
• Arkansas25,371
• California32,920
• Colorado31,198
• Connecticut52,407
• Delaware 32,282
• District of Columbia 37,326
• Florida 27,064
• Georgia 25,049
• Hawaii 28,263
• Idaho34,537
• Illinois31,011
• Indiana32,021
• Iowa27,805
• Kansas29,866
• Kentucky24,771
• Louisiana26,285

• Montana26,944
• Nebraska27,954
• Nevada26,886
• New Hampshire39,046
• New Jersey31,591
• New Mexico32,016
• New York41,771
• North Carolina29,410
• North Dakota32,973
• Ohio32,097
• Oklahoma23,432
• Oregon28,003
• Pennsylvania27,835
• Rhode Island34,312
• South Carolina26,326
• South Dakota30,487
• Tennessee22,174
• Texas27,775
• Utah26,524

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STUDENT CHILD EARNEDINCOME EXCLUSION

• We exclude up to 1,510/mo. of earned income,
  up to a calendar year total of 6,100 for
  SSI recipients under age 22 who are in a
  school or training program (2007 rates)
• Exclusions are adjusted annually.
• SSI recipient must be under age 22
  regularly attending school

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BLIND WORK EXPENSES
A blind SSI recipient who is working may deduct
ordinary necessary work-related expenses from
countable earned income. Examples include guide
dog expenses, taxes, lunch, transportation.
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PLAN FOR ACHIEVING SELF-SUPPORT (PASS)

• PASS allows an individual with disability
  including blindness to set aside income
  and/or resources to pay for things they need
  to reach a work goal
• Can increase or maintain SSI payment amount
  by excluding income/resources
• Can establish SSI eligibility

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• Must have expenses necessary to reach goal
• Must show anticipated length
• Must show how money/ resources will be used

• Must be in writing (SSA-545)
• Must be approved by Social Security
• Must have specific feasible work goal

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The Ticket to Work Work Incentives Improvement
Act (TWWIIA)

• Social Security SSI disability beneficiaries
  will receive a Ticket they may use to obtain
  vocational rehabilitation, employment or other
  support services from an approved provider of
  their choice.
• The Ticket program is voluntary.

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Ticket Services to be DeliveredThrough
Employment Networks (EN)
EN qualified State, local, or private
organization that elects to assist beneficiaries
in finding maintaining employment.

• Contact Maximus, Inc. at 1-866-968-7842
• Beneficiaries can only assign their Ticket to one
  EN (or VR agency) at a time
• A Ticket is considered in use when the
  Ticket-holder develops a written Individual Work
  Plan (IWP) with the EN, or an Individual Plan for
  Employment (IPE) with the VR agency

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Services To Be Provided Under Individual Work
Plans

• May include
• case management
• work incentives planning
• supported employment
• career planning
• career plan development
• vocational assessment

• job training
• placement
• follow-up services
• such other services as may be specified by
  Social Security

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TWWIIA Medicare Changes

• Extended Medicare coverage provision effective
  10/1/2000
• Medicare will continue at least 93 months (7
  years, 9 months) after TWP ends (total of at
  least 8-1/2 years including TWP months). AN
  ADDITIONAL 4-1/2 YEARS OF COVERAGE

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Work Incentive Enhancements
Expedited Reinstatement ofDisability Benefits
Effective 1/1/2001
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SSDI Benefits Medicare Will BeReinstated If

• Individual lost SSDI due to
• performance of work activity
• over the allowable limit
• Files request for reinstatement within 60
  months of last month of entitlement
• Disability same as (or related to)
  disability that was basis for original claim
• Current disability renders person incapable
  of substantial work
• activity

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SSI Benefits Will BeReinstated If

• Person became ineligible for SSI due to
• performance of substantial work activity
• Files request for reinstatement within 60 months
  of last month of entitlement
• Disability same as (or related to) disability
  that was basis for original claimNOTE If
  the individual is eligible for SSI payments, the
  general rules for Medicaid eligibility will apply

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SSI Benefits Will Be Reinstated If

• Current disability renders individual
• incapable of substantial work activity
• Individual satisfies SSIs non-medical
• requirements (i.e., SSIs income
• resource rules)

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• Must contact SSA to request EXR and complete
  necessary forms. Provisional payments do not
  begin until forms have been completed.
• Up to 6 months of SSDI or SSI benefits paid
  while reinstatement application is pending.
• If Social Security determines a person is not
  entitled or not eligible for reinstatement, any
  resulting overpayment cannot be recovered unless
  Social Security determines individual knew or
  should have known that s/he did not meet
  reinstatement requirements

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EXR vs. New Claim

• Provisional Payments
• Benefit Computation
• Medicare Coverage
• Retroactivity
• Insured Status
• Return to Work Issues

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During the period a beneficiary is using a
ticket, Social Security may not initiate a CDR to
determine if individual is no longer disabled
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Elimination of the Work-Triggered CDR

• Effective 1/1/02 for persons who have received
  SSDI benefits for at least 24 months
• No CDR may be scheduled solely as a result of
  persons work activity
• SSDI recipients will still be subject to
  regularly scheduled CDRs not triggered by work
  activity to termination of benefits if they
  perform SGA (more than 900/month)

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NEED MORE INFORMATION?
Call 1-800 772-1213 or visit our Website
www.socialsecurity.gov/work