Understanding Social Security: Can It Be Done? February 18, 2004 Toni Bender-ERI Holly Johnson-ERI

Understanding Social Understanding Social Security:Security:

Can It Be Done?Can It Be Done?February 18, 2004February 18, 2004

Toni Bender-ERIToni Bender-ERI

Holly Johnson-ERIHolly Johnson-ERI

Potential loss of benefits is Potential loss of benefits is one of the most persistent one of the most persistent and pervasive fears among and pervasive fears among

people with significant people with significant disabilities who are disabilities who are

considering employmentconsidering employment

Social Security Disability Social Security Disability InsuranceInsurance (Title II)(Title II)

Entitlement programsEntitlement programs DisabilityDisability Medicare CoverageMedicare Coverage

SSDI DAC

SSDI Work IncentivesSSDI Work Incentives

TWP -Trial Work PeriodTWP -Trial Work Period SGA - Substantial Gainful ActivitySGA - Substantial Gainful Activity EPE - Extended Period of EligibilityEPE - Extended Period of Eligibility Expedited ReinstatementExpedited Reinstatement IRWE/SubsidyIRWE/Subsidy EPMCEPMC

Trial Work Period (TWP)Trial Work Period (TWP) 9 months of $580 or more (no limit)9 months of $580 or more (no limit)

– as of January 1, 2004as of January 1, 2004 2003 - $5702003 - $570 80 hours of self-employment activity 80 hours of self-employment activity

per monthper month Don’t need to be consecutiveDon’t need to be consecutive Only one TWP per disability Only one TWP per disability

entitlemententitlement Review by SSA when completedReview by SSA when completed

Trial Work PeriodTrial Work Period

JanJan

$600$600FebFeb

$400$400MarMar

$1,000$1,000AprilApril

$0$0

MayMay

$1,200$1,200JuneJune

$570$570JulyJuly

$590$590AugAug

$810$810

SeptSept

$560$560OctOct

$700$700NovNov

$700$700DecDec

$700$700

Substantial Gainful Substantial Gainful ActivityActivity(SGA)(SGA)

Measure of ability to work Measure of ability to work $810 per month-as of January 1, $810 per month-as of January 1,

20042004 In 2003, SGA was $800 per monthIn 2003, SGA was $800 per month $1,350 per month for the blind $1,350 per month for the blind

(2004)(2004)

If performing work that is “SGA” If performing work that is “SGA” after the TWP cash SSDI benefits after the TWP cash SSDI benefits stopstop

Reducing Countable Reducing Countable IncomeIncome

Subsidy

IRWE

Impairment Related Work Impairment Related Work Expenses (IRWE)Expenses (IRWE)

Expenses that are necessary to Expenses that are necessary to work, related to the person’s work, related to the person’s disability and paid for by the disability and paid for by the workerworker

May be considered to reduce May be considered to reduce countable income below SGAcountable income below SGA

IRWE ExampleIRWE Example

John is working and earning $840 per John is working and earning $840 per month. He pays $40 each month for month. He pays $40 each month for specialized transportation to drive him specialized transportation to drive him too and from work. too and from work.

How does this expense help John?How does this expense help John?

$840.00$840.00 Work EarningsWork Earnings-$ 40.00-$ 40.00 IRWEIRWE$800.00$800.00 Countable Earned IncomeCountable Earned Income

SubsidySubsidy

Value of additional support to Value of additional support to perform a job, or difference perform a job, or difference between actual wages received between actual wages received and value of work performedand value of work performed

May reduce income below SGA like May reduce income below SGA like IRWEIRWE

EXAMPLES:EXAMPLES: more frequent breaks, more frequent breaks, more supervision/support, lower more supervision/support, lower production requirementsproduction requirements

Extended Period of Extended Period of EligibilityEligibility

(EPE)(EPE)

Consecutive 36 month period after Consecutive 36 month period after TWPTWP

Cash benefits reinstated for Cash benefits reinstated for months under SGA ($810) without months under SGA ($810) without a new applicationa new application

If at SGA at end of EPE, no more If at SGA at end of EPE, no more SSDI paymentsSSDI payments

Expedited Reinstatement Expedited Reinstatement (EXR)(EXR)

Effective 1/1/01Effective 1/1/01 Reinstate without new application if:Reinstate without new application if:

-Unable to work, because of medical -Unable to work, because of medical impairmentsimpairments-Medical condition same or related, and -Medical condition same or related, and -File request within 60 months of date -File request within 60 months of date last entitled.last entitled.

After 24 months of EXR payments, After 24 months of EXR payments, receive a new TWP and EPE.receive a new TWP and EPE.

Reapplication Reapplication

If unable to maintain working at SGA If unable to maintain working at SGA level after the completion of the EPE.level after the completion of the EPE.

Reapplying within 60 months of last Reapplying within 60 months of last benefit payment, no waiting period.benefit payment, no waiting period.

Reapplying after 60 months of last Reapplying after 60 months of last benefit payment, 5 month waiting benefit payment, 5 month waiting period.period.

New TWP and EPENew TWP and EPE

Medicare Medicare

Federal health insurance programFederal health insurance program 24-month waiting period after SSDI 24-month waiting period after SSDI

benefits startbenefits start $66.60/month Part-B premium (year $66.60/month Part-B premium (year

2004); Part A is free2004); Part A is free

Extended Period of Extended Period of MedicareMedicare

Coverage (EPMC)Coverage (EPMC) Continued Medicare coverage even Continued Medicare coverage even

if no longer eligible to receive SSDI if no longer eligible to receive SSDI payment because of workpayment because of work

At least 93 months of coverage At least 93 months of coverage after TWP endsafter TWP ends

Billed quarterly for months an SSDI Billed quarterly for months an SSDI payment isn’t receivedpayment isn’t received

Supplemental Security Supplemental Security IncomeIncome

SSI- (Title XVI)SSI- (Title XVI) Needs based programNeeds based program

Elderly or Individuals with Elderly or Individuals with disabilitiesdisabilities

MedicaidMedicaid

State SupplementsState Supplements

Federal SSI EligibilityFederal SSI Eligibility

Earnings must be below SGA at Earnings must be below SGA at application onlyapplication only

Unearned income below $584 if single, Unearned income below $584 if single, living aloneliving alone

Assets below $2,000 for single person, Assets below $2,000 for single person, $3,000 for couple$3,000 for couple

Automatic Medicaid (Medical Assistance)Automatic Medicaid (Medical Assistance) Maximum payment for a single person, Maximum payment for a single person,

living alone is $564/month (2004 living alone is $564/month (2004 amount, changes annually)amount, changes annually)

SSA Doesn’t Count All of SSA Doesn’t Count All of Your Income...Your Income...

General Income Exclusion of $20General Income Exclusion of $20

Deducted first from unearned Deducted first from unearned incomeincome

Earned Income ExclusionEarned Income Exclusion$65 per month plus$65 per month plus

1/2 of the rest1/2 of the rest

Example:Example:

Rich is working at the grocery Rich is working at the grocery store earning $775 a month.store earning $775 a month.

What will his SSI payment be?What will his SSI payment be?

Example:Example:$775 (earnings)$775 (earnings)- 20 (general income exclusion)- 20 (general income exclusion)- 65- 65 (earned income exclusion) (earned income exclusion)$690 $690 ÷ 2÷ 2$345 (countable earned income)$345 (countable earned income)

$564 (Federal Benefit Rate-2004)$564 (Federal Benefit Rate-2004)-345 -345 (countable earned income)(countable earned income)$219 (Federal SSI Payment)$219 (Federal SSI Payment)

Reducing Countable Reducing Countable Income for SSI purposesIncome for SSI purposes

Impairment Related Work Expenses Impairment Related Work Expenses (IRWE)(IRWE)

PASS PlanPASS Plan Student Earned Income ExclusionStudent Earned Income Exclusion Blind Work ExpenseBlind Work Expense

IRWE for SSI RecipientsIRWE for SSI Recipients

Same expenses allowed as for Same expenses allowed as for SSDISSDI

Can increase SSI payment $1 for Can increase SSI payment $1 for $2 of expenses$2 of expenses

IRWE ExampleIRWE Example $775 (earnings)$775 (earnings)

- 20 (general income exclusion)- 20 (general income exclusion)- 65- 65 (earned income exclusion) (earned income exclusion)$690$690

-$ 50-$ 50 (IRWE-Specialized transportation) (IRWE-Specialized transportation) $640 $640

÷ 2÷ 2$320 (countable earned income)$320 (countable earned income)

$564 (Federal Benefit Rate-2004)$564 (Federal Benefit Rate-2004)-320 -320 (countable earned income)(countable earned income)$244 (Federal SSI Payment)$244 (Federal SSI Payment)

W/O IRWEW/O IRWE W/ IRWEW/ IRWE$219$219 $244$244

Plan for Achieving Self Plan for Achieving Self Support (PASS)Support (PASS)

Sets aside income/resources (such Sets aside income/resources (such as earnings or SSDI) for items or as earnings or SSDI) for items or services needed for a vocational services needed for a vocational goal goal

Income/Resources set aside not Income/Resources set aside not considered countable incomeconsidered countable income

Increases or establishes SSI Increases or establishes SSI payments for the length of the planpayments for the length of the plan

Needs SSA approvalNeeds SSA approval

Student Earned Income Student Earned Income ExclusionExclusion

A student under age A student under age 2222

Regularly attending Regularly attending schoolschool

Excludes up to Excludes up to $1,370 per month in $1,370 per month in 2004 (in addition to 2004 (in addition to regular SSI regular SSI disregards) disregards)

Excludes up to Excludes up to $5,520/yr (2004)$5,520/yr (2004)

Blind Work Expenses Blind Work Expenses Only for SSI recipientsOnly for SSI recipients Used instead of IRWEUsed instead of IRWEExamples: Examples:

Transportation Payroll taxesUnion duesAdaptive equipmentLunches while working Service animal and expenses

Continued Medical Continued Medical Assistance Assistance

Section 1619 (b)Section 1619 (b) Continued Medicaid when earnings are Continued Medicaid when earnings are

too high for an SSI paymenttoo high for an SSI payment Income up to threshold of $ Income up to threshold of $ 27,645 27,645

(2004) (2004) For SSI-E Eligible $29,948.48 (2004)For SSI-E Eligible $29,948.48 (2004) Can request individualized threshold if Can request individualized threshold if

medical costs are higher than average medical costs are higher than average and meet the needs test.and meet the needs test.

If lost due to excess assets or income, If lost due to excess assets or income, can re-qualify within 12 monthscan re-qualify within 12 months

State SSI SupplementsState SSI Supplements

Eligible if entitled to $1 of Federal Eligible if entitled to $1 of Federal SSISSI

WI State Supplement - $83.78WI State Supplement - $83.78 Exceptional Expense Supplement - Exceptional Expense Supplement -

$95.99$95.99 Caretaker Supplement-$250 1Caretaker Supplement-$250 1stst

child, $150 for each additional childchild, $150 for each additional child

Medical AssistanceMedical Assistance

MA DeductibleMA Deductible Medical Assistance for individuals with Medical Assistance for individuals with

higher income - “medically needy”higher income - “medically needy” 6-month re-certification period6-month re-certification period Deductible amount increases with Deductible amount increases with

workwork Do a financial comparison between Do a financial comparison between

county MA and MAPPcounty MA and MAPP

Medical AssistanceMedical Assistance

People with disabilities who are working or interested in work

can purchase Medicaid by paying a monthly premium, based on income.

Available Statewide March 15, 2000

Individual Criteria for Individual Criteria for MAPPMAPP

Applicant must:Applicant must: Be considered to have a disability by the Be considered to have a disability by the

Disability Determination Bureau (DDB) Disability Determination Bureau (DDB) without counting earningswithout counting earnings

Have countable assets less than $15,000Have countable assets less than $15,000 Adjusted gross income of 250% FPLAdjusted gross income of 250% FPL

Be working, Be working, OROR, enrolled in an approved , enrolled in an approved Health and Employment Counseling ProgramHealth and Employment Counseling Program

Medical Assistance Medical Assistance Purchase PlanPurchase Plan

Medicaid waiver services available Medicaid waiver services available to MAPP participantsto MAPP participants

Enrolling in MAPP could eliminate Enrolling in MAPP could eliminate cost share or spend downcost share or spend down

May have a MAPP premiumMay have a MAPP premium Applicant should do a financial Applicant should do a financial

comparison before enrollingcomparison before enrolling

BPA & OBPA & O

Benefits Planning, Benefits Planning, Assistance and OutreachAssistance and Outreach

What does BPA & O have What does BPA & O have to offer?to offer?

Benefits Planning Assistance & Benefits Planning Assistance & OutreachOutreach– Information and ReferralInformation and Referral– Benefit Problem Solving and AdvocacyBenefit Problem Solving and Advocacy– Benefits Analysis and AdvisementBenefits Analysis and Advisement– Benefit Support PlanningBenefit Support Planning– Benefit ManagementBenefit Management

How to contact How to contact BPA&O?BPA&O?

ERI –1-877-826-1752 ERI –1-877-826-1752 or or 1-877-242-13571-877-242-1357

Riverfront –1-800-949-7380 Ext 401Riverfront –1-800-949-7380 Ext 401

Independence First – 1-414-291-7520Independence First – 1-414-291-7520