OREGON’S WORK INCENTIVES NETWORK (WIN) When you work, you WIN! This presentation is sponsored by The Oregon Competitive Employment

OREGON’S WORK INCENTIVES NETWORK

(WIN)When you work, you WIN!

http://www.win-oregon.com

This presentation is sponsored by The Oregon Competitive Employment Project, which is part of the Oregon State Department of Human Services, Office of Vocational Rehabilitation Services funded through a Medicaid Infrastructure Grant from the U.S. Centers for Medicare and Medicaid Services (CFDA #93.768).

Updated April 2010

Office of Vocational Rehabilitation Services

SOME BASIC TERMS YOU MIGHT NOT KNOW

SSA: Social Security Administration SSI: Supplemental Security Income SSDI: Social Security Disability Insurance

Temporary Assistance to Needy Families (TANF) Supplemental Nutrition Assistance Program (SNAP) Housing Assistance (HUD) Unemployment Insurance Medicare Savings Programs (QMB) Low Income Subsidy (LIS) Medicaid (OHP or OHP+)

Other Federal & State Benefits Training

Overview of Title II

p. 19

To be eligible for a T2 benefit based on disability:

• Have insured status based on:• Own work record (SSDI)• Parent’s work record (SSCDB)• Deceased spouse’s work record (SSDWB)

• Meet SSA’s Definition of Disability:• A person must be determined to be

medically disabled• Not be working or earning less than SGA


THE BASICS: SSDI PAYMENT AND HEALTH CARE SYSTEM

SSDI – Cash Benefit: Be disabled by SSA definition: and Be “insured” or draw off “insured” worker who is

disabled, retired, deceased. Amount varies based on work history. No asset test.

SSDI – Health Care: Medicare (after 24 month waiting period).

Social Security Disability Insurance (SSDI)

Reach Insured status based on your own work record:

• 20 credits earned of all credits needed, at least in the 10 years prior to onset of disability

• Those disabled prior to age 31 need less to qualify

• Possible to earn up to four credits per year

• One credit = $1,120 for 2010

p. 19

To be eligible for Social Security as an adult child with a disability individuals must be: 18 years of age or older Disabled by SSA’s definition before age 22;

and, Child of an insured worker who are either

disabled, retired or deceased. If child marries, benefits end unless marriage is

to another Title II beneficiary

Childhood Disability Benefits

p. 20

To qualify a widow(er) must be found disabled before the end of a certain period: Month of a spouse’s death Last month of entitlement to mother’s benefits Last month of previous entitlement to DWB

DWB are not payable prior to age 50 Must meet specific disability criteria Waiting period of five consecutive calendar months

Disabled Widow(er) Benefits

p. 20-21

Check amount is based, in general, on amount paid in FICA taxes. Varies from person to person

Total Family Benefit: Max amount all dependents can draw, split between number of dependents

CDB/DWB: check amount is a % of the insured workers benefit. Varies as well. If Insured Worker is drawing a benefit check,

their amount is not reduced/changed if CDB is being drawn.

Title II Disability Check Amounts


THE BASICS: SSI PAYMENT AND HEALTH CARE SYSTEM

SSI - Cash Disabled by SSA definition; Little to no assets; under $2,000 for an individual,

$3000 for a couple; Little to no income; and Benefit Amount for 2011 is $674, $1,011 for a couple,

reduced by other income. SSI – Health Care

Medicaid.


The SSI CalculationStep Calculations

Unearned Income General Income Exclusion (GIE) - Countable Unearned Income = Gross Earned Income Student Earned Income Exclusion - Remainder GIE (if not used above) - Remainder Earned Income Exclusion (EIE) - Remainder Impairment Related Work Expense (IRWE) - Remainder Divide by 2 Blind Work Expenses (BWE) - Total Countable Earned Income =

Total Countable Unearned Income Total Countable Earned Income + PASS Deduction - Total Countable Income = Base SSI Rate (check for VTR or PMV) Total Countable Income - Adjusted SSI Payment Total Income Unearned Income Adjusted SSI Wages TOTAL INCOME =

The SSI program has specific resource limitations set by statute and include real or personal property (including cash). Limits - $2,000 single / $3,000 couple Not subject to regular COLAs Limit cannot be exceeded at the beginning of each month Resources in excess will render individuals ineligible for

SSI cash benefits Ineligibility will continue until resources fall below

allowable limits Eligibility will cease if excess continues for 12

consecutive months

Resource Test

p. 33-34

Countable: most assets are counted, such as Bank accounts, stocks/bonds, property you don’t live

on Excluded Assets: there are a few assets that don’t count,

such as The house you live in, a car you use for medical/work,

special needs trust, Property Essential to Self Support (work incentive)

Key: does person have access to it to pay for food and shelter

Countable and Excluded Resources


SSI is the “2 to 1” Benefit

Every $2 earned causes a $1 cash reduction SSDI is about phases and SSI is about a calculation SGA is not a consideration with SSI benefits Work Incentives keep more cash in a beneficiary’s

pocket Many ways to stay connected to SSI and Medicaid if

working

Must first determine household or non-household Primary household living arrangements:

◦ Non-institutional care◦ Home ownership◦ Rental liability◦ Public assistance households◦ Separate consumption◦ Separate purchase of food for oneself◦ Sharing ◦ Earmarked sharing

Determinations are subject to SSA appeals process

Living Arrangements

p. 29-31

Five month waiting period from month of onset of disability for cash benefit

Additional 24 month qualifying period for Medicare coverage

Months needn’t be accumulated consecutively Months accumulated can be applied to subsequent case

should entitlement cease due to SGA and entitlement be re-established

If 24 months completed prior to losing entitlement and re-established within 5 years (7 for CDB), 24 add. months not required

Medicare Coverage

Hospital Insurance / Part A financed through FICA pays for inpatient hospital care and certain follow-up

Medical Insurance / Part B pays for doctor’s services and variety of other medical

services not covered under Part A voluntary and financed through monthly premiums paid

by beneficiaries opting for coverage ($96.40)

Four Part Medicare

p. 57

Managed Care / Part C Generally administered by HMO type health care

agencies.

Prescription Drug Coverage / Part D Provides prescription drug coverage for Medicare

covered participants.

Four Part Medicare

Extended coverage (Part A free) - a minimum of 93 months following the conclusion of the TWP

Beneficiaries can buy into the Medicare program once the extended Medicare coverage is exhausted. Medicaid may help pay Part A premium if under income threshold

They must no longer be entitled to benefits because of having earnings above SGA and must have extended period of Medicare eligibility.

Extended Medicare Coverage

p. 59


Keeping Access to Medical Assistance

A person with a disability who works in Oregon will very likely have access to medical benefits. Medicaid Continuation (1619b) Employed Persons with Disabilities Medicare Continuation Medicare for Persons with Disabilities Who Work


Oregon’s Work Incentive Network (WIN)

WIN is a benefits and work incentives planning service that helps people with disabilities:

1. MAKE INFORMED DECISIONS about work and their benefits;

2. USE WORK INCENTIVES to achieve their employment goals; and

3. NAVIGATE THE BENEFITS SYSTEMS when they begin working.

TANF SNAP Housing Assistance Unemployment Insurance Veteran’s Benefits Medicare Savings Programs Low Income Subsidy Medicaid

Other Federal & State Benefits Training

Temporary Assistance to Needy Families

Program Intent Provide cash assistance to needy families Case management Promote personal responsibility and accountability Reduce families living in poverty by promoting self

sufficiency, employment & community resources

PRE-TANF

Program Intent Provide screenings, case management & cash

assistance to needy families Holistic assessment; including the whole family,

strengths, needs, goals Focus on family stability, employment and self

sufficiency

TANF Grant Amounts

Typical grant amounts: 2 person = $448, income limit = $499 3 person = $528, income limit = $616 4 person = $647, income limit = $795 5 person = $747, income limit = $932

Examples above are maximum benefits based on 0 income.

TANF and Employment

Example: Family of 3, TANF countable income $616. They were

receiving a full TANF grant of $528 based on 0 income. New job with earnings of $600 per month. Family is still below countable income of $616.

When looking at income computer will calculate:

Earned income at 50% reduction Grant of $528 - $300 = $228 new grant amount

Supplemental Nutrition Assistance Program

Basic Eligibility and Program Requirements

SNAP

The intent of the SNAP Program is to improve the health and well-being of eligible individuals by providing a means to meet the nutritional needs.

Basic requirements

Must have a valid Social Security Number Must be a US citizen or meet certain alien

status requirements Must participate in the OFSET program Students must meet certain criteria

Financial Eligibility

Categorical eligibility 185% of the Federal Poverty Level Deductions

Clients are responsible for:

Reapplying for benefits and responding to Interim Change Reports

Responding to requests for additional information from their worker

Knowing their reporting requirements and reporting when required

Housing Choice Vouchers (HCV):

Provides tenant-based rental assistance in privately-owned units

Tenants pay rent based on income

Rental subsidy is paid by Housing Authority (HA) to landlord

Public Housing:

Project-based rental assistance in housing units owned and managed by HA

Tenants pay income-based or flat rent

Housing authority performs repairs, annual inspections, collects rent, etc.

Public Housing vs. Vouchers

Public Housing is owned and managed by the local public housing authority (PHA or HA). Housing Authority

serves as the landlord.

Subsidized housing or Housing Choice Vouchers (a.k.a. Section 8) is owned and operated by private owners, individuals, or landlords. Housing Authority is not the landlord HA provides rental subsidies to private owners/landlords Subsidy follows the tenant, not the property

Rental Developments

Multifamily Housing (HUD) is where the subsidy is given to the owner, who provides affordable housing to low-income families. The housing subsidy stays with the property.

Rural Development (USDA), similar to Multifamily Housing, subsidized rental assistance to low-income individuals and families in non-metropolitan settings

Participant EligibilityMust be a U.S citizen, national or non-citizen with eligible immigration status.Must meet the low-income guidelines as published by HUD.

Income Limits Income Limits:

http://www.huduser.org/DATASETS/il.html 30% of the Median Very Low Income Low-Income

30% of the Median: 40% of all public housing admissions 75% of all housing choice voucher

admissions

The Application Process

Pre-application completed – income is calculated and eligibility determined

Applicant is placed on waiting list Some HAs have wait list preferences,

i.e., Homeless Current county/city resident Terminally ill Young and disabled (for Mainstream only)


Initial Screening and background check—must deny applicants for certain crimes

HAs may deny for other reasons Owing a HA money Committed fraud

Income, assets, and deductions are verified by third party source


Applicant reaches top of waiting list Applicant attends

briefing/orientation Applicant receives a ‘voucher’, and

housing search begins Applicant finds unit, landlord

completes Request for Tenancy Approval form.


Unemployment Insurance Program

Program Intent “Pay benefits promptly to claimants who are out

of work through no fault of their own.”


Eligibility for Unemployment Insurance

There are three tests an individual must meet to qualify for unemployment insurance: Be unemployed as defined in state law, Qualify as a worker based on prior employment,

and Be out of work through no fault of his/her own.


Ways to Qualify for Unemployment Insurance

There are two ways to qualify: Be paid at least $1,000 in wages from employment

subject to UI law AND have total base year wages equal to or exceeding one and a half times the wages paid in the highest quarter of the base year, or

Have some wages paid in the base year and perform at least 500 hours of work during the base year at employment subject to UI law.


How Benefit Amounts are Determined

The weekly benefit amount (WBA) is 1.25 percent of the wages paid during the base year from subject employment, within minimum and maximum amounts set by law.

The minimum weekly benefit is $115 and the maximum weekly benefit is $492 for new claims filed effective June 28, 2009.

Beginning with claims filed effective July 4, 2010 the minimum WBA will be $116 and the maximum $496. Benefit amounts for claims effective before July 4, 2010 will not change.


Maximum Benefit Amount for UI

The maximum benefit amount (MBA) is the total regular benefits a person can draw during the lifetime of the claim. For most people, the MBA is 26 times the weekly benefit amount. However, people who have very low base year wages qualify for the lesser of 26 times the weekly benefit amount or 1/3 of the total base year wages.

Qualified Medicare Beneficiaries

QMB provides additional medical coverage for Medicare recipients. When used alone, QMB refers to all QMB programs.

Sometimes these programs are referred to as “Medicare Savings Programs”, or MSPs.

The QMB programs are:

QMB-BAS: Qualified Medicare Beneficiaries - Basic. The basic QMB program.

QMB-SMB: Qualified Medicare Beneficiaries - Special Medicare Beneficiary.

QMB-SMF: SMB, Full federal reimbursement. SBI: State Buy-In. For Medicare Part A beneficiaries

with countable incomes above 135% of the Federal Poverty Level. SBI is a case descriptor, not a program. More on this later.

QMB benefits

QMB-BAS: payment of Medicare Part A and Medicare Part B premiums, co-pays and deductibles. QMB-BAS is considered a medical benefit and recipients receive a medical card.

QMB-SMB/SMF and SBI: payment of Medicare Part B premiums only. SMB, SMF, and SBI are not medical benefits.

QMB Non-financial Eligibility Requirements

To receive QMB or any of its subprograms, an individual must be receiving Medicare Part A. (OAR 461-135-0730)

A person does not have to receive Medicare Part B benefits to be eligible for QMB benefits.

Medicare Part D

Prescription Drug Program and Low Income Subsidy

(Extra Help)

Prescription Drug Plan

Beneficiaries enroll themselves through participating drug plan (PDP)…

SSA does not process Part D enrollments Beneficiaries enroll during an enrollment

period Participants must meet deductible,

premium and copayment responsibilitioes Premium amount will vary from plan to

plan

Part D Participation voluntary CMS can assist a beneficiary in enrolling in

a plan through its website http://www.medicare.gov

Refer all questions regarding Part D coverage to 1-800-Medicare

Beneficiaries can also get assistance selecting a plan through their State Health Insurance Counseling and Assistance Program (SHIP)

http://www.medicare.gov/

Medicaid (OHP+) Eligibility for People with Disabilities

Specifically for People with Disabilities1. SSI

2. Former SSI Recipients:1619(b)

3. Former SSI Recipients: DAC/CDBs

4. Former SSI Recipients: Pickle

5. Former SSI Recipients: DWB

6. 300%

7. Mental Health Non-Waivered

8. Employed Persons with Disabilities

Doors on the House of Medicaid

Order of Use

If eligible for SSI, 1619b, or any of the Former SSI Protected groups, those should be used first. There is no monthly premium/fee/liability

If not eligible for those doors, determine most cost effective door to use 300% or EPD MH Non-Waivered or EPD

Your Role1. Is NOT to determined eligibility

2. Is to verify eligibility During comp intake ask a few questions

about the person’s situation to be sure it matches the Medicaid group they are going under

When verification comes back, check to make sure everything matches.

If you find someone could be better off under a different group; contact case worker, pull in Medicaid Policy Analyst support as needed


IT TAKES A TEAM TO REMOVE THIS BARRIER

You can’t do your job AND be a Work Incentive Expert..…..

BUT YOU CAN: 1. Let people know there are WORK INCENTIVES that support their employment efforts;

2. Recognize MYTHS and communicate FACTS; and

3. Encourage people to connect to WIN for more individualized analysis.


QUESTIONS?CALL THE WIN STAFF IN YOUR AREA!

Or for more information about WIN:http://www.win-oregon.com

Documents

OREGON’S WORK INCENTIVES NETWORK (WIN) When you work, you WIN! This presentation is sponsored by The Oregon Competitive Employment