Social Security Administration

SSA Disability Benefit Programs

Social Security Supplemental Security Income (SSI)

• Based on a No work requirement; worker’s earningsincome, resources are factors

• Family members Only for individual, possibly entitled not family

Definition of Disability Same for Both Programs

• Physical/mental impairment expected to last (or has lasted) 12 months

&

• Impairment prevents worker from engaging in

“Substantial Gainful Activity” (SGA)

What is “SGA”?

• “Gainful activity” is work

• To be considered “substantial,” gross earnings must be at least $940* monthly

* $1,570 for blind

Disability “Onset Date”

• Refers to earliest date condition meets medical requirements

&

• Person was not working above SGA level ($940 monthly)

Who Qualifies for Social Security Disability Benefits?

• Worker - filing on own work record

• Disabled widow(er) - filing on deceased spouse’s record; minimum age 50

• Disabled Adult Child - filing on parent’s record;

over age 18, disabled before 22

To be Insured, Workers need “Credits”

• $1,050 earnings = one credit

• Can earn maximum of four per year

For Worker, Age at Onset Dictates Credits Required

•Age 31 or older:- 20 credits in 40-credit period pre-onset

•Age 24 to 30 - credits for half the time from 21-onset

• Under Age 24- 6 credits in three-year period pre-onset

Who Qualifies for SSI Benefits?

• Categories of recipients- aged (65 and older)- blind- disabled adults and children

• Receive cash benefits, Medicaid

SSI Income Limits

• Federal maximum monthly payment, no other income:

- $637 for individual- $956 for couple (both on SSI)

• If other income, $20 exclusion applies- e.g., $500 Social Security results in $157 federal SSI

SSI State Supplement – Penna.

• State adds up to $27.40 or $48.30 in separate check

exception: residents of Medicaid facility only due federal payment of $30

SSI - Resource Limits

• Resources: cash, bank accounts, bonds, stocks, non-home property

• Limits: $2,000 individual $3,000 couple

Filing Disability Application – Online at www.socialsecurity.gov

• For Social Security disability, both medical and non-medical portions can be completed online

• For SSI, only the medical portion can be completed online; non-medical must be completed in-person or by telephone

Filing Disability Application – By Telephone or In-Office

• Call 1-800-772-1213, weekdays 7:00 a.m. to 7:00 p.m.

• Set up telephone/in-office appointment; will be sent “Disability Starter Kit”in advance

Speeding Up Application

• Average processing time: 92 days

• Applicant can help by supplying:- names, dates, etc., of doctors,

hospitals, clinics, & institutions- names of medications- medical records, lab tests- summary of jobs, type of work

Who Makes Decision?

• Medical information sent to Disability Determination Services

(DDS)

• Disability evaluation specialist, physician review evidence, make determination

If Social Security Claim Approved…

• Benefits due after 5-month waiting period e.g., onset date - March 10, 2008 entitlement begins - September 2008

paid - October 2008

• Medicare begins after 24 months of entitlement: September 2010

If SSI Claim Approved…

• Benefits usually retroactive to effective date of application

• Medicaid entitlement coincides with benefit entitlement

If Claim Denied…

• Upon receipt of denial notice, 60 days to file hearing

• If hearing denied, other appeals remain: - Appeals Council Review - Federal court review

Medicare

• Federal health insurance program administered by Centers for Medicare

& Medicaid Services (CMS)

• SSA makes eligibility determinations, enrolls people, gets card issued

Medicare – Who Gets It?

• 65 or older- eligible for Soc. Sec. benefits, or - worked 10 years for government entity,

paid Medicare tax

• Under 65 - entitled to Soc. Sec. disab. 24 months (no waiting period for ALS)

or kidney failure (& insured for benefits)

Traditional Parts of Medicare

• Part A - Hospital Insurance - covers inpatient care in hospital, skilled nursing facility, some home health care, hospice; but .... long-term care limited - length of in-patient stay

dictates amount of coverage - no premium, but financed by

worker’s 1.45% tax

Traditional Parts of Medicare

• Part B - Medical Insurance- outpatient procedures,

medical supplies- $96.40 standard monthly premium ... .... but, sliding-scale premium for singles with income $82K+,

couples with $164K+;affects 4% of beneficiaries

Another “Part” of Medicare

• Part C – Medicare Advantage Plan - health plan option, like Medigap plan; receive all health care services thru provider organization- includes HMOs, PPOs, special needs plans, private fee-for-service plans

- pay Part B premium & plan premium; lower out-of-pocket costs, more covered services

Newest Part of Medicare – Part D Prescription Drug Plan

• Began 2006, CMS responsible - open to all Medicare recipients - choose from plans of private companies - important: compare current plan - enroll soon after applying for Medicare; later, can only enroll Nov. 15 – Dec. 31

Part D “Extra Help”

• SSA responsible

• People of limited means can get help with: - premium, deductible, co-pays

• Must apply, unless in “deemed” category

• Apply online or use paper application

Work Incentives

Social Security

&

Supplemental Security Income (SSI)

Social Security Beneficiary Returning to Work

• Trial Work Period- can work in nine months- regardless of earnings, benefit paid- to count as TWP month,

earnings at least $670- nine months can be scattered

over 60-month period

At conclusion of TWP, ongoing work evaluated

• If work “not substantial” (under $940), benefit continues

• If work “substantial” ($940+), benefit paid months 10-12, then suspended

Months #13 through #45 .... Extended Period of Eligibility

• After 12-months TWP & grace months, “EPE” runs 33 months, to month 45

• Benefit unpaid for months #13-45 whenever SGA ($940+) performed

• Likewise, benefit paid for EPE months under $940

Impairment-Related Work Expenses

• After TWP completed, the costs of some impairment-related items, services needed to work can be deducted from earnings in determining SGA ... $1100 earnings

- $165 IRWE $935 = no SGA

• Individual must not be reimbursed for item, cost must be “reasonable,” and item paid for in a work month

What about Work after EPE?

• Month #45 is last EPE month

* SGA in month 46 or later terminates eligibility

* But .....

“Expedited Reinstatement”

* If earnings fall below SGA, benefit reinstated...no new application needed

* Request must be made within 60 months of termination

* Must have same disability

* Can receive up to six months of benefits, including Medicare

Continuation of Medicare

• All disability recipients are Medicare-eligible after 24 months of benefit entitlement

• After TWP, Medicare can continue for 93 months regardless of SGA

SSI Recipient Returning to Work

• No TWP, no EPE

• SGA not an issue

• Earnings reduce payments, but benefits continue as long as income, resource limits not exceeded

How Earnings Reduce SSI

• Unlike unearned income, earnings don’t reduce SSI dollar-for-dollar

• Subtract $65 ($85) from monthly gross earnings; half of remainder counts against SSI

• $600 earnings Half of $515 = -$85 exclusion $515 remainder $257.50 SSI reduction

Monthly Earnings Cut-off

• Earnings of $1,359+ results in no SSI payable

• $1359 earnings Half of $1274 -$85 exclusion is

$1274 remainder $637

• SSI limit: $637.00 - $606.40 countable income 0 = no SSI payable

Impairment-Related Work Expenses

• Remember, SGA not an issue for SSI once on; but IRWE reduces countable earnings

• $1267.80 earnings $1182.80 -$85.00 exclusion - $52.00 IRWE

$1182.80 $1130.80 Half of $1130.80 = $565.40 countable earnings

• SSI limit $637.00 - $565.40 countable income $71.60 SSI payable

Continuation of Medicaid

• If earnings too high to allow SSI payment, Medicaid still continues if ...

.... yearly earnings don’t exceedPennsylvania threshold:

$28,554

Work Exclusion for Students

• Must be under age 22 and in regular school attendance

• Up to $1,550 earnings excluded per month

• Maximum $6,240 excluded yearly

Plan for Achieving Self-Support (PASS)

• Use or setting aside of income, resources to achieve work goal, increase prospects for self-support

* Excluded income, resources don’t count against SSI, thereby increasing payment

* Must be in writing, estimate time period for attaining goal

Ticket to Work

• Gives disabled choice in obtaining free rehabilitation & vocational services

• Provides more incentives for disabled to work & lessen dependence on public benefits

• Removes barriers that make people choose between medical coverage and work

The Ticket Itself

• New disability recipients, age 18-64, will be sent Ticket, letter, & booklet

• Ticket certificate can be “used” to obtain free vocational, employment services from organizations called “Employment Networks”

- ENs are paid, but only if disabled individuals work

• Ticket program is voluntary!

Upon Ticket receipt ...

• Recipient not required to do anything; remember....voluntary program

• But ....if interested in receiving services, call Program Manager (Maximus, Inc.)

• Later ... take Ticket to an Employment Network (EN) to obtain services

Employment Network (EN)

• Any agency or instrument of the state, or a private entity responsible for the coordination or actual delivery of services can become EN

• Can be single entity, consortium, or association of organizations collaborating to combine resources to serve Ticket holders

Examples of ENs

• State VR agencies

• Any public/private entity providing appropriate services (job readiness, placement, voc. rehab., training, etc.)

• Employers offering job training, voc. rehab., support, retention, or other types of job-related services and/or assistance for the disabled

ENs Serving Philadelphia

• Currently, 34 ENs signed up

• Seven are based in city

How do People reach ENs?

• SSA contracted with a Program Manager – Maximus, Inc.

• Maximus recruits, monitors ENs; also facilitates access to ENs

• When Ticket sent, people referred to Maximus toll-free number & www.yourtickettowork.com

Assigning a Ticket

• Before “assigning” Ticket, person first discusses services, etc., with EN

• EN can refuse to accept the Ticket

• If agreement is reached, individual work plan which details desired employment goals is written

• After plan drawn up, Ticket considered assigned and “in use”

What’s in It for Disabled Individual?

• Ticket-users not subject to medical Continuing Disability Reviews as long as making “timely progress”

• “Timely progress” - assumed in first two years of Ticket use - in third year, 3 of 12 months must be SGA ($940) - in fourth year, 6 of 12 months SGA - in fifth year, 6 of 12 months must be non-pay

What’s in It for ENs?

• ENs paid when Ticket users either:have earnings which result in no cash benefit, or .... have earnings at or above SGA

• ENs, therefore, have vested interest in getting people back to work

The National Numbers So Far ....

• 10.4 million Tickets sent

• 192,000 Tickets assigned

• One of every 54 Tickets sent out assigned

• 93% of assigned Tickets have gone to state VRs, 7% to new ENs

• Note that pre-Ticket, state VRs “rehabbed” 10,000 people yearly

Another Ticket Partner: WIPA

• SSA awarded contracts to organizations; called Work Incentives Planning and Assistance (WIPA) organizations

• They conduct outreach efforts re work incentives, provide planning and assistance, can also provide one-on-one counseling, advice, etc.

• Disability Rights Network serves Philadelphia

Another Ticket Partner: Protection & Advocacy Program

• SSA awarded contracts to legally-based disability rights agencies to provide legal representation & other advocacy services

• In Pennsylvania, Disability Rights Network has the contract