Florida Benefits Information Referral NetworkFlorida Benefits Information Referral Network

PresentsPresents

“Changing Face of Benefits”:“Changing Face of Benefits”: Knowledge for Successful EmploymentKnowledge for Successful Employment

Sponsored ThroughSponsored ThroughAgency For Persons With DisabilitiesAgency For Persons With Disabilities

Medicaid Infrastructure GrantMedicaid Infrastructure Grant

Developed ByDeveloped BySharon Brent, DirectorSharon Brent, Director

Training and Technical AssistanceTraining and Technical AssistanceNational Disability InstituteNational Disability Institute

Principles of Project TrainingPrinciples of Project Training

1. Information provided in the training is one tool for decision making about employment

2. Good decisions are the result of good planning

3. The training is based on the philosophy of self-determination and person centered planning.

Building Blocks for Building Blocks for Self-DeterminationSelf-Determination

1. A person has the FREEDOM to dream, make his or her own decisions and plan their own life.

2. A person has the AUTHORITY to control how money is spent for supports

3. A person has the SUPPORT needed from people they choose, i.e. family, friends, employees.

4. A person is required to take RESPONSIBILITY to do what he or she says they will do

Overview of EligibilityOverview of EligibilitySSI and SSDISSI and SSDI

Call Social Security at 1-800-772-1213; 0r Apply On-Line www.socialsecurtiy.gov; or visit local SSA Field Office

Collect information about the disability and about work history

Complete Forms from SSA—Make copy Keep appointment with SSA SSA moves file to DDS (Disability Determination Service)

for medical review, returning decision to SSA SSA sends letter of eligibility determination

Approved; Denied (reconsideration); 2nd denial (Appeal)

CHECKLIST FOR SUCCESSCHECKLIST FOR SUCCESS

Make copies of all documents you give to SSA: both forms you fill out and evidence you want them to have that are in your possession. Do not LOSE your copies!!

When you call SSA (1-800-772-1213) keep a record: Date Name of person you spoke to What you asked What they told you

Checklist-continuedChecklist-continued

Promptly open and read ALL mail sent by SSA. When SSA gives a deadline response date, compliance within that date is required. Seek help immediately for help. Keep ALL paperwork, letters, and mailing envelopes in your file. Do Note Lose!!!!

You must report pay stubs each month to SSA. Be sure to report to correct field office (Zip Code of the payee is the key). Report by mail, and/or walk into the office. Keep wage records in your file. If on SSI & SSDI report to each program separately.

Checklist-continuedChecklist-continued

If a person receives SSI and/or Medicaid, remember to keep all resources/assets below $2,000/individual $3,000/couple in any month to maintain eligibility. Medicaid eligibility may vary from State to State.

When a major life change occurs (address, marriage, employment, lose of job, divorce, children) report to SSA immediately, both to 1-800-772-1213 and to local SSA field office.

DEFINITION OF DISABILITYDEFINITION OF DISABILITY

The SSA defines disability for both SSI and SSDI programs as the inability to engage in

Substantial Gainful Activity (SGA) by reason of any medical (physical and/or

mental or blind) impairment.

Disability must have lasted or be expected to last for a continuous period of not less than

12 months or result in death.

DefinitionDefinitionSubstantial Gainful ActivitySubstantial Gainful Activity

SGA=A basic test used by SSA to establish disability status

SGA is the performance of significant mental and/or physical duties for profit.

It is usually determined to be gross earnings (before taxes) of an amount of money that is set January 1 of 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 annual SGA level amount.

Eligibility of BenefitsEligibility of BenefitsSupplemental Security Income-SSI

Unearned Income (Not Wages)• SSDI, VA, Annuities

Income (Earned Wages)• 12 months no SGA income• SGA factor during initial eligibility• Once eligible SGA non-issue

Resources (NOT Wages or Unearned Income

• $2,000/month/Individual• $3,000/month/Couple

Medical Eligibility• Medical Eligibility Defined

Medical Insurance-MEDICAID• SSI connected, State Administered

Social Security Disability Insurance-SSDI Required Work Credits in F.I.C.A

5 Month Waiting Period

SGA• 12 months consecutive-initial eligibility • Factor During EPE and Beyond

Medical Eligibility• Medical Eligibility Defined

DAC –Disabled Adult Children• Disability Prior to Age 22• Never Legally Married-NOT On Title II

Benefits• Insufficient FICA-or Higher Parent Amout• Parent FICA Opens(Dies;Retires;Disabled)• Possible continuation of Medicaid-Pickle

Amendment Medicare (Medical Insurance)

• 24 months upon eligibility • Part A-Free-Part B/D-Premium

SSI and MedicaidSSI and MedicaidResource ExampleResource Example

The SSI/Medicaid programs have specific resource limitations in order to be eligible to receive and/or maintain benefits. The monthly maximum amount for SSI (Federal) is $2,000/individual $3,000/couple. Medicaid (State) may vary the allowed amount for eligible status based on State rules. (Neither must not exceed the specific amount at the beginning of each month).

The Resource limitation is set by statute and is countable real or personal property including cash.

SSI ResourcesSSI ResourcesCounted-MaybeCounted-Maybe

Countable by SSA (maybe):• Cash, Savings Accounts, Stocks, Bonds, CD’s,

IRA’s etc.• Land (Owned but not lived on)• Anything owned which could be converted to

cash and used for Food and Shelter (including utilities)

• Resources of a spouse. Resources of parent if beneficiary is under 18 (minor).

SSI ResourcesSSI Resources(Maybe) Excluded(Maybe) Excluded

An owned home you live in and the land it sits on. Household goods and personal property in total (as of March, 2005) Clothing someone might give or gift to a beneficiary (as of March 2005) Burial Space for beneficiary and immediate family Burial funds up to $1500 for individual and spouse Life Insurance with a combined face value of not more that $1500 Retroactive SSI or SSDI amount for up to 9 months (Keep receipts on how money

is spent) Property in Specific Trust A bank account for Plan for Achieving Self-Support (PASS) An Individual Development Account (IDA) Property Essential for Self-Support (PESS) One automobile, regardless of value (as of March 2005)

1. Employment or medical treatment2. Modified for use by an individual with a disability3. Geographic climate, terrain, distance, or similar factors impeding the performance of essential daily activities.

SSI Wage Calculation Formula SSI Wage Calculation Formula

SSI and Earned Income (No Unearned Income/No Work Incentives)Step 1

$________ Earned Income (Gross Wages) - $ 20.00 General Exclusion - $ 65.00 Earned Income Exclusion

$_________ Countable Earned Income

Step 2$_________Countable Earned Income from Step 1 by 2 Division Answer $________

- $_________Subtract division answer from Countable Earned Income$_________Final Revised Countable Earned Income

Step 3 $_________Maximum SSI Benefit (Federal Benefit Rate + State Supplement) - $________ Final Revised Countable Earned Income (Step 2) $_________New Monthly SSI Benefit

SSI Wage CALCULATION FormulaSSI Wage CALCULATION Formula

Step 4$_______ Gross Earned Income (Step 1)

+ $_______ New Monthly SSI Benefit (Step 3)$________Total Monthly Gross Income

Step 5$_____Gross Earned Income (Step 1) x 15% = FICA, Medicare, State &

Federal Income Tax, SDI, etc. - $_____Estimated Tax from Gross Income

$_____Net Income After Taxes + $_____New SSI Amount (Step 3)

$_____Total Monthly Cash In Hand

TRIAL WORK PERIOD-TWPTRIAL WORK PERIOD-TWPSSDI WORK INCENTIVESSDI WORK INCENTIVE

Unless medical recovery is determined, (SSDI) beneficiaries are entitled to a 9 month Trial Work Period (TWP) for testing work skills while maintaining the monthly cash benefits. During this TWP full benefit checks will continue regardless of the amount of money earned. The 9 months of TWP 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)

The TWP ends only when an individual has 9 months of TWP within a 60 month consecutive period of time (5 years).

Once all 9 months of TWP have been earned within the 60 month window a person then enters Extended Period of Eligibility (EPE).

EXTENDED PERIOD OF ELIGIBIITY (EPE)EXTENDED PERIOD OF ELIGIBIITY (EPE)SSDI WORK INCENTIVESSDI WORK INCENTIVE

At the conclusion of the 9 month TWP beneficiaries will immediately enter into the 36 month EPE as long as the medical eligibility continues.

The 36 month period begins in the month following the 9 month TWP whether a person is determined to be earning SGA or not.

During EPE cash benefits continue only for months SGA is not earned. Any month SGA is earned the individual is not eligible for the cash benefit. The first month of SGA (grace months) benefits continue. Next two months are considered grace months and if SGA is earned benefits continue.

When 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 is earning SGA or above and the EPE is completed, a person is no longer eligible for a cash benefit.

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.

If a person needs support in order to earn income document and record the time and activity of support in order to determine if earnings are actually SGA. (See Work Incentive Subsidies and Impairment Related Work Expenses).

WORK INCENTIVESWORK INCENTIVESCOMPARISON CHARTCOMPARISON CHART

Social Security Disability Insurance Supplemental Security Income

SSDI SSI

Trial Work Period Continuation of SSI

Extended Period of Eligibility Student Earned Income Exclusion

Continuation of Medicare 1619 A and 1619 B

Impairment Related Work Expense Impairment Related Work Expense

Section 301 Section 301

Special Rules for the Blind Blind Work Expense

Subsidies Subsidies

Ticket To Work Property Essential for Self-Support

Expedited Reinstatement Plan for Achieving Self-Support

Ticket To Work

Expedited Reinstatement

WORK INCENTIVES PLANNING WORK INCENTIVES PLANNING AND ASSISTANCEAND ASSISTANCE

Work Incentives Planning and Assistance (WIPA) Programhttp://www.socialsecurity.gov/work/ServiceProviders/

wipafactsheet.html

The goal of the WIPA program is to better enable SSA beneficiaries with disabilities to make informed decisions about work. Each WIPA project has Benefits Specialists called Community Work Incentives Coordinators (CWIC) who will: 1. Provide work incentives planning and assistance to

beneficiaries of SSI an/or SSDI with disabilities; and2. Conduct outreach efforts to those beneficiaries who are

potentially eligible to participate in federal or state work incentives programs.

WIPA Agencies by State For more specific information, visit the state-by-state contact list AT ABOVE ADDRESS.

DISABILITY PROGRAM DISABILITY PROGRAM NAVIGATOR INITIATIVENAVIGATOR INITIATIVE

Disability Program Navigator (DPN) http://www.doleta.gov/disability/onepagers/

dpn_factsheet_august2006.pdf The Department of Labor (DOL) and the Social Security

Administration (SSA) have jointly established a new position, the Disability Program Navigator, within DOL’s One-Stop Career Centers.

The Disability Program Navigator helps people with disabilities “navigate” through enormous challenges of seeking work, complex rules surrounding entitlement programs, and provides work support programs now available at DOL funded One-Stop Career Centers.

Disability Program Navigators by State For more specific information, visit the state-by-state contact list.

Area Work Incentives Coordinator Area Work Incentives Coordinator SSA-AWICSSA-AWIC

Area Work Incentives Coordinator (AWIC)http://www.ssa.gov/work/Beneficiaries/awic.html AWICs provide assistance to personnel in field offices on

employment supports & outreach by: Coordinating and/or conducting local public outreach on

work incentives; Providing, coordinating, and/or overseeing training for all

personnel on SSA’s employment support programs; Handling some sensitive or high profile disability work-issue

cases, and; Monitoring the disability work-related issues in their

respective areas.

SSI and Earned Income Tax Credit SSI and Earned Income Tax Credit

NOTE: On July 18, 2005, SSA issued Final Rules amending the SSI regulations by making technical revisions to rules on income and resources based on the Social Security Protection Act (SSPA) of 2004 and several other statutory changes. These revisions, among other things, clarify that certain types of income are excluded when determining SSI income and resources. Any unspent portion of Federal income taxes related to an Earned Income Tax Credit (EITC) is excluded from resources for a time period of 9 months following the month of receipt.For more information see:http://www.ssa.gov/regulations/articles/rin0960_ae79f.htm

States may have different rules for how they look at a persons resources and eligibility to both SSI and/or Medicaid in a State. States decide what counts as income and resources when there is a State Supplement to SSI and when administering the Medicaid Program. Important to understand State rules as well as the Federal rules above.

Individual Development AccountsIndividual Development Accounts An IDA is a special savings account for people with low

incomes. The money set aside by a person who is earning wages in an IDA Account will be matched with another dollar or more for every dollar saved by the individual. An EITC is looked at as earned income and can be matched in and IDA program.

Savings and matched money can be used for education, starting a small business, or first time home purchase.

A person will learn budgeting, saving, banking and credit information

Individuals in an IDA can also receive one-on-one counseling and other training

Match dollars come from a combination of Federal money and other business, or organizations supporting Asset Development.

A person who is eligible for SSI and/or Medicaid who has an approved IDA account will not have money that is set aside for the IDA count as a resource.

Websites of ImportanceWebsites of Importance

http://www.socialsecurity.gov Social Security Administration Home Page http://www.socialsecurity.gov/work Social Security Administration Work http://www.fdhc.state.fl.us/ Florida Agency for Health Care Admin http://www.floridajobs.org/ Agency for Workforce Innovation http://www.dcf.state.fl.us/ess/ssifactsheet.pdf Medicaid http://www.dcf.state.fl.us/ess/fsfactsheet/pdf Food Stamps http://www.myflorida.state.fl.us Public Housing Agencies http://www.advocacycenter.org Protection and Advocacy http://rehabworks.org Vocation Rehabilitation http://www.fddc.org Florida Developmental Disabilities Council http://www.apd.state.fl.us Agency for Persons with Disabilities http://disability.law.uiowa.edu/dpn Law, Health Policy and Disability Center http://www.cfed.or IDA Directory www.reitour.org Real Economic Impact Tour