Benefits & TransitionBenefits & Transition

Overview of SSI vs. SSDIOverview of SSI vs. SSDI

&&

Medicaid vs. MedicareMedicaid vs. Medicare

For For transitiontransition aged aged beneficiariesbeneficiaries

Title IITitle II

Few different types of Title II benefitsFew different types of Title II benefits Focus on SSDI: Social Security Disability Focus on SSDI: Social Security Disability

InsuranceInsurance

SSDISSDI

Our focus will be Child Disability Our focus will be Child Disability Benefit (CDB, formerly DAC) Benefit (CDB, formerly DAC)

Based off work record that parent Based off work record that parent paid taxes on (fica taxes)paid taxes on (fica taxes)

Disability that occurred before age Disability that occurred before age 2222

Must be older than 18 to receive thisMust be older than 18 to receive this

SSDI Work IncentivesSSDI Work Incentives

Trial Work Period months (TWP)Trial Work Period months (TWP) 9 months: do not have to be 9 months: do not have to be

consecutive!consecutive! TWP counted when someone earns $720 TWP counted when someone earns $720

(in 2012) or more(in 2012) or more Still receive full cash benefitStill receive full cash benefit Amount usually increases every year OR Amount usually increases every year OR

does not increasedoes not increase

SSDI Work IncentivesSSDI Work Incentives

Substantial Gainful Activity (SGA)Substantial Gainful Activity (SGA) $1010 (this amount can increase annually)$1010 (this amount can increase annually) SSA uses this amount to determine SSA uses this amount to determine

eligibility for benefitseligibility for benefits If person earns more than SGA: If person earns more than SGA:

receives NO benefit and can be receives NO benefit and can be terminated terminated

Does not come into affect until after Trial Does not come into affect until after Trial Work Period Months (TWP) are completeWork Period Months (TWP) are complete

SSDI Work IncentiveSSDI Work Incentive

Extended Period of Eligibility (EPE)Extended Period of Eligibility (EPE) 36 Consecutive months: happens 36 Consecutive months: happens

regardless of earningsregardless of earnings Begins the month immediately following Begins the month immediately following

the TWPthe TWP If individual’s earnings are above SGA: If individual’s earnings are above SGA:

no cash benefit; if below SGA: will no cash benefit; if below SGA: will receive cash benefitreceive cash benefit

TWP ExampleTWP Example

Chris started to receive SSDI in January 2012 Chris started to receive SSDI in January 2012 and March 1and March 1stst 2012 started working and is 2012 started working and is earning $800.00 a monthearning $800.00 a month

What will happen to his benefits (if he What will happen to his benefits (if he continues to earn this amount) June 30continues to earn this amount) June 30thth 2012? 2012?

What will happen to his benefits (if he What will happen to his benefits (if he continues to earn this amount) December 1st continues to earn this amount) December 1st 2012?2012?

What if Chris stopped working August 30What if Chris stopped working August 30thth 2012 and restarted in April of 2017?2012 and restarted in April of 2017?

SSDI Work IncentivesSSDI Work Incentives

Incentives that can be used-Incentives that can be used-especially if beneficiary is hovering especially if beneficiary is hovering around SGA!around SGA! Impairment Related Work Experience Impairment Related Work Experience

(IRWE)(IRWE) Subsidy/Special conditionSubsidy/Special condition AveragingAveraging

SSDI IRWE and SGA SSDI IRWE and SGA ExampleExample

Person is earning $9.00/hour and is Person is earning $9.00/hour and is working $30 hours a week for total working $30 hours a week for total monthly earnings of $1080 monthly earnings of $1080

Paying $160 a month in job coachingPaying $160 a month in job coaching SSA would calculate SGA: $1080-SSA would calculate SGA: $1080-

$160=$920 so this person would still $160=$920 so this person would still receive full cash benefit.receive full cash benefit.

Why Bore you with all of the Why Bore you with all of the work incentive information?work incentive information?

When you hear people say they can’t When you hear people say they can’t work or they will lose their benefits work or they will lose their benefits you will be able to tell them it’s not you will be able to tell them it’s not true!true!

Many “safety nets” in place for Many “safety nets” in place for people to “try” workingpeople to “try” working

MedicareMedicare

Eligible for Medicare 24 months after Eligible for Medicare 24 months after eligibility for SSDI cash benefitseligibility for SSDI cash benefits

Part A, Part B, Part DPart A, Part B, Part D

MedicareMedicare

Extended Period of Medicare Extended Period of Medicare Coverage (EPMC)Coverage (EPMC) Up to 93 months of Medicare coverage Up to 93 months of Medicare coverage

after the completion of TWPafter the completion of TWP Healthcare coverage even if cash Healthcare coverage even if cash

benefit gets reduced to $0!benefit gets reduced to $0!

Supplemental Security Income Supplemental Security Income (SSI)(SSI)

Needs basedNeeds based Disability Determination from the Disability Determination from the

Disability Determination Bureau Disability Determination Bureau (DDB)(DDB)

Current Federal Benefit Rate (FBR): Current Federal Benefit Rate (FBR): $698.00$698.00

SSISSI

Income paid in 1 month affects the Income paid in 1 month affects the cash benefit 2 months latercash benefit 2 months later

Full benefit rate: $698 Full benefit rate: $698 1/3 reduction rate: $465.331/3 reduction rate: $465.33 States might have their own States might have their own

supplementssupplements

SSI Work IncentivesSSI Work Incentives

Student Earned Income Exclusion Student Earned Income Exclusion (SEIE)(SEIE) Exclusion of inform for individuals who Exclusion of inform for individuals who

are under the age of 22 and regularly are under the age of 22 and regularly attending schoolattending school

SSA will not count up to $1,700 monthly SSA will not count up to $1,700 monthly (max: $6,840 per year)(max: $6,840 per year)

This work incentive is applied first!This work incentive is applied first!

SSI Work IncentivesSSI Work Incentives

General Income Exclusion (GIE)General Income Exclusion (GIE) $20 disregard on unearned income; if $20 disregard on unearned income; if

not unearned income then applied to not unearned income then applied to earned incomeearned income

Earned Income Exclusion (EIE)Earned Income Exclusion (EIE) $65 and ½ disregard on earned income$65 and ½ disregard on earned income

SSI Work IncentivesSSI Work Incentives

Impairment Related Work Expense Impairment Related Work Expense (IRWE)(IRWE) Related to disability, paid for out of Related to disability, paid for out of

pocket and the beneficiary needs it in pocket and the beneficiary needs it in order to workorder to work

SSA will “repay” the individual $1 for SSA will “repay” the individual $1 for every $2 spent out of pocketevery $2 spent out of pocket

Any examples???Any examples???

Plan for Achieving Self Plan for Achieving Self SupportSupport

Set aside money (other than SSI) to Set aside money (other than SSI) to meet vocational goalmeet vocational goal

Money in the pass plan: does not Money in the pass plan: does not count towards SSI eligibilitycount towards SSI eligibility

SSI benefit ExampleSSI benefit Example

Individual is receiving full benefit Individual is receiving full benefit rate and is earning $373.00 a monthrate and is earning $373.00 a month

Not a studentNot a student No IRWENo IRWE Setting $100 a month away in a PASS Setting $100 a month away in a PASS

plan for a training programplan for a training program

SSI Benefit ExampleSSI Benefit Example

$373.00 monthly earnings and subtract$373.00 monthly earnings and subtract $100.00 for the Pass Plan for a total of$100.00 for the Pass Plan for a total of $273.00 you would then apply the $273.00 you would then apply the GIE: $273.00-$20.00=$253.00 you would thenGIE: $273.00-$20.00=$253.00 you would then Apply the EIE: $253-$65.00=$188 and then…Apply the EIE: $253-$65.00=$188 and then… $188/2=$94 and the final step:$188/2=$94 and the final step: $698-$94=$604$698-$94=$604 $604 will be monthly cash benefit 2 months later$604 will be monthly cash benefit 2 months later

SSI Benefit ExampleSSI Benefit Example

Sarah earns $850.00 in September Sarah earns $850.00 in September 20122012

Full time student; under the age 22Full time student; under the age 22 No IRWENo IRWE Eligible for the SSI full cash benefitEligible for the SSI full cash benefit No unearned incomeNo unearned income What will her cash benefit be in What will her cash benefit be in

November 2012?November 2012?

Answer…Answer…

September earnings: $850.00September earnings: $850.00 $850.00-$1700 (Student Earned Income $850.00-$1700 (Student Earned Income

Exclusion)=$0Exclusion)=$0 Sarah’s benefit in November will be the Sarah’s benefit in November will be the

full benefit because of the SEIE: $698.00full benefit because of the SEIE: $698.00 Sarah still has $5,990.00 of the SEIE for Sarah still has $5,990.00 of the SEIE for

the remainder of the year the remainder of the year

Another One!Another One!

Ben earns $552 a monthBen earns $552 a month Not a studentNot a student Eligible for the 1/3 reduction rateEligible for the 1/3 reduction rate Pays $80 a month for a job coach Pays $80 a month for a job coach

and has an approved IRWE for thisand has an approved IRWE for this What will his benefit be?What will his benefit be?

Answer…Answer…

$552 Earnings-$20.00 (General Income $552 Earnings-$20.00 (General Income Exclusion)=$532.00Exclusion)=$532.00

$532.00-$65.00 (Earned Income $532.00-$65.00 (Earned Income Exclusion)=$467.00Exclusion)=$467.00

$467.00-$40.00 (Impairment Related Work $467.00-$40.00 (Impairment Related Work Expense)=$427.00Expense)=$427.00

$427.00/2 (Earned Income Exclusion $427.00/2 (Earned Income Exclusion continued)=$213.50continued)=$213.50

$465.33 (1/3 Reduction rate)-$213.50=Benefit $465.33 (1/3 Reduction rate)-$213.50=Benefit amount of: $251.83amount of: $251.83

SSI/MedicaidSSI/Medicaid

States have different rules for Medicaid eligibility (i.e States have different rules for Medicaid eligibility (i.e some states automatically approve SSI beneficiaries for some states automatically approve SSI beneficiaries for Medicaid coverage, others have separate applicationMedicaid coverage, others have separate application

Coverage: Coverage: medically necessary doctor visitsmedically necessary doctor visits hospitalizationshospitalizations prescription drugsprescription drugs mental health servicesmental health services dental caredental care vision carevision care alcohol and drug treatmentalcohol and drug treatment equipment and supplies and equipment and supplies and transportation to medical appointments transportation to medical appointments

Medicaid “incentives”Medicaid “incentives”

1619b: Continued Medicaid coverage 1619b: Continued Medicaid coverage if cash benefit is $0 due to EARNED if cash benefit is $0 due to EARNED incomeincome First 12 months of this: “Suspension First 12 months of this: “Suspension

Period”Period”

Medicaid/MedicareMedicaid/Medicare

When someone receives both When someone receives both Medicaid and Medicare: Medicaid and Medicare: Part B Premiums are coveredPart B Premiums are covered All deductibles and co-pays are between All deductibles and co-pays are between

$0-$6$0-$6

Example: SSI/SSDI and Example: SSI/SSDI and earningsearnings

Receiving $607 in SSDI and receives Receiving $607 in SSDI and receives $111.00 in SSI$111.00 in SSI Calculation for SSI payment:Calculation for SSI payment:

$607-$20 (GIE)=$587.00$607-$20 (GIE)=$587.00 $698.00 current FBR-$587.00=$111.00$698.00 current FBR-$587.00=$111.00

Example SSI/SSDI and Example SSI/SSDI and earningsearnings

Receiving $607 in SSDI and receives Receiving $607 in SSDI and receives $111.00 in SSI and earning $199.95 a month$111.00 in SSI and earning $199.95 a month $199.95-$65 (EIE)=$134.95 then divide by 2 (EIE $199.95-$65 (EIE)=$134.95 then divide by 2 (EIE

continued)=$67.48 (countable earned income)continued)=$67.48 (countable earned income) $587 (countable unearned income)+ $67.48 $587 (countable unearned income)+ $67.48

(countable earned income)=$654.48(countable earned income)=$654.48 $698 (current FBR) - $654.48= $43.52 SSI cash $698 (current FBR) - $654.48= $43.52 SSI cash

benefitbenefit Total monthly earnings with work: Total monthly earnings with work:

$607+199.95+ $43.52$607+199.95+ $43.52=$850.47 =$850.47 (and any (and any other state specific supplements)other state specific supplements)

Ticket to WorkTicket to Work

All person receiving SSI or SSDI have a All person receiving SSI or SSDI have a “ticket”“ticket”

Can assign to local Employment Network Can assign to local Employment Network to receive assistance obtaining to receive assistance obtaining employmentemployment

More information: More information: http://ssa.gov/work/aboutticket.html

Important Take Away Important Take Away MessagesMessages

When beneficiaries work-they earn MORE moneyWhen beneficiaries work-they earn MORE money Big changes can occur Big changes can occur

With change in earnings and/or living situationWith change in earnings and/or living situation when beneficiary turns 18when beneficiary turns 18 is no longer a studentis no longer a student parent dies/retires or becomes disabled themselves orparent dies/retires or becomes disabled themselves or enough work credits are earnedenough work credits are earned

Refer ALL beneficiaries for Benefits Counseling Refer ALL beneficiaries for Benefits Counseling prior to graduationprior to graduation

There are ways to maintain health insurance!There are ways to maintain health insurance!

Important Take Away Important Take Away MessagesMessages

Invite Benefits Counselors to Invite Benefits Counselors to meetings with families who have meetings with families who have transition aged youth!transition aged youth!

Encourage families to inform SSA Encourage families to inform SSA that the individual is paying their fair that the individual is paying their fair share of room and boardshare of room and board

Earnings can affect other benefits: Earnings can affect other benefits: Food Stamps, HousingFood Stamps, Housing