SOCIAL SECURITY BENEFITSSSDI and SSI

Social Security Administration

Overview of

Disability Programs

SSDI & SSI

SOCIAL SECURITY DISABILITY--SSDI

• Insurance program based on quarters of coverage-paid by FICA taxes

• Not based on financial need • Earned quarters--$1090=One quarter• Disabled or blind under Social Security rules• 5 month waiting period• Medicare eligible after entitled for 24 months

Spouse Benefits

• Age 62 and married to worker• Any age mothers-worker’s child under age

16• Divorced spouse-married 10 years, age 62

unmarried• Surviving divorced spouse-age 60 married

10yrs can be remarried after age 60• Widow (er) married 9 months age 60• Disabled widow (er) age 50

Child Disability Benefits

• As a child (under 18) auxiliary beneficiary on the record of a parent receiving SSA benefits or deceased-disability not a factor

• As a Disabled Adult Child (over age 18) on the account of a parent

• SSI-as a child whose parents meet the income/resource limits-disability is a factor

SUPPLEMENTAL SECURITY INCOME SSI

• Federal welfare program based on need• Aged, disabled or blind• Be a U.S. citizen or qualified alien• Income/resources of spouse or parents (if

under 18) may affect eligibility• No waiting period• Automatic Medi-cal eligibility in CA• Paid by general taxes not FICA taxes

Disability Definition

• The same for both programs

• Inability to work is key for adults

• Inability to function is key for kids

• Disability must be severe enough to keep adult from doing any substantial work

• Disability must be expected to last 12 months

• ….or result in death

Who decides if you’re disabled?

Non-Disability Factors Disability Factors

•Social Security caseworker•SSI caseworker•Appeals and RepPayee paperwork handled by SSA Office

Medical folder sent to California Department of Social Services: Disability and Adult Services (DDS)

Representative Payees

Who needs one?

•Children

•Drug addicts

•Alcoholics

•Adults who are legally incompetent

•Psychological disorders

Who can be one?

•Parent or family member

•Legal guardian

•A close friend

•Custodian of the person

•Social Service agency

If Your Claim is Approved

• Generally takes 3-5 months to get decision

• SSDI benefits begin with the 6th full month of your disability (waiting period)

• Ex: Disability begins 01/09 and file 02/09 First payment month 07/09 payable in 08/09

• SSI benefits payable month after you file

• SSI review done before first payment

Appeal Process

• Initial claims 32% approval rate• 1st-Reconsideration: Claim sent back to

DDS for another review 8%• 2nd- Hearing: Administrative Law Judge

69% 2007 SSA Statistical Report• 3rd-Appeals Council Review: Judge

reviews ALJ decision• 4th Federal Courts: Civil court action• All have time periods

SSA Medical Benefits

Medicare•Part A-D•Federal program tied to SSDI and age 65•Entitled age 65 or 25th month after disability benefits•Monthly premiums

Medi-Cal•State program Medicaid•California Dept. of Social Services•Tied to SSI•Hawaii separate application•Medi-Cal pays Medicare premiums

SSA WORK INCENTIVES

• Most people with disabilities want to work

• SSA offers a package of work incentives to help them

• Work incentives allow beneficiaries to:

--Test ability to work and

--Gradually become self-supporting

FEARS, MYTHS, AND TRUTHS ABOUT WORK AND DISABILITY BENEFITS

• If I start working my benefits will stop or my income will go down-Fear

• Work incentives allow for continuation of cash benefits for a period of time-Truth

• I can make more money not working-Myth• Going to work will generally increase overall

income-Truth• I can’t work because I’ll lose my Medical

Insurance-Fear• Healthcare (Medicare and Medi-cal) can

continue even if claimant is working-Truth

FEARS, MYTHS, AND TRUTHS ABOUT WORK AND DISABILITY BENEFITS

• I’m afraid that if I go to work and my benefits stop, I’ll get sick again and have a hard time getting back on benefits-Fear

• Expedited Reinstatement can pay up to six months while you wait for decision-Truth

• I can’t get a good paying job-Myth• PASS Program, Ticket to Work and

Community Partners can help you-Truth• I get and SSA check-Myth• SSA benefits are SSDI-Truth

SSDI PRIMARY WORK INCENTIVES

• Trial Work Period

• Extended Period of Eligibility-SGA $980/1640

• Expedited Reinstatement

• Continuation of Medicare

• 301 VR payment

• Ticket to Work

TRIAL WORK PERIOD (TWP)

• Allows claimant to test work ability while still receiving full SSDI for 9 months

TWP• 2009-$700 constitutes a TWP month

• We give you a rolling 5 year period to earn the nine months

• If earning at or above the current SGA level we pay for the tenth month and two additional “grace” months

• Gives beneficiary a trial run on working

LET’S REVIEW THE NUMBERS…

• 9 Trial work months• 3 Grace months• During these

months claimant receives full SSDI check and their wages

EXTENDED PERIOD OF ELIGIBILITY

Starts at end of TWP and extends for 36 months

Claimant whose earnings drop below SGA in any month can get full SSDI payment for that month

Automatic reinstatement if work stops

IRWE

LET’S REVIEW THE NUMBERS…

• 9 Trial work months

• 3 Grace months

• During these months claimant receives full SSDI check and their wages

• 36 Extended period of eligibility—During these months claimant is entitled to the full SSDI check any month wages fall below SGA

EXPEDITED REINSTATEMENT

• Starts at end of EPE and runs for the following 60 months

• Claimant who stopped work due to same disability can be paid while we make a medical decision

• Pay up to six months

LET’S REVIEW THE NUMBERS..

• 9 Trial work months

• 3 Grace months

• 36 months Extended period of eligibility

• 60 months Expedited reinstatement

• 105 months = Almost 9 years that claimant stays connected to SSDI for the cash benefits

• 301 Pmts

CONTINUATION OF MEDICARE

• Starts at end of TWP

• 93 months starting the month after TWP

• 9 month TWP

• 93 months after TWP

• 102 Months of Medicare = 8 ½ years

TICKET TO WORK ACT OF 1999

• Ticket is a voucher to receive rehabilitation or training services from Employment Networks (EN)

• Almost anyone receiving SSDI or SSI disability 18-64

• Does not mean SSA believes claimant is no longer disabled

TICKET PROCESS OVERVIEW

• Ticket received by an SSDI/SSI claimant

• Claimant decides if they want to attempt to return to work and use the ticket

• Claimant contacts MAXIMUS 1-866-968-7842 for information on EN’s

• Claimant selects EN and they agree on an IWP (Individual Work Plan)

MORE TTW ENHANCEMENTS

• The Continuing Disability Review (CDR) process has changed

• Beneficiaries using Ticket will not be selected for a medical CDR

• SSDI/SSI beneficiaries who have received benefits for 24 months No Med CDR Section 111 Protection

• Regularly scheduled CDR’s will continue

SSI Payment Computation

$ 500.00 Social Security- 20.00 General Exclusion$ 480.00 Countable income$ 500.00 Wages- 65.00 Earned Income Exclusion$ 435.00 ÷ 2 = $217.50 Countable incomeTotal C/I $217.50 + $480.00 = $697.50$870.00 - $697.50 = $172.50 SSI

SSI WORK INCENTIVES

• Impairment related work expenses-IRWE

• Blind work expenses BWE

• Earned Income Exclusion

• Plan to Achieve Self Support-PASS

• Property Essential to Self support-PESS

• EXR• Continued Medi-cal

eligibility-1619b $2899 month

• Reinstatement eligibility without new application

• Student Earned income Exclusion

• 301 pmts

SSI WORK INCENTIVE EXAMPLE

• Tom goes back to work at Petco ParkSSI rate CA $935 no countable income $2500 gross wages -$1640 Student Earned Income Exclusion -$85 General & Earned Income Exclusion $775 countable income -$50 IRWE for Drugs -$725 countable income

SSI WORK INCENTIVES

$725 countable income -$362.50 ½ remaining earnings =$362.50 countable income -$100 BWE taxes and lunches at work =$262.50 countable income -$162.50 PASS for books and computer =$100 countable income $935-$100 = $835 SSI + $2500 wages =$3335 Total monthly income

Dealing with Social Security

• Online www.socialsecurity.gov

• Telephone: 1-800-772-1213

• In person

• 8 Branch offices in San Diego County

• Servicing areas

SAN DIEGO SSA OFFICESToll Free 1-800-772-1213

• 1333 Front St San Diego CA 92101 Tel: 619.557.5257• 626 L St. Chula Vista CA 91911 Tel: 619.427.7414• 846 Arnel St El Cajon CA 92020 Tel: 619.440.2943• 2160 S El Camino Real Oceanside CA 92054 Tel: 760.439.8025

• 8505 Aero Drive San Diego CA 92123 Tel: 858.278.1099• 2530 E Plaza Blvd National City CA 91950 Tel: 619.267.1175• 7961 University Ave La Mesa CA 91941 Tel: 619.464.8533• 367 Via Vera Cruz San Marcos CA 92078 Tel: 760.471.2155

QUESTIONS

E-Serviceswww.socialsecurity.gov

• Apply for retirement• Apply for SSDI• Apply for Medicare

Part D• Request a Social

Security statement• COA, telephone #• Replace Medicare

card

• Check status of online application

• Request a proof of income letter

• Get a form 1099/1042S

• Apply for direct deposit

• Retirement Estimator

HOW TO CONTACT THE PASS CADRE

♦ Toll Free 1.888.674.6250 ♦ Local 619.557.6605 ♦ Fax 619.557.5722 ♦ Mailing Address: 1333 Front Street San Diego CA 92101 ♦ PASS Specialist: Patrick Mattis & Peter Prather