basic boot camp for understanding benefits & work

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(Benefits Boot Camp)- SECT

BASIC Boot Camp for Understanding Benefits & Work

Presented by: Supported Employment Consultation

& Training (SECT) Center1100 Broadway

Anderson, IN 46012www.sectcenter.org

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Fall In! Your in Boot Camp now!!!

Sergeants: Payne & SuffrinA.K.A. Dennis Born & Denise Norris as your Boot

Camp Commanders

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The purpose of your “BASIC” Training

To give a brief overview of eligibility requirements for Title II and Title XVI Social Security and Medicaid programs.

To provide tools for calculating the impact of work income on Social Security and Medicaid.

Identify 2009 entitlement changes.

To identify educational resources available to individuals, case managers, and families.

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How Does Work Affect Benefits?

“…subjects reject competitive employment …in view of the fact that the working person loses money from his/her pension check and risks

losing the disability pension altogether if work continues for long.

Warner and Polak, Community Mental Health Journal, Vol. 31, No. 5, Oct. 1995

67% of unemployed individuals with disabilities indicate the reason they are not working because the increase income from work may cause a loss

or decrease in healthcare benefits.Indiana Medicaid Action Coalition, Healthcare Barriers to Employment Survey, 2000

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Social Security Administration:

Two Disability Programs: Title XVI

SUPPLEMENTAL SECURITY INCOME (SSI)

Title IISOCIAL SECURITY DISABILITY INSURANCE (SSDI)/SOCIAL SECURITY DISABLED ADULT CHILD (SSDAC)

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Obtaining SS Information:

Obtain Completed SSA Consent Forms for Release of a Benefits

Planning Query (BPQY) to an Authorized 3rd Party

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Benefits Planning Query (BPQY)Confidential Social Security Data

NAME: SSN:

Social Security Disability Insurance (SSDI)

Supplemental Security Income(SSI)

RECORD See Below See Below

CASHType of Benefit

Current Status

Statutory Blindness

Date of Disability Onset

Date of Entitlement

Full Amount

Net Amount

Others Paid on This Record

Total Family Cash Benefit

Overpayment Balance

Monthly Amount Withheld

Disabled Adult Child

Current Pay

No

8/31/91

08/91

$167.00

$78.00

No

$167.00

$0.00

$0.00

Disabled Individual

Current Pay

No

08/01/04

08/04

$456.50

$456.50

No

$0.00

None

MEDICAL REVIEWSNext Medical Review

Medical Re-exam Cycle

06/11

7+ years

09/23/07

3+ years

REPRESENTATIONRepresentative Payee

Authorized Representative

Yes

No

Yes

No

SSA-2459 Date Produced: 8/7/06July 2001 Page 1 of 2

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NAME: SSN:

HEALTH INSURANCE MEDICARE MEDICAID

Type PART A PART B PART C/D State determination

Start 08/1993 10/2004 01/2006

Stop

Buy-In or Subsidy No No 100%

SSI WORK EXCLUSIONS

Blind Work Expense

Impairment Related Work Expenses

Student Earned Income Exclusion

PASS Exclusion

SSDI WORK ACTIVITY

Trial Work Months Start: End: Used: 0 Months

Month of Cessation N/A

Current SGA Level $860.00

RECENT EARNINGS ON RECORD

YEAR EARNINGS YEAR EARNINGS MONTHS EARNINGS MONTHS EARNINGS 1989 $481.56 1990 $0.001991 $1,100.59 1992 $37.411993 $0.00 1994 $365.791995 $50.00 1996 $53.441997 $114.18 1998 $0.001999 $0.00 2000 $0.002001 $0.00 2002 $0.002003 $0.00 2003 $742.86

SSA-2459 Date Produced: 8/7/06July 2001 Page 2 0f 2

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SSI:A federal program that provides monthly payments to

persons with disabilities on a needs basis

Eligibilityo Have little or no unearned incomeo Be considered medically disabledo Initially not be working or working and earning less

than the Substantial Gainful Activity (SGA) level ($940 in 2008) $980 in 2009

o Have limited countable resources ($2,000 for an individual and $3,000 for an eligible couple in 2009)

2009 Federal Benefit Rate (FBR)o $674 (individual)/ $637 in 2008o $1,011.00 (eligible couple)/ $956 in 2008

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SSI & Work Incentives:

EXCLUSIONS General

o Excludes first $20 of incomeo Applies to unearned or earned income

Earnedo Excludes first $65 of earned incomeo Excludes one-half (1/2) of remaining gross

earnings

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SSI & Work Incentives

PLAN FOR ACHIEVING SELF-SUPPORT

STUDENT EARNED INCOME EXCLUSION

Property Essential to Self-Support (PESS)

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Other SSI Work Incentives

1619 a & b StatusPublic Law 99-643 - will not lose SSI eligibility due to exceeding SGA

Reinstatement of Eligibility Without a New Application

Section 301: Continued Payment under a Vocational Rehabilitation Program

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Both SSI & SSDI Work Incentives

IMPAIRMENT RELATED WORK EXPENSE

SSI

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SSDI/SSDACAn earned entitlement that enables former workers, who due

to a disability are unable to work, to receive monthly cash benefits and Medicare insurance

Eligibility (SSDI)o Have worked and paid Social Security taxeso Be considered medically disabledo Not be working, or working and earning less than the

Substantial Gainful Activity (SGA) level ($980 in 2009/ $940 in 2008)

Eligibility (SSDAC)o Be a dependent of an insured worker who is disabled, retired,

or deceasedo Under age 18, or 18 years of age or older and who has become

totally and seriously disabled before age 22o Not be working, or working and earning less than the

Substantial Gainful Activity (SGA) level ($980 in 2009/ $940 in 2008)

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SSDI/SSDAC & Work

Trial Work Periodo Allows an individual to continue to receive their

check regardless of the amount of money they earn

• $700 in 2009/ $670 in 2008• 9 months - do not need to be consecutive – in a 60

month rolling period

Extended Period of Eligibilityo Protects an individual’s eligibility but not

his/her checko 36 consecutive monthso Earnings over SGA will affect check

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Other SSDI Work Incentives

Impairment Related Work Expenseo Allows an individual to deduct the cost of certain

items/services from their gross wages in order to keep earnings below SGA

Subsidy & Special Conditions

Section 301: Continued Payment under a Vocational Rehabilitation Program

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Medicaid

A federal/state funded medical assistance program

administered by the Indiana Family and Social Services

Administration (FSSA)

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Medicaid EligibilityMust be substantially impaired per the definition of disability in State law:

• A physical or mental impairment, disease, or loss • Appears reasonably certain to last twelve (12) months or

more• Substantially impairs the person’s ability to perform labor

or services or to engage in useful occupation• Determination of disability is based on the individual’s

age, education, work experience, and functional limitations

Must meet certain income and resource limits:• 2009 Income Standard is $674 (individual) and $1,011.00

(couple) * will most likely follow SSA guidelines for 2009

• 2009 resource limits are $1,500 (individual) and $2,250 (couple)

Must be a resident of Indiana

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Medicaid & Work

Spend-downo Enables recipients to qualify for

some Medicaid when their income exceeds the Medicaid Monthly Income Standard

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Medicaid & Work

1619 Status “the big gun!!!”o1619 (a)• Must receive SSI & Medicaid• Protects an individual’s Medicaid

eligibility without a spend-down when earning exceed SGA

o1619 (b)• Must receive SSI & Medicaid• Protects an individual’s Medicaid

eligibility without a spend-down when his/her SSI check is reduced to zero (0) due to earnings

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Medicaid & WorkMedicaid for Employees with Disabilities (MED Works)

o Eligibility• Meet state definition of disability• Between ages of 16 and 65• Be engaged in a substantial and reasonable work effort• Have monthly income that exceeds the spend-down income

standardo 2009 Income Limit = $3,159 (as of 3/1/09)o 2009 Resource Limits

• $2,000 (single)• $3,000 (couple)

o Monthly premiums • Must pay premium based on gross monthly income• Zero (0) premium for single persons earning less than $1,353 or

married couples earning less than $1,821 (as of 3/1/09)

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Example: Joe receives $850.00 SSDI each month. He obtains a job as an Auto Technician working 20 hours a week. He earns $7.00 an hour.

Note: Gross Monthly Earned Income: Hours X $ X 4.3 (weeks) = GMEI (20 X 7 X 4.3 = $602.00)

Unearned Income Only- Spend down

(Before Obtaining Employment)

Step 1 $ unearned income (e.g., SSDI)

- 15.50 general disregard $ total countable income

Step 2 $ total countable income

- 623.00 income standard $ spend-down

Earned and Unearned Income- Spend down

(Before MED Works)

Step 1 $ unearned income - 15.50 general disregard $ countable unearned income Step 2 $ gross monthly earned income - 65.00 earned income disregard $ revised earned income ÷ 2 divide by 2 $ countable earned income Step 3 $ countable unearned income + countable earned income $ total countable income Step 4 $ total countable income - 623.00 income standard $ spend-down amount

850.00

834.50

834.50

211.50

850.00

834.50

602.00

537.00

268.50

834.50268.50

1103.00

1103.00

480.00

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2009 MED Works Premiums

GrossmonthlyIncome

as a

percentof FPG

<150% 150%≤175% >175%≤200% >200%≤250% >250%≤300% >300%≤350% >350%

Single

GrossMonthlyincome

$0-$1,353

$1,354-$1,580 $1,581-$1,8050

$1,806-$2,257 $2,258-$2,708 $2,709-$3,159 $3,160.+

MonthlyPremium $0 $48 $69 $107 $134 $161 $187

Married

GrossMonthlyincome

$0-$1,821

$1,822-$2,125 $2,126-$24292 $2,430-$3,036 $3,0374-$3,643

$3,644-$4250 $4,251+

MonthlyPremium $0 $65 $93 $145 $182 $218 $254

Please note: Gross monthly income must be at or below the high dollar figure within a given percentage range. For example, in a family size of one, an individual must earn $1,276.00 (gross monthly) or less to qualify for MED Works with no premium. If that same individual earns $1,276.01, earnings would be rounded up to the next income level of $1,277.00, resulting in a $48 monthly premium.

Note: To figure out the premium add gross earned income with unearned income to equal gross monthly income.

Example: $ 602.00 gross earned income (wages)+ 850.00 unearned income$1452.00 total gross monthly income premium cost: $ 48.00

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Medicare

A federally funded health insurance program for individuals:

Aged 65 or older

Have end-stage renal disease

Receiving SSDI/SSDAC benefits

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Medicare & WorkReceive at least 93 months of premium-free hospital insurance (Part A) after Trial Work Period even with earnings over Substantial Gainful Work Activity.

Medicare could continue if you never work over Substantial Gainful Activity.

Medicare Buy-Backo Purchase Medicare If it’s stopped due to worko Options

• Part A & Part B• Part A only

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Other Entitlement Work Incentives

The Indiana Food Stamp Program

Section 8 Housing

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Acronyms

BPQY Benefits Planning QueryBWE Blind Work ExpenseCDR Continuing Disability ReviewDDS Disability Determination ServicesEPE Extended Period of EligibilityFBR Federal Benefit RateFPG Federal Poverty GuidelineIRWE Impairment-Related Work ExpenseMAD Medicaid for the Disabled – Full CoverageMADW Medicaid for the Disabled – Working IndividualMADI Medicaid for the Disabled – Medically ImprovedPASS Plan for Achieving Self-SupportPESS Property Essential to Self-SupportPMP Primary Medical ProviderSGA Substantial Gainful ActivitySSA Social Security AdministrationSSDAC Social Security Disabled Adult/ChildSSDI Social Security Disability Insurance (Title II)SSI Supplemental Security Income (Title XVI)TWP Trial Work PeriodUWA Unsuccessful Work AttemptWIPA Work Incentives Planning and Assistance BPAO Benefits Planning, Assistance, & Outreach

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Contact Information

The Supported Employment Consultation and Training (SECT) Center

1100 BroadwayAnderson, IN 46012www.sectcenter.org

Dennis Born, S.E.C.T. Director Denise Norris

Trainer/Consultant Community Work Incentive Coordinator

765.641.8382 765.635.4439 [email protected] [email protected]

mailto:[email protected]

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