the red book 2012

8/3/2019 The Red Book 2012

1/59

2012 RED BOOK

A SUMMARY GUIDE TO EMPLOYMENT SUPPORTS

FOR PERSONS WITH DISABILITIES UNDER THE SOCIAL

SECURITY DISABILITY INSURANCE AND SUPPLEMENTAL

SECURITY INCOME PROGRAMS

8/3/2019 The Red Book 2012

2/59

TABLE OF CONTENTS

INTRODUCING THE 2012 RED BOOK 1

WHATS NEW IN 2012 2Automatic Adjustments E ective January 1, 2012 2

CONTACTING US 3How to Reach Social Security 3

Request copies o the Red Book or other SSA Publications 3

HOW DO WE DEFINE DISABILITY? 5Our De nit ion o Disability 5

What is Substantial Gainul Activity (SGA)? 5

How Do We Evaluate Your Work Activity or SGA Purposes? 5

What I You Are Sel-employed? 5

OVERVIEW OF OUR DISABILITY PROGRAMS 7Social Security Disability Insurance Program (SSDI) 7

Supplemental Security Income Program (SSI) 7

When You Receive Both SSDI and SSI 7

Comparison o the SSDI and SSI Disability Programs 8

RETURNING TO WORK 9What Are Your Responsibilities When You Return to Work? 9

When Will We Review Your Disability? 9

When Will Your Bene ts Stop? 9

HOW DO EMPLOYMENT SUPPORTS HELP? 11SSDI Employment Supports 11

SSI Employment Supports 11

Guide to Employment Supports 12

RESOURCES TO ASSIST YOU RETURN TO WORK 13Work Incentive Liaison (WIL) 13Area Work Incentives Coordinator (AWIC) 13

Bene ts Planning Query (BPQY) 13

Work Incentives Planning and Assistance (WIPA) Projects 13

Work Incentives Seminar (WISE) 14

State Vocational Rehabilitation Providers 14

Protection and Advocacy or Bene ciaries o Social Security (PABSS) 14

Individual Development Accounts (IDA) 15

SSDI AND SSI EMPLOYMENT SUPPORTS 16Subsidies and Special Conditions 16

Unsuccessul Work Attempt (UWA) 17Impairment-Related Work Expenses (IRWE) 18

Examples o Deductible and Non-Deductible IRWE 19

Plan to Achieve Sel-Support (PASS) 21

Who Can Help You Set Up a PASS? 22

Examples o a PASS 22

Ticket to Work 23

Continued Payment under Vocational Rehabilitation or Similar Program (Section 301) 24

Expedited Reinstatement (EXR) 25

8/3/2019 The Red Book 2012

3/59

SSDI ONLY EMPLOYMENT SUPPORTS 26Trial Work Period (TWP) 26

Extended Period o Eligibility (EPE) 27

Unincurred Business Expenses (Sel-Employment) 28

Continuation o Medicare Coverage 29

Medicare or Persons with Disabilities Who Work 30

SSDI at a Glance What Happens When You Go to Work 32

SSI ONLY EMPLOYMENT SUPPORTS 33Earned Income Exclusion 33

Examples o the Earned Income Exclusion 33

Student Earned Income Exclusion (SEIE) 34

Property Essential to Sel-Support (PESS) 36

Special SSI Payments or Persons Who Work Section 1619(a) 37

Reinstating SSI Eligibility Without a New Application 38

Special Bene ts I You Are Eligible Under 1619 and Enter a Medical Facility 39

Medicaid While Working Section 1619(b) 402012 State Threshold Amounts or Persons with Disabilities 41

2012 States with Separate Threshold Amounts or Blind Persons 41

SPECIAL RULES FOR PERSONS WHO ARE BLIND 42How We Apply SGA Under SSDI to Persons Who Are Blind 42

Blind Work Expenses (BWE) 43

Comparison o Monthly SSI Payment With BWE Versus IRWE 43

Accommodations or Persons Who Are Blind or Visually Impaired 44

ADDITIONAL HELP WITH HEALTH CARE FOR PERSONS WITH DISABILITIES 45Medicaid Buy-In or Working Persons with Disabilities 45

Help with Medicare Part A Premiums 45

EXAMPLE OF CONCURRENT BENEFITS WITH EMPLOYMENT SUPPORTS 46Summary o Example with Concurrent Bene ts 50

DEMONSTRATION PROJECTS UPDATE 51Accelerated Bene ts 51

Bene t O set National Demonstration (BOND) 51

Youth Transition Demonstration (YTD) 51

Current Events 51

GLOSSARY 52

8/3/2019 The Red Book 2012

4/59

1

INTRODUCING THE 2012 RED BOOK

Purpose o the Red Book

One o the Social Security Administrations (SSA) highest priorities is to support the e orts o disabled

bene ciaries who want to work by developing policies and services to help them reach their employment

goal The Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs include

a number o employment support provisions commonly reerred to as work incentives

The Red Book is a general reerence tool designed to provide a working knowledge o these provisions We

write the Red Book primarily or educators, advocates, rehabilitation proessionals, and counselors who serve

persons with disabilities We also expect that applicants and bene ciaries will use it as a sel-help guide

The Red Book contains a general description o our disabilit y-related policies For inormation speci c to your

situation regarding eligibility or bene ts, you may need to contact us You will nd contact inormation on

page 3

The Red Book, including the Spanish language version, is available online at:

www.socialsecurity.gov/redbook

Purpose of Employment Supports

Congress intended the employment support provisions to provide you with the assistance you need to move

rom bene t dependency to independence Employment supports help you to enter, re-enter, or stay in the

workorce by protecting your eligibility or cash payments and/or health care until you achieve this goal

Di erent rules apply to bene ts based on retirement or age We cover those rules in other publications Most

SSA publications and other public inormation materials are available at our Internet site, Social Security Online,

located at www.socialsecurity.gov

Plain Language

We tried to keep the Red Book clear and brie We ollowed Plain Language guidelines We generally use

we, us, and our to reer collectively to the Social Security Administration (SSA), the Social Security Act,

our regulations, and operating instructions We use you and your to reer to the person who is claiming

bene ts based on disability

Previous Editions

This 2012 edit ion replaces all previous editions
http://www.socialsecurity.gov/redbookhttp://www.socialsecurity.gov/http://www.socialsecurity.gov/http://www.socialsecurity.gov/redbook

8/3/2019 The Red Book 2012

5/59

2

WHATS NEW IN 2012

Automatic Adjustments Eective January 1, 2012

Substantial Gainul Activity (SGA)

The Substantial Gainul Activity (SGA) amount or persons with disabilities other than blindness, is$1,010 per

month in 2012

For persons who are blind, the amount o earnings that indicate SGA is$1,690 per month in 2012 Details on

SGA are onpage 5

Trial Work Period (TWP) Months

The monthly earnings amount that we use to determine i a month counts as a TWP month is $720 per month

in 2012 The amount is unchanged rom 2011 Details on the TWP are onpage 26

Federal Benet Rate (FBR)

For 2012, the SSI Federal Bene t Rates is $698 per month or an eligible individual and $1,048 per month

or an eligible couple

Student Earned-Income Exclusion (SEIE)

For 2012, the amount o earnings that will have no e ect on eligibility or bene ts or SSI bene ciaries who arestudents is$6,840 a year The amount o earnings that we can exclude each month, until we have excluded

the maximum or the year, is$1,700 a month Details on the SEIE are onpage 34

Medicare Part A Hospital Insurance

For 2012, the monthly Medicare Part A Hospital Insurance base premium is $45100, and the 45% reduced

premium is$24800

Medicare Part B Supplemental Medical Insurance

For 2012, the Part B Supplemental Medical Insurance monthly base premium is $9990 Details on Medicare or

Persons with Disabilities Who Work are onpage 30

Medicaid While WorkingFor 2012, we increased the Medicaid While Working State Threshold Amounts or persons with disabilit ies We

use yearly state threshold amounts to decide i earnings are high enough to replace SSI and Medicaid bene ts

We listed the 2012 amounts or each state onpage 41.

8/3/2019 The Red Book 2012

6/59

3

CONTACTING US

How to Reach Social Security

Internet AccessOur Internet site, Social Security Online, is located at www.socialsecurity.gov Most SSA publications and other

public inormation materials are available at this site

Links that may be o interest to the community serving persons with disabilities:

www.socialsecurity.gov/disabilityThis site provides comprehensive inormation on our disability bene ts programs

www.socialsecurity.gov/workThis site provides inormation on our Ticket to Work program It also lists the

Work Incentive Planning and Assistance and Protection and Advocacy groups

(seepage Resources to Assist You Return to Work on page 13)

By TelephoneCall our toll-ree number, 1-800-772-1213, between 7 am and 7 pm, Monday through Friday I you have a

touch-tone telephone, recorded inormation and services are available 24 hours a day, including weekends

and holidays

I you are hearing impaired, call our toll-ree TTY/TDD number 1-800-325-0778 between 7 am and 7 pm,

Monday through Friday

Find Your Local OfceI you have a problem or question, try our toll-ree telephone number rst Our telephone representatives will

either help you or put you in contact with your local o ce, i needed Many local telephone directories list

local o ces under Social Security

I you have Internet access, you can nd your local o ce by going to the Social Security O ce Locator on

our website, Social Security Online, at www.socialsecurity.gov/locator Enter your postal ZIP code to get the

address, telephone number, and directions to your local o ce

By MailI you have been unable to resolve a problem atercalling our toll-ree telephone number or atercontacting

your local o ce, you may write to the O ce o Public Inquiries:

Social Security Administration

O ce o Public Inquiries

6401 Security Blvd

Baltimore, MD 21235-6401

Request copies o the Red Book or other SSA Publications

I you want copies o our public inormation materials (including the Red Book), ax your request to

410-965-2037, or mail your request to:

O ce o Supply & Warehouse Management


239 Supply Building

6301 Securit y Blvd


We will not ship to Post O ce boxes
http://www.socialsecurity.gov/http://www.socialsecurity.gov/disabilityhttp://www.socialsecurity.gov/workhttp://www.socialsecurity.gov/locatorhttp://www.socialsecurity.gov/locatorhttp://www.socialsecurity.gov/workhttp://www.socialsecurity.gov/disabilityhttp://www.socialsecurity.gov/

8/3/2019 The Red Book 2012

7/59

4

Send Comments or Suggestions about the Red BookMail your comments to:


O ce o Program Development and Research

Attention: Red Book Editor

PO Box 17778


or ax your comments to: 410-597-0825, Attention: Red Book Editor

or email: [email protected]
mailto:[email protected]:[email protected]

8/3/2019 The Red Book 2012

8/59

5

HOW DO WE DEFINE DISABILITY?

Our Denition o Disability

To meet our de nition o disability, you must not be able to engage in any substantial gainul activit y (SGA)

because o a medically-determinable physical or mental impairment(s):

That is expected to result in death, or

That has lasted or is expected to last or a continuous period o at least 12 months

Note: There is a separate denition o disability or children (under age 18) who are applying or the Supplemental

Security Income (SSI) program. A disabled child also qualies or the SSI employment supports described later in the

Red Book.

What is Substantial Gainul Activity (SGA)?

We use the term substantial gainul activity to describe a level o work activity and earnings

Work is substantial i it involves doing signi cant physical or mental activities or a combination o both For

work activity to be substantial, it does not need to be perormed on a ull-time basis Work activity perormed

on a part-t ime basis may also be substantial gainul activity

Gainul work activity is:

Work perormed or pay or pro t; or

Work o a nature generally perormed or pay or pro t; or

Work intended or pro t, whether or not a pro t is realized

We use SGA as one o the actors to decide i you are eligible or disabilit y bene ts I you receive SSDI bene ts,

we use SGA to decide i your eligibilit y or bene ts continues ater you return to work and complete your Trial

Work Period (TWP, seepage 26) I you receive SSI bene ts based on disability, we apply di erent standards

to determine i your eligibilit y or bene ts should continue For details on how we calculate SSI bene ts, see

page 33We do not use SGA as a actor to determine initial eligibility or SSI bene ts i you are blind

How Do We Evaluate Your Work Activity or SGA Purposes?

We generally useearnings guidelines to evaluate whether your work activity is SGA

The amount o monthly earnings we consider to be SGA depends on the nature o your disability The Social

Security Act speci es a higher SGA amount or persons who meet the de nition o blindness described by the

law For details on our rules about earnings and blindness, seepage 42 I your impairment is anything other

than blindness, earnings averaging over $1,010 a month (or the year 2012) generally demonstrate SGA I you

are blind, earnings averaging over $1,690 a month (or the year 2012) generally demonstrate SGA or SSDI

We usually adjust these amounts every year based on increases in the national average wage index

What I You Are Sel-employed?

I you are sel-employed and your disabilit y is not blindness, the way we evaluate your work activity or SGA

purposes will depend on whether we evaluate your work activity beore or ater you have received SSDI

bene ts or 24 months and the purpose o the evaluation We will evaluate your work under The Three Tests or

the Countable Income Test to determine i your work activity is SGA, depending on when you work

8/3/2019 The Red Book 2012

9/59

6

The Three Tests:We apply three tests to evaluate your work activity when you init ially apply or SSDI and beore you have

received SSDI bene ts or 24 months We will also use the three tests to evaluate your work activity during the

re-entitlement period to determine i we can reinstate your bene ts in the Extended Period o Eligibility (see

page27) Your sel-employment work activity is SGA i:

You render signi cant services to the business, and you had average monthly earnings over the SGA level

($1,010 in 2012); orYour work is comparable to the work o persons without disability in your community engaged in the

same or similar businesses; or

Your work is worth more than the SGA level earnings in terms o its e ects on the business or when

compared to what you would have to pay an employee to do the work

The Countable Income Test:

We apply the countable income test i you have received SSDI bene ts or at least 24 months We will only use

the countable income test to determine whether you have engaged in SGA and i your disability has ended as

a result o that SGA

We will compare your countable earnings to the SGA earnings guidelines I your monthly countable earningsaverage more than $1,010 (in 2012), we will determine that your work is SGA unless there is evidence that you

are not rendering signi cant services in the month I your monthly countable earnings average less than

$1,010, we will decide that your work is not SGA

I you are sel-employed and your disability is blindness, we decide SGA based on whether you have

received a substantial income rom the business and rendered signi cant services to the business We make

this determination using your countable earnings We also use your countable earnings to determine whether

your work is SGA and we can reinstate bene ts during the Extended Period o Eligibility (seepage 27)

I you are sel-employed, your disability is blindness, and you are age 55 or older, special rules apply

I your earnings demonstrate SGA but your work requires a lower level o skill and abilit y than the work

you did beore age 55, or when you became blind, whichever is later, we will suspend, not terminate, yourbene ts Your eligibilit y or SSDI bene ts continues inde nitely, and we pay your bene ts or any months

earnings all below SGA

8/3/2019 The Red Book 2012

10/59

7

OVERVIEW OF OUR DISABILITY PROGRAMS

We manage two programs that provide bene ts based on disability or blindness, the Social Security Disability

Insurance (SSDI) program and the Supplemental Security Income (SSI) program

Social Security Disability Insurance Program (SSDI)

SSDI provides bene ts to disabled or blind persons who are insured by workers contributions to the SocialSecurity trust und These contribut ions are based on your earnings (or those o your spouse or parents) as

required by the Federal Insurance Contributions Act (FICA) Title II o the Social Security Act authorizes SSDI

bene ts Your dependants may also be eligible or bene ts rom your earnings record

Supplemental Security Income Program (SSI)

The SSI program makes cash assistance payments to aged, blind, and disabled persons (including children)

who have limited income and resources The Federal Government unds SSI rom general tax revenues Many

states pay a supplemental bene t to persons in addition to their Federal bene ts Some o these states have

made arrangements with us to combine their supplemental payment with our Federal SSI payment into one

monthly check to you Other states manage their own programs and make their payments separately Title XVI

o the Social Security Act authorizes SSI bene ts

When You Receive Both SSDI and SSI

We use the term concurrent to describe persons who are eligible or disability bene ts under both the SSDI

and SSI programs To show how a persons concurrent bene ts would be a ected by returning to work, we

have provided an example o a concurrent bene ciary situation onpage 46

Note: The SSDI and SSI programs share many concepts and terms, however, there are also many very important

diferences in the rules afecting eligibility and benet payments. The ollowing table summarizes diferences

between the SSDI and SSI programs. These diferences are important as many persons may apply or be eligible or

benets under both programs.

8/3/2019 The Red Book 2012

11/59

8

Comparison o the SSDI and SSI Disability Programs

SSDI SSI

Source o payments Disability trust und General tax revenues

Minimum Initial

QualicationRequirements

Must meet SSAs disability criteria Must

be insured due to contributions madeto FICA based on your own payroll

earnings, or those o your spouse or

your parents

Must meet SSAs disability criteria

Must have limited income and

resources

Health InsuranceCoverage Provided

Medicare Consists o hospital

insurance (Part A), supplementary

medical insurance (Part B), and

Medicare Advantage (Part C) Voluntary

prescription drug bene ts (Part D) are

also included Title XVIII o the Social

Security Act authorizes Medicare

Medicaid A jointly-unded, Federal-State

health insurance program or persons

with limited income and resources

It covers certain children, and some

or all o the aged, blind, and disabled

in a state who are eligible to receive

ederally-assisted income maintenance

payments Tit le XIX o the Social Security

Act authorizes Medicaid The law gives

the states options regarding eligibility

under Medicaid

How do we gureyour monthlypayment amount?

We base your SSDI monthly payment

amount on the workers lietime average

earnings covered by Social Security We

may reduce the amount i you receive

Workers Compensation payments

(including Black Lung payments) and/or

public disability bene ts, or example,certain state and civil service disability

bene ts Other income or resources do

not a ect your payment amount We

usually adjust the monthly payment

amount each year to account or cost-o-

living changes

We can also pay SSDI monthly bene ts

to dependents on your record, such as

minor children

To gure your payment amount, we

start with the Federal Bene t Rate (FBR)

In 2012, the FBR is $698 or a quali ed

individual and $1,048 or a quali ed

couple We subtract your countable

income rom the FBR and then add your

state supplement, i any

We do not count all o the income that

you have The income amount let ater

we make all the allowable deductions is

countable income

The sections on SSI employment

supports explain some o the ways that

we can exclude income

We usually adjust the FBR each year to

account or cost-o-living changesIs a StateSupplementalPayment provided?

There is no state supplemental payment

with the SSDI program

Many states pay some persons who

receive SSI an additional amount called

a state supplement The amounts

and quali cations or these state

supplements vary rom state to state

8/3/2019 The Red Book 2012

12/59

9

RETURNING TO WORK

What Are Your Responsibilities When You Return to Work?

I you receive SSDI or SSI bene ts, you or your representative payee must promptly report any changes in work

activity You must tell us right away i:

You start or stop work;

You already reported your work, but your duties, hours, or pay have changed;

You start paying or expenses that you need or work due to your disability Seepage 18or more

inormation on impairment-related work expenses

You can report changes in your work activity by phone, ax, mail, or in person Call our toll-ree number

1-800-772-1213 between 7 am and 7 pm, Monday through Friday, or visit your local SSA o ce You can nd

your local o ce by going to our website at www.socialsecurity.gov

When you report changes in your work activity, we will give you a receipt to veriy that you have properly

ul lled your obligation to report Keep this receipt with all o your other important papers rom Social Security

When Will We Review Your Disability?We will review your case periodically to see i your condition has medically improved or i you can perorm SGA

I you have received SSDI bene ts or at least 24 months, we will not do this review just because you are

working We also will not perorm a review to see i your condition has medically improved while you are using

a Ticket to Work (seepage 23) We will review your case when we receive inormation that you may have

medically improved or during a regular, scheduled continuing disability review

I you receive SSI bene ts, we may review your case i you work and are eligible or Medicaid While Working or

i there are changes in your work status We will not review your case more oten than once a year

When Will Your Benets Stop?

I you receive SSDI benets and we nd that you no longer meet the requirements or disability due either

to work at the SGA level or medical improvement, we say that your disabilit y ceased I we nd that your

disabilit y ceased due to work at the SGA level, our decision is e ective in the month shown by the evidence I

we nd that your disability ceased due to medical improvement, our decision is e ective in the month shown

by the evidence, or the month we give you writ ten notice, i later In either case, we pay SSDI bene ts or the

cessation month and the ollowing 2 months We call these 3 months the grace period

Your SSDI bene ts may continue:

I we cease your disability due to your work at the SGA level and then your earnings all below SGA within

the Extended Period o Eligibility (seepage 27), or

I we ceased your disabilit y due to medical improvement andyou are participating in a program ovocational rehabilitation or similar services (seepage 24)
http://www.socialsecurity.gov/http://www.socialsecurity.gov/

8/3/2019 The Red Book 2012

13/59

10

I you receive SSI benets and we nd that you no longer meet the requirements or disability due to

medical improvement, we say that your disability ceased Our decision is e ective with the month shown

by the evidence, or the month we give you written notice, i later However, your SSI eligibility continues or

that month and the ollowing 2 months i you meet all the non-disability-related requirements including the

income and resources tests We call these 3 months the grace period

I we cease your disability due to medical improvement, your SSI bene ts may continue i you are participating

in a program o vocational rehabilitation or similar services, employment services, or other support services

(seepage 24)

You are not eligible or an SSI payment or any months you do not meet the non-disability eligibility

requirements, or example, the income or resources tests

8/3/2019 The Red Book 2012

14/59

1

HOW DO EMPLOYMENT SUPPORTS HELP?

The employment-support provisions are intended to assist you in your e orts to become sel-su cient

through work Employment supports can help you nd a job or start a business, protect your cash and medical

bene ts while you work, or save money to go to school I your bene ts end because o your work and you

have to stop working later, employment supports can make it easy to begin receiving bene ts again

We discuss each employment support on the ollowing Pages You should view all o the employment

supports as a total package to ully appreciate the multiple levels o support available to help you achieve your

personalized goal o greater economic independence The ollowing table provides a brie description o the

SSDI and SSI employment supports The last column in the table indicates the Page number in the Red Book

where you can nd a more detailed description o the employment support

SSDI Employment Supports

The SSDI employment supports provide help over a long period o time to allow you to test your ability

to work, or to continue working, and gradually become sel-supporting and independent In general, you

have at least 9 years to test your ability to work This includes ull cash payments during the rst 12 months

o work activity, a 36-month re-entitlement period during the Extended Period o Eligibility (EPE), and a5-year period in which we can start your cash bene ts again without a new application (see Expedited

Reinstatement,page 25) You may continue to have Medicare coverage during this time or even longer

SSI Employment Supports

The SSI employment supports o er ways or you to continue receiving your SSI checks and/or Medicaid coverage

while you work Some o these provisions can increase your net income to help cover special expenses

Once you receive SSI, we consider that your disability continues until you medically recover, even i you work

I you cannot receive SSI checks because your earnings are too high, your eligibility or Medicaid may continue

while you are working In most cases, i you lose your job or are unable to continue working, you can begin

receiving checks again without ling a new application

8/3/2019 The Red Book 2012

15/59

12

Guide to Employment Supports

Employment Support(Alphabetically Listed)

How This Employment Support Can Help YouSee

page

Blind Work Expenses (BWE) Do you work, receive SSI based on blindness, and havework-related expenses?

43

Continued Payment Under aVocational Rehabilitation orSimilar Program (Section 301)

Has your medical condition improved and are youparticipating in a vocational rehabilitation or similar program?

24

Earned Income Exclusion How do we gure your monthly SSI payment amounti you work?

33

Expedited Reinstatement (EXR) I your bene ts ended because you successully returned towork, can you get bene ts again i you stop working?

25

Extended Period o Eligibility (EPE) How long can you receive SSDI bene ts ater youreturn to work?

27

Impairment-Related Work Expenses

(IRWE)Do you pay or items or services related to your disability thatyou need in order to work? 18

Medicaid While Working Section 1619(b) What happens to your Medicaid ater you return to work? 40

Medicare Continuation What happens to your Medicare ater you return to work? 29

Medicare or Persons withDisabilities Who Work

What happens i you are no longer eligible or ree MedicarePart A because o your work?

30

Plan to Achieve Sel-Support(PASS)

Do you receive SSI (or SSDI and are eligible or SSI) and want toset aside money to pursue an employment goal?

21

Property Essential to Sel-Support(PESS)

Do you receive SSI and own property or resources that areessential to your means o sel-support?

36

Reinstating SSI Eligibility Withouta New Application

How can you restart your SSI cash payments i you stopworking?

38

Special SSI Payments or PersonsWho Work Section 1619(a)

What happens to your SSI cash bene ts when your earnedincome is substantial but you are still disabled?

37

Special SSI Payments or PersonsEligible Under Section 1619 WhoEnter a Medical Treatment Facility

What happens to your SSI payment i you are working, but youhave to enter a medical acility?

39

Subsidy and Special Conditions Do you work and receive SSDI but have extra help on the jobor have ewer or simpler tasks than other workers?

16

Ticket to Work (Ticket or TTW)Do you want assistance to help you return to work? 23

Trial Work Period (TWP) How can you test your abilit y to work without losingyour SSDI bene ts?

26

Unincurred Business Expenses Do you receive SSDI and are you sel-employed? 28

Unsuccessul Work Attempt (UWA)What happens to your SSDI bene ts i you t ry to return towork but have to stop working or reduce your hours becauseo your disability?

17

8/3/2019 The Red Book 2012

16/59

1

RESOURCES TO ASSIST YOU RETURN TO WORK

You can get inormation about SSAs employment support provisions at any o our SSA eld o ces around the

country You may also call us toll ree at 1-800-772-1213, rom 7 am to 7 pm, Monday through Friday

Work Incentive Liaison (WIL)

Each o our local Social Security o ces has a Work Incentive Liaison (WIL) who provides advice and inormationabout our work incentive provisions and employment support programs to individuals with disabilities and

outside organizations that serve those with disabilities

Area Work Incentives Coordinator (AWIC)

AWICs are experienced employment support experts who:Coordinate and/or conduct public outreach on work incentives in their local areas;

Provide and/or coordinate and oversee training on SSAs employment support programs or all personnel

at local Social Security o ces;

Handle sensitive or high pro le disability work-issue cases, i necessary; and

Monitor the disability work-issue workloads in their areas

Inormation on how to contact your local AWIC is available at

www.socialsecurity.gov/work/awiccontacts.html

Benets Planning Query (BPQY)

A BPQY provides inormation about a bene ciarys disability cash bene ts, health insurance, scheduled continuing

disability reviews, representative payee, and work history, as stored in SSAs electronic records The BPQY is an

important planning tool or a bene ciary, an AWIC, PASS Specialist, bene ts counselor, or other person who may be

developing customized services or a disability bene ciary who wants to start working or stay on the job

We provide BPQYs to bene ciaries, their representative payees and their authorized representatives o record upon

request Bene ciaries can request a BPQY by contacting their local SSA o ce or by calling SSAs toll ree number,1-800-772-1213between 7 am and 7 pm, Monday through Friday People who are dea or hard-o-hearing may

call our toll-ree TTY/TDD number,1-800-325-0778, between 7 am and 7 pm Monday through Friday

I someone other than the bene ciary, representative payee, or authorized representative (a bene ts

counselor, or example) wishes to receive a BPQY, they must submit two SSA-3288 orms (Consent or Release

o Inormation) that have been signed by the bene ciary One is to authorize the release o Social Security

records and the other to authorize the release o Internal Revenue Service earnings records Both releases must

contain the bene ciarys Social Security number or the claim number Copies o the SSA-3288 are available at

www.socialsecurity.gov/work/ormsandpubs.html

Work Incentives Planning and Assistance (WIPA) Projects

WIPA projects are community-based organizations that receive grants rom SSA to provide all Social Security

and SSI disability bene ciaries (including transition-to-work aged youth) with ree access to work incentives

planning and assistance Each WIPA project has counselors called Community Work Incentives Coordinators

(CWIC) who:

Provide work incentives planning and assistance to our bene ciaries with disabilities to assist them in

achieving nancial independence;
http://www.socialsecurity.gov/work/awiccontacts.htmlhttp://www.socialsecurity.gov/work/formsandpubs.htmlhttp://www.socialsecurity.gov/work/formsandpubs.htmlhttp://www.socialsecurity.gov/work/awiccontacts.html

8/3/2019 The Red Book 2012

17/59

14

Conduct outreach e orts to those bene ciaries (and their amilies) who are potentially eligible to

participate in Federal or state employment support programs; and

Work in cooperation with Federal, state, private agencies and nonpro t organizations that serve

bene ciaries with disabilit ies

I you are one o the many SSDI or SSI disabilit y bene ciaries who want to work, a WIPA project can help you

understand the employment supports that are available to you and enable you to make inormed choices

about work and achieving nancial independence

WIPA services are available in every state, the District o Columbia, and the US Territories o American

Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands I you want to locate

the WIPA organization nearest you, please call 1-866-968-7842 or 1-866-833-2967 (TTY/TDD) or the

hearing-impaired You can also nd contact inormation in our service provider directory on our website at

www.socialsecurity.gov/work

Work Incentives Seminar (WISE)

Work Incentive Seminar Events (WISE) eature inormation to help Social Security disability bene ciaries make

the decision to re-enter the workorce or to work or the rst time Various employment service providers,

including Vocational Rehabilitation, Protection and Advocacy Services, and Employment Networks discuss

the services and supports they o er, while ormer bene ciaries who have used the Ticket to Work program to

become employed o er rst-hand address accounts o their success All WISE take place via ree internet-based

webinars Some o the webinars are designed to address a broad range o disabilit ies, while others target

people in speci c disability categories or age ranges The webinar-based ormat allows bene ciaries to learn

about vital employment resources without having to travel to another location, and to access the inormation

24 hours a day, at their convenience

State Vocational Rehabilitation Providers

State Vocational Rehabilitation agencies urnish a wide variety o services to help people with disabilit ies

return to work These services may provide you with the training or other support that you need toreturn to work, to enter a new line o work, or to enter the workorce or the rst time You can also

nd a list o state Vocational Rehabilitation agencies in our service provider directory on our website at


Protection and Advocacy or Beneciaries o Social Security (PABSS)

In every state and US Territory, there is an agency that protects the rights o persons with disabilities This

Protection and Advocacy System also administers the SSA-unded Protection and Advocacy or Bene ciaries o

Social Security (PABSS) program Each PABSS agency can:

Investigate any complaint you have against an employment network or other service provider that is

helping you return to work;Give you inormation and advice about vocational rehabilitation and employment services;

Tell you about SSAs work incentives that will help you return to work;

Provide consultation and legal representation to protect your rights in the e ort to secure or regain

employment ; and

Help you with problems concerning your individual work plan under the Ticket to Work program
http://www.socialsecurity.gov/workhttp://www.socialsecurity.gov/workhttp://www.socialsecurity.gov/workhttp://www.socialsecurity.gov/work

8/3/2019 The Red Book 2012

18/59

1

These services are ree to persons receiving SSDI or SSI bene ts based on disability or blindness I you want

to locate the PABSS agency nearest you, please call 1-866-968-7842 or 1-866-833-2967 (TTY/TDD) or

the dea and hearing impaired You can also nd contact inormation in our service provider directory at:


Individual Development Accounts (IDA)

I you are working and have limited income, you may be eligible or an Individual Development Account (IDA)

through the Temporary Assistance to Needy Families (TANF) program or an Assets or Independence Act (AFIA)

grant An IDA is a trust-like bank account that helps you save your earnings to go to school, buy a home, or

start a business When you make a deposit to the account, a participating non-pro t organization matches

your deposit The typical match is one dollar or each dollar that you deposit The Federal government adds

an addit ional match, limited to $2,000 or an individual or $4,000 or a household over the lie o the program

(usually ve years)

I you have an IDA through TANF or an AFIA grant, we do not count any earnings you deposit into your

account, any matching deposits, or any interest earned as SSI income or resources As a result, your SSI bene ts

may increaseNote: IDAs that are not ederally unded are not exempt rom SSI and will be counted under the

income and resource rules o SSI.

We do not determine whether you are eligible to have an IDA For more inormation about IDAs and to locate a

program in your area, visit:www.ac.hhs.gov/programs/ocs/af/index.html
http://www.socialsecurity.gov/workhttp://www.acf.hhs.gov/programs/ocs/afi/index.htmlhttp://www.acf.hhs.gov/programs/ocs/afi/index.htmlhttp://www.socialsecurity.gov/work

8/3/2019 The Red Book 2012

19/59

8/3/2019 The Red Book 2012

20/59

1

Unsuccessul Work Attempt (UWA)SSDI and SSI eligible

What is a UWA?

A UWA is an e ort to do substantial work, in employment or sel-employment, which you stopped or reducedto below the SGA level ater a short time (6 months or less) because o:

Your impairment; or

Removal o special conditions related to your impairment that you needed to help you work (seepage 16)

What is the benet o a UWA i you receive SSDI?

When we make an SGA decision to determine i your disabilit y continues or ceases because o your work, we

do not count your earnings during a UWA

Can a UWA occur during the Extended Period o Eligibility?

Yes During the EPE (seepage 27), we consider a UWA as part o our SGA decision or months up to and

including the month we decide your disability has ceased

Can a UWA occur during the Trial Work Period?

No We do not consider a UWA during the TWP (seepage 26) or ater we decide that your disability has

ceased

Does a UWA aect your monthly SSI payment?

For SSI, we only consider a UWA at the time you le an initial claim Ater that, we do not consider a UWA in

guring your SSI payment

8/3/2019 The Red Book 2012

21/59

18

Impairment-Related Work Expenses (IRWE)SSDI and SSI eligible

How can IRWE help you?

We deduct the cost o certain impairment-related items and services that you need to work rom your gross

earnings when we decide i your work is SGA It does not matter i you also use these items and services or

non-work activit ies

When will we deduct your IRWE?

We deduct IRWE or SGA purposes when:

The item(s) or service(s) enables you to work;

You need the item(s) or service(s) because o a physical or mental impairment;

You pay or the item(s) or service(s) and are not reimbursed by another source such as Medicare,

Medicaid, or a private insurance carrier;

The cost is reasonable, that is, it represents the standard charge or the item or service in your community

How do we use IRWE to gure your SSI monthly payments?I you receive SSI bene ts, we will exclude IRWE rom your earned income when we gure your monthly

payment amount i you meet the requirements above and you paid the expense in a month that you received

earned income or perormed work while you used the IRWE

Can IRWE be deducted during a non-work month?

Generally, you must be working in the month you pay or an IRWE However in certain situations, we can

deduct IRWE amounts or expenses you pay beore you start or ater you stop work

What types o expenses are deductible?

The ollowing table outlines the types o expenses that are deductible as IRWE

8/3/2019 The Red Book 2012

22/59

1

Examples o Deductible and Non-Deductible IRWE

TYPE OF EXPENSE IRWE DEDUCTIBLE NOT DEDUCTIBLE

Transportation Costs 9 The cost o structural or operationalmodi cations to your vehicle that you needto t ravel to work, even i you also use the

vehicle or non-work purposes9 The cost o driver assistance or taxicabs you

need because o your disability rather thanthe lack o public transportation

9 Mileage expenses at a rate determined by usor an approved vehicle and limited to travelto and rom work

[ The cost o your vehicle whether modi edor not

[ The costs o modi cations to your vehicle

that are not directly related to yourimpairment or critical to the operationo your vehicle, or example, paint or pinstriping

[ Your travel expenses related to obtainingmedical items or services

Attendant Care Services9 Services perormed in the work sett ing

9 Services perormed to help you prepareor work, the trip to and rom work, andater work; or example, bathing, dressing,

cooking, and eating9 Services that incidentally also bene t your

amily, or example, meals shared by youand your amily

9 Services perormed by your amily memberor a cash ee where he/she su ers aneconomic loss by reducing or endinghis/her work to help you, or example, iyour spouse must reduce his or her workhours to help you get ready or work

[ Services perormed on non-workdaysor help with shopping or generalhousekeeping, or example, cleaning andlaundry

[ Services perormed or someone else inyour amily, or example, babysitting

[ Services perormed by your amily memberor payment in-kind, or example, roomand board

[ Services perormed by your amily memberor a cash ee where he/she su ers noeconomic loss This includes servicesprovided by your non-working spouse

Medical Devices

9 Deductible devices include wheelchairs,

dialysis equipment, pacemakers, respirators,traction equipment, and braces

[ Any device you do not use or a medical

purpose

Prosthesis9 Arti cial hip, arti cial replacement o an arm,

leg, or other parts o the body[ Any prosthetic device that is primarily or

cosmetic purpose

Residential Modi cations9 I you are employed outside o home,

modi cations to the exterior o yourhouse that permit access to the street or totransportation; or example:

Exterior rampsRailingsPathways

9 I you are sel-employed at home,modi cations made inside your homein order to create a workspace toaccommodate your impairment Thisincludes enlarging a doorway into an o ceor workroom and/or modiying o ce spaceto accommodate your dexterity challenges

[ I you are employed outside o home,modi cations to the interior o your house

[ I you are sel-employed at home, you cannotdeduct any modi cation-related expensesthat you will deduct as a business expensewhen determining SGA

8/3/2019 The Red Book 2012

23/59

20

TYPE OF EXPENSE IRWE DEDUCTIBLE NOT DEDUCTIBLE

Routine Drugs & Routine

Medical Services

9 Regularly prescribed medical treatment ortherapy that is necessary to control yourdisabling condition, even i control is notachieved This includes:

Anti-convulsant drugs

Blood level monitoring

Radiation treatment

Chemotherapy

Corrective surgery or spinal disorders

Anti-depressant medication

Psychotropic medications

Counseling and therapy services

Your physicians ee relating to these

services

[ Drugs and/or medical services used or yourminor physical or mental health problems,or example:

Routine physical examinations

Allergy treatments

Dental examinations

Optician services

Diagnostic Procedures 9 Procedures related to the control,

treatment, or evaluation o your disablingcondition; or example, brain scans, andelectroencephalograms

[ Procedures not related to your disabling

condition, or example, allergy testing

Non-Medical

Appliances & Devices

9 In unusual circumstances, devices orappliances that are essential or thecontrol o your disabling conditioneither at home or at work; or example,an electric air cleaner i you have severerespiratory disease Your physician mustveriy this need

[ Devices you use at home or at the o cethat are not ordinarily or medical purposesand or which your doctor has not veri ed amedical work-related need These include:

Portable room heaters

Air conditioners

Dehumidi ers

Humidi ers

Other Items & Services 9 Expendable medical supplies; or example,incontinence pads, elastic stockings, andcatheters

9 The cost o a service animal including ood,licenses, and veterinary services

[ An exercise bicycle or other device youuse or physical tness, unless veri ed asnecessary by your physician

[ Health insurance premiums

8/3/2019 The Red Book 2012

24/59

2

Plan to Achieve Sel-Support (PASS)SSDI and SSI eligible

How can a PASS help you?

A PASS allows you to set aside other income besides your SSI and/or resources or a speci ed period o time so

that you may pursue a work goal that will reduce or eliminate the SSI or SSDI bene ts you currently receive For

example, i you receive SSDI, wages, or other income, you could set aside some o that money to pay expensesor education, vocational training, or starting a business as long as the expenses are related to achieving your

work goal

We do not count the income that you set aside under your PASS when we gure your SSI payment amount We

do not count the resources that you set aside under your PASS when we determine your init ial and continuing

eligibilit y or SSI

A PASS can help you establish or maintain SSI eligibility and may increase your SSI payment amount For

example, i you receive $800 per month in SSDI, you have too much income to be eligible or SSI But i you

otherwise qualiy or SSI and have a work goal, you could use some o your SSDI to pay or PASS expenses to

help you reach your work goal Because we would not count the portion o your SSDI you are using toward

your PASS, this could reduce your countable income enough so you could be eligible or SSI

In addition, other agencies may not count income that SSA has excluded or a PASS when they determine your

eligibilit y or housing assistance or the Supplemental Nutrition assistance Program (ood stamps)

Who can have a PASS?

I you receive SSI or could qualiy or SSI ater setting aside income or resources so that you may pursue a work

goal, you could bene t rom a PASS

What are the requirements or a PASS?

Your PASS must:

Be designed especially or you;Be in writing We preer that you use our orm, the SSA-545-BK You can get copies o the

PASS orm, SSA-545-BK, at your local o ce, rom any PASS Expert, or rom our website at

www.socialsecurity.gov/online/ssa-545.html;

Have a speci c work goal that you are capable o perorming;

Have a speci c timerame or reaching your goal;

Show what income you receive (other than your SSI payments) and/or resources you have that you will

use to reach your goal;

Show how you will use your income and resources to reach your work goal;

Show how the money you set aside will be kept separate rom other unds;

Be approved by us; and

Be reviewed periodically by us to assure your plan is actually helping you make progress towards yourwork goal
http://www.ssa.gov/online/ssa-545.htmlhttp://www.ssa.gov/online/ssa-545.html

8/3/2019 The Red Book 2012

25/59

22

Who Can Help You Set Up a PASS?SSDI and SSI eligible

Anyone may help you with your PASS; or example, vocational counselors, social workers, bene t specialists or

employers We will evaluate the plan and decide i it is acceptable We can also help you put your plans in writing

SSA has specially-t rained employees (PASS Specialist) that work with the PASS program When you submit a

writ ten PASS proposal to a PASS Specialist, he or she will review it to:Make sure the work goal is reasonable;

Make sure that you need the items and services listed on the PASS application to reach the work goal;

Make sure the expenses are reasonably priced; and

Work with you to make any needed changes

The ollowing Internet site provides a map that you can use to locate the PASS Cadre or your area

www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm

Where can you get more inormation about a PASS?

You can get a PASS Specialists telephone number by calling our toll-ree number 1-800-772-1213

between 7 am and 7 pm Monday through Friday or visit our website at:www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm

You can ask or a pamphlet entitled Working While Disabled A Plan or Achieving Sel-Support(SSA Publication

No 05-11017) It is also available online at www.socialsecurity.gov/pubs/11017.html You can also get a copy

rom your local o ce or by calling our toll-ree number 1-800-772-1213 between 7 am and 7 pm Monday

through Friday

Examples o a PASS

A Sample PASS (SSI ONLY)Example 1 Wages Being Excluded under an approved PASS

Billy wants to go to school to become a social workerBilly works part time and earns $66500 per month

We gure Billys countable income using the earned income ormula (Seepage 33)

$66500 - $2000 = $64500 - $6500 = $58000

$58000 / 2= $29000 in countable income

Billys earned income reduces his SSI bene t o $69800 by $29000 per month to $40800

He agrees to spend the $29000 in countable income on his education and we approve a PASS

We set aside this income and his SSI increases by $290/month or the PASS timerame Billy receives

$69800 in SSI bene ts, and has $29000 to use or approved PASS expenses

A Sample PASS (SSDI ONLY)Example 2 SSDI Being Excluded under an approved PASS

Maria wants to go to school and become a paralegal

She receives $800 in SSDI bene ts

Marias employment goal needs to be expected to generate enough income to eliminate SSDI (Have

expected earnings over $101000 per month SGA or 2012)

Maria determines she needs $780 per month or tuition, books, and school supplies We can exclude up to

$78000 per month in SSDI income This represents the ull amount o Marias SSDI payment ater deduction

o the SSI general exclusion This will make Maria eligible or the ull SSI payment ( $698 or 2012)

Maria must use the SSI payment o $698 or living expenses and use the PASS unds o $78000 or

approved plan expenses
http://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htmhttp://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htmhttp://www.ssa.gov/pubs/11017.htmlhttp://www.ssa.gov/pubs/11017.htmlhttp://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htmhttp://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm

8/3/2019 The Red Book 2012

26/59

2

Ticket to WorkSSDI and SSI eligible

What is a Ticket?

The Ticket to Work Program is an innovative program or persons with disabilit ies who want to work

and participate in planning their employment A Ticket increases your available choices when obtaining

employment services, vocational rehabilitation services, and other support services you may need to get or

keep a job It is a ree and voluntary service You can use the Ticket i you choose, but there is no penalty or

not using it You might not be subject to a continuing disability review while you are using your Ticket

How can I take part in the Ticket Program?

This program is available in all 50 states and 10 United States Territories Many SSDI and SSI disability

bene ciaries are eligible to obtain services rom a state vocational rehabilitation (VR) agency or another

approved provider o their choice We call these approved providers Employment Networks Employment

Networks (ENs) are private organizations or government agencies that have agreed to work with Social

Security to provide employment services to bene ciaries with disabilities You can participate in the program

by contacting an EN or by calling the Ticket Call Center at the number below For a list o approved ENs, please

visit https://yourtickettowork.com/web/ttw/en-directory

Where do I get more inormation?

For more inormation on Ticket to Work, including a list o approved Employment Networks, call

1-866-YOURTICKET (1-866-968-7842) or or TTY/TDD call 1-866-833-2967 between 8 am to 8 pm

Eastern time (Monday through Friday)

You can nd inormation about the Ticket to Work Program online at www.chooseworkttw.net
https://yourtickettowork.com/web/ttw/en-directoryhttp://www.chooseworkttw.net/http://www.chooseworkttw.net/https://yourtickettowork.com/web/ttw/en-directory

8/3/2019 The Red Book 2012

27/59

24

Continued Payment under Vocational Rehabilitationor Similar Program (Section 301)

SSDI and SSI eligible

How do I qualiy or continued payment under Section 301?

I we nd that you are no longer disabled due to medical improvement, your bene t payments usually stop

However, i you are participating in an appropriate program o vocational rehabilitation or similar services, your

bene ts may continue until your participation in the program ends

To qualiy or continued payments under Section 301:

You must be participating in an appropriate program o vocational rehabilitation or similar services that

began beore your disability ends under our rules; and

We must review your program and decide that your continued participation in the program will increase

the likelihood o your permanent removal rom the disabilit y bene t rolls

What is an appropriate program o vocational rehabilitation or similar services?

An appropriate program must be approved by us and includes:

The Ticket to Work

A Vocational Rehabilitation Agency using an individualized plan or employment (IPE)

Support services using an individualized written employment plan

A Plan to Achieve Sel-Support (PASS)

An individualized education program (IEP) or an individual age 18 through 21

How long may my benets continue?

Under Section 301, your bene ts may continue until you:

Complete your program;or

Your participation in the program stops; orWe decide that your continued participation in the program will not increase the likelihood o your

permanent removal rom the disabilit y bene t rolls

8/3/2019 The Red Book 2012

28/59

2

Expedited Reinstatement (EXR)SSDI and SSI eligible

What is EXR?

EXR is a saety net or people who successully return to work and lose their entitlement to SSDI or SSI bene ts

and payments I your cash payments ended because o your work and earnings, and you stop work within 5

years o when your bene ts ended, we may be able to start your bene ts again

How does EXR help you?

I you have stopped receiving bene ts due to your work, we may be able to restart them again The EXR

provision allows you to receive up to 6 months o temporary cash bene ts while we conduct a medical review

to decide i we can reinstate your bene ts You may also be eligible or Medicare and/or Medicaid during the

provisional bene t period

Who can be reinstated?

You are eligible to request EXR i you meet allthe ollowing requirements:

Your previous entitlement to SSDI bene ts terminated due to perormance o SGA; or your previous SSIdisability/blindness eligibility terminated because o excess earned income or a combination o earned

and unearned income;

You are not perorming SGA in the month you apply or EXR;

You are unable to work at the SGA level due to your medical condition;

Your current medical impairment(s) is the same as, or related to, your original disabling impairment(s); and

You request EXR within 5 years rom the month your bene ts stopped

8/3/2019 The Red Book 2012

29/59

26

SSDI ONLY EMPLOYMENT SUPPORTS

Trial Work Period (TWP)SSDI eligible

How does the TWP help you?

The TWP allows you to test your ability to work or at least 9 months During your TWP, you will receive ullSSDIbene ts regardless o how high your earnings might be as long as you report your work activity and you have a

disabling impairment

When does the TWP start?

Your TWP starts when you begin working and perorming services In 2012, we consider your work to be

services or the TWP i your gross earnings are more than $720 a month, or i you work more than 80 hours in

sel-employment in a month Your TWP cannot begin until the rst month you are entitled to SSDI bene ts, or

the month you le or bene ts, whichever is later

How long does the TWP last?

The TWP continues until you accumulate 9 TWP service months (not necessarily consecutive) within a rolling60-month period

What happens when you complete your TWP?

Ater you complete your TWP, you begin your Extended Period o Eligibility (EPE, seepage 27) During the

EPE, we evaluate your work and earnings to decide i you can work at the SGA level (seepage 5)

What else do you need to know about the TWP?

You are not eligible or disability bene ts or a TWP i you work at the SGA level within 12 months o the

start o your impairment(s) and beore we approve your claim or disability bene ts This is because your

impairment does not meet our de nition o disabilit y (seepage 5

We can consider medical evidence that might demonstrate your medical recovery at any time Thereore,it is possible or your bene ts to stop due to your medical recovery beore the end o your TWP

We will not conduct a continuing disability review i you are participating in the Ticket to Work program

and you are using your t icket (seepage 23)

Unsuccessul Work Attempts (UWA) do not apply during the TWP (seepage 17)

Usually, we adjust the dollar amount o TWP services each year based on the national average wage index

Does the TWP apply to SSI?

No A TWP does not apply to the SSI program

8/3/2019 The Red Book 2012

30/59

2

Extended Period o Eligibility (EPE)SSDI eligible

What is the EPE?

The EPE begins the month ater the TWP ends, even i you are not working that month The rst 36 months othe EPE is the re-entitlement period

How does the EPE help you?

During the 36-month re-entit lement period, you get bene ts or months your earnings or work activities

are below the substantial gainul activity (SGA) level as long as you continue to have a disabling impairment

We suspend bene ts or months your earnings are over the SGA level I your earnings all below the SGA

level in the re-entitlement period, we can start your bene ts again (This is a di erent rule than Expedited

Reinstatement (EXR) that we describe onpage 25)

What happens the rst time you work above SGA?

The rst time that you work above SGA in the EPE, we will decide that you no longer meet the requirementsor disability due to work, and we say that your disability ceased We will pay bene ts or the month your

disabilit y ceased and the ollowing 2 months We call this the grace period I your earnings all below SGA and

you are still in the 36-month re-entitlement period, we can restart your bene ts without a new application

Can you continue to receive benets ater the 36-month re-entitlement period ends?

I you are not working above SGA and are eligible or a bene t payment or the 37th month o the EPE, you will

continue to receive bene ts until you:

Work a month at the SGA level, or

Medically recover

What happens i you work ater the re-entitlement period ends?

Your bene ts will end i you work above SGA ater the 36-month re-entitlement period However you may be

able to start your bene ts again i you stop work within the next 5 years (see EXR onpage 25)

Do you get an EPE under SSI?

No The EPE applies only to persons who receive SSDI cash bene ts

8/3/2019 The Red Book 2012

31/59

28

Unincurred Business Expenses (Sel-Employment)SSDI eligible

What are unincurred business expenses?

Unincurred Business Expenses are contributions made by others to your sel-employment business e ort

For example, i the state VR agency gives you a computer or your business, or a riend works or your business

as unpaid help, these are unincurred business expenses

We generally ollow the Internal Revenue Service (IRS) rules to gure your net earnings rom sel-employment

The IRS only allows you to deduct expenses you actually paid or incurred debt When we make an SGA

decision, we also deduct unincurred business expenses rom your net earnings because we want an accurate

measure o the value o your work

What qualies as an unincurred business expense?

For an item or service to qualiy as an unincurred business expense:

It must be an item or service that the IRS would allow as a legit imate business expense i you

had paid or it

Do unincurred business expenses aect your SSI payments?

No We do not deduct unincurred business expenses rom earnings when we gure your SSI payment amount

8/3/2019 The Red Book 2012

32/59

2

Continuation o Medicare CoverageSSDI eligible

What is Continuation o Medicare Coverage?

Most persons with disabilities who work will continue to receive at least 93 consecutive months o Hospital

Insurance (Part A); Supplemental Medical Insurance (Part B), i enrolled; and Prescription Drug coverage

(Part D), i enrolled, ater the 9-month Trial Work Period You do not pay a premium or Part A Although cash

bene ts may cease due to work, you have the assurance o continued health insurance (93 months is 7 years

and 9 months)

When does this start?

The 93 months start the month ater the last month o your TWP

How do you qualiy?

You must already have Medicare and be working at SGA, but not be medically improved

8/3/2019 The Red Book 2012

33/59

30

Medicare or Persons with Disabilities Who WorkSSDI eligible

Can you buy Medicare coverage?

Yes Ater premium-ree Medicare coverage ends due to work, you can buy continued Medicare coverage, as

long as you remain medically disabled I you have limited income and resources you may be eligible or state

assistance with these costs under various Medicare Savings Programs Your state Health and Human Services

agency makes the determination about whether you qualiy or this help

Who is eligible to buy Medicare coverage?

You are eligible to buy Medicare coverage i:

You are not yet age 65; and

You continue to have a disabling impairment; and

Your Medicare stopped due to work

What kind o Medicare coverage can you buy?

Premium Hospital Insurance (Part A) is available at the same monthly cost that uninsured eligible retiredbene ciaries pay I you have less than 30 quarters o coverage, the premium is $451 in 2012 However, you may

qualiy or a reduction in this premium (see below)

Premium Supplemental Medical Insurance (Part B) is available at $9990 per month; this is the same monthly cost

that uninsured eligible retired bene ciaries pay in 2012

You can buy Part A separately without Part B You cannot buy Part B unless you also buy Part A Premium

Prescription Drug coverage (Part D) is also available

Do you qualiy or a reduction in your monthly Part A premium?

You may qualiy or a 45% reduction in the monthly amount o your premium or Part A You qualiy or the

reduced premium o $24800 in 2012 i you:

Have 30 or more quarters o coverage on your earnings record; or

Have been married or at least 1 year to a worker with 30 or more quarters o coverage;or

Were married or at least 1 year to a deceased worker with 30 or more quarters o coverage;or

Are divorced, ater at least 10 years o marriage, rom a worker who had 30 or more quarters o coverage

at the time the divorce became nal

When can you enroll?

You may enroll:

During your initial enrollment period (the month you are noti ed about the end o your premium-ree

health insurance and the ollowing 7 months);orDuring the annual general enrollment period (January 1 through March 31 o each year);or

During a special enrollment period You can enroll at any time while you are working, covered under

an employer group health plan, still have a disabling impairment, or during the 8-month period that

begins with the rst ull month ater your employment or group health plan coverage ends, whichever

occurs rst

For Part D, you may enroll (or change plans) during the annual coordinated election period (November 15

through December 7 each year)

8/3/2019 The Red Book 2012

34/59

3

How does it work with an employers group health plan?

I you purchase Part A and maintain your employer group health plan, Medicare will be your primary payer i

you are working Your group health plan would become a secondary payer

When does the state pay premiums or Medicare?

States are required to pay Part A premiums or some working persons with disabilities You qualiy i you:

Are eligible to enroll in Medicare Part A or persons with disabilities who work; and

Meet certain income and resource standards; and

Apply or assistance with your state Medicaid agency; and

Are ineligible or Medicaid on any other basis

Note: Persons with disabilities who work should contact their state health and human services agency or

inormation. Seepage 45 or more inormation about state help with Medicare Part A premiums.

8/3/2019 The Red Book 2012

35/59

32

SSDI at a Glance What Happens When You Go to WorkSSDI eligible

SSDI employment supports can help you protect your cash and medical bene ts while you work When your

bene ts end because o your work and you have to stop working later, employment supports can make

it easy to begin receiving bene ts again You should view all o the SSDI employment supports as a total

package to ully appreciate the multiple levels o support available to help you achieve your goal o greater

economic independence

Beginning the Process The Trial Work Period (TWP)

Your trial work period is a time when you can test your ability to work During your trial work period, we pay

you disability payments no matter how much you earn Details on the TWP are onpage 26

How it works:

Lasts or 9 months

The 9 months do not have to be in a row

Must take place within 60 months (5 years)

For 2012, the monthly earnings amount that we use to determine i a month counts as a TWP month is

$720 per month The 2012 sel-employment earnings or activity that we use to determine i a month

counts as a TWP month is$720 per month or 80 hours per month

The Next Step The Extended Period o Eligibility (EPE)

Your extended period o eligibilit y starts the month ater your trial work period ends Details on the EPE are on

page 27

How it works:

Ater your trial work period ends, you get a 36-month extended period o eligibility Whether we can pay you

during this period depends on how much you work and earn

During your extended period o eligibility:

We can pay you or any month your work and earnings are not at a substantial gainul activity (SGA) level, and

We can pay you or the rst month that your work and earnings are substantial and or the next 2 months

Your bene ts will terminate i your work is substantial in any month ater your extended period o eligibility ends

Your Saety Net-Expedited Reinstatement (EXR)

Expedited Reinstatement is your saety net i your cash bene ts end because o your work I you make less money

or you have to stop working because o your disability, we may be able to restart your bene ts right away i

You stop working above the substantial gainul activity level, andYour disability is the same as or related to your current disability, and

You make your request within 5 years o when your bene ts end

Details on EXR are onpage 25

What About Medicare

I your disability payments stop because o your work, the Medicare coverage you have can continue i your

disabilit y still meets our rules It can continue or at least 93 months ater your trial work period ends Details on

Continuation o Medicare Coverage are onpage 29

8/3/2019 The Red Book 2012

36/59

3

SSI ONLY EMPLOYMENT SUPPORTS

Earned Income ExclusionSSI eligible

Do we count all your earned income when we gure your SSI payment?

We do not count the rst $65 o the earnings you receive in a month, plus one-hal o the remaining earningsThis means that we count less than one-hal o your earnings when we gure your SSI payment amount

We apply this exclusion in addition to the $20 general income exclusion We apply the $20 general income

exclusion rst to any unearned income that you may receive

The ollowing table shows two examples o how we apply the general income exclusion and the earned

income exclusions

Examples o the Earned Income Exclusion

Situation 1Ed receives $361 SSDI each month,

wages o $289 each month,and no other income

$361 SSDI- 20 General income exclusion$341 Countable unearned income

$289 Earned income- 65 Earned income exclusion

$224- 112 remaining earnings$112 Countable earned income

$341 Countable unearned income+ 112 Countable earned income$453 Total countable income

$698 2012 Federal Bene t Rate-453 Total countable income$245 SSI payment

Available Income$361 SSDI+289 Wages+245 SSI Payment$895 Total Monthly Income

Situation 2Ed receives wages o $450 each month,no SSDI, and $13 o unearned income

rom another source

$0 SSDI$ 13 Other unearned income- 20 General income exclusion$ 7 Remaining general income exclusion

$450 Earned income

- 7 Remaining general income exclusion$443- 65 Earned income exclusion$378

remaining earnings

$189 Total countable income

$698 2012 Federal Bene t Rate-189 Total countable income

$509 SSI payment

Available Income$450 Wages+ 13 Unearned income

+509 SSI Payment$972 Total Monthly Income

8/3/2019 The Red Book 2012

37/59

34

Student Earned Income Exclusion (SEIE)SSI eligible

How does the student earned income exclusion help you?

I you are under age 22 and regularly attending school, we do not count up to $1,700 o earned income per

month when we gure your SSI payment amount The maximum yearly exclusion is $6,840 These amounts are

or the year 2012; we usually adjust these gures each year based on the cost-o-living

What is the denition o regularly attending school?

Regularly attending school means that you take one or more courses o study and attend classes:

In a college or university or at least 8 hours a week; or

In grades 7-12 or at least 12 hours a week; or

In a training course to prepare or employment or at least 12 hours a week (15 hours a week i the course

involves shop practice); or

For less time than indicated above or reasons beyond the student s control, such as illness

Does home schooling qualiy?I you are home-taught, you may be considered regularly attending school i:

You are instructed in grades 7-12 or at least 12 hours a week; and

The instruction is in accordance with a home school law o the state or other jurisdiction in which you

reside

I you are home-taught because o a disabilit y, you may be considered regularly attending school by:

Studying a course or courses given by a school (grades 7-12), college, university or government agency; and

Having a home visitor or tutor who directs the study

How do we apply the income exclusion?

We apply the student earned income exclusion beore the general income exclusion or the earned

income exclusion

8/3/2019 The Red Book 2012

38/59

3

How about an example For this example we are using 2012 amounts

Below are wages that Joan, a student receiving SSI, earned each month in 2012

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

$1730 $1730 $1730 $870 $840 $800 $800

Since Joan is a student, she is eligible or the Student Earned Income Exclusion That means we can

exclude a greater amount o Joans earnings when we gure her SSI bene t amount Below are the

amounts o Joans monthly earnings that we do not count each month subject to the monthly and yearly

limits Remember the 2012 monthly limit is $1,700 and the years limit is $6,840 In November, we reach

the yearly excludable amount o $6,840


$1700 $1700 $1700 $870 $840 $30 $0

Below are monthly wage amounts we still count Since we reached the yearly limit o excludable

earnings in November, we must count all o Joans December earnings


$30 $30 $30 $0 $0 $770 $800

Now we apply the SSI Earned Income Exclusion (see page 38) to the remaining countable earnings to

any monthly earnings that remain (Formula: $20 general exclusion plus gross earnings minus $65 andminus one hal o the remainder) Here are the earnings we will count when we determine Joans SSI

monthly bene ts


$0 $0 $0 $0 $0 $34250 $35750

I Joan has no other income and is eligible or the ull FBR ($698), her SSI bene t amount will be:


$698 $698 $698 $698 $698 $35550 $35750

8/3/2019 The Red Book 2012

39/59

36

Property Essential to Sel-Support (PESS)SSI eligible

How does PESS help you?

We do not count some resources that are essential to your means o sel-support when we decide your

continuing eligibility or SSI

What is not counted?

We do not count your property i you use it in a trade or business (or example, inventory or goods) or

personal property you use or work as an employee (or example, tools or equipment) Other use o the

item(s) does not matter

We do not count up to $6,000 o equity value o non-business property that you use to produce goods or

services essential to daily activities An example is land you use to produce vegetables or livestock solely or

consumption by your household

We do not count up to $6,000 o the equity value o non-business income-producing property i the property

yields an annual rate o return o at least 6 percent An example is a rental property

You must be using the property we are excluding under the PESS provision or your sel-support activities I

you are not currently using this property because o circumstances beyond your control, you must expect to

start using it again within a reasonable period o time, usually 12 months

What type o resources do not qualiy as PESS?

We do not consider liquid resources, or example, stocks, bonds, or notes as PESS, unless you use them as part

o a trade or business

8/3/2019 The Red Book 2012

40/59

3

Special SSI Payments or Persons Who Work Section 1619(a)SSI eligible

What is Section 1619(a)?

You can receive SSI cash payments even when your earned income (gross wages and/or net earnings rom

sel-employment) is at the SGA level This provision eliminates the need or the Trial Work Period (TWP) or

Extended Period o Eligibility (EPE) under SSI

How do you qualiy?

To qualiy, you must:

Have been eligible or an SSI payment or at least 1 month beore you begin working at the SGA level; and

Still be disabled; and

Meet all other eligibility rules, including the income and resource tests

How does it work?

Your eligibility or SSI will continue or as long as you meet the basic eligibilit y requirements and the income

and resource tests We will continue to gure your SSI payment amount in the same way as beore I your stateprovides Medicaid to persons on SSI, you will continue to be eligible or Medicaid

Do you need to apply?

You do not need to le a special application Just keep us up to date on your work activity

8/3/2019 The Red Book 2012

41/59

38

Reinstating SSI Eligibility Without a New ApplicationSSI eligible

How does it help you?

I you have been ineligible or SSI payments due to your work, you may be able to restart your SSI cash

payments again at any time without a new application

I you have been ineligible or SSI and/or Medicaid or any reason other than work or medical recovery, you

may be able to restart your SSI cash payment and/or Medicaid coverage within 12 months without a new

application When your situation changes, contact us and ask about how you can restart your SSI bene ts

and/or Medicaid

I your cash payment and Medicaid benets ended because o your work and earnings, and you stop work within

5 years o when your benets ceased, we may be able to start your benets again under Expedited Reinstatement

(seepage 25)

8/3/2019 The Red Book 2012

42/59

3

Special Benets I You Are Eligible Under 1619 and Enter a Medical FacilitySSI eligible


I you are working and eligible under section 1619, you may receive an SSI cash bene t or up to 2 months

while in a Medicaid acilit y or a public medical or psychiatric acility

What happens i you enter a Medicaid acility?

Usually, i you enter a Medicaid acility where Medicaid pays more than 50% o the cost o care, your SSI

payment is limited to $30 per month, plus any state supplement, minus any countable income However, i

you enter a Medicaid acilit y while you are eligible under section 1619, we will gure your bene t using the ull

Federal Bene t Rate or up to 2 months

What happens i you enter a public medical or psychiatric acility?

Usually, i you are in a public medical or psychiatric acility, you are not eligible to receive an SSI payment

However, i you enter a public medical or psychiatric acilit y while you are eligible under section 1619, your

SSI cash bene ts may continue or up to 2 months For this provision to apply, the acility must enter an

agreement with us that will allow you to keep all o your SSI payment

8/3/2019 The Red Book 2012

43/59

40

Medicaid While Working Section 1619(b)SSI eligible


Ater you return to work, your Medicaid coverage can continue, even i your earnings (alone or in combination

with your other income) become too high or an SSI cash payment

How do you qualiy?

To qualiy, you must meet all o the ollowing quali cations:

Were eligible or an SSI cash payment or at least 1 month;

Would be eligible or cash payment except or earnings;

Still be disabled;

Still meet all other eligibility rules, including the resources test;

Need Medicaid in order to work; and

Have gross earned income that is insu cient to replace SSI, Medicaid, and any publicly unded attendant

care (See ollowing threshold amount discussion)

The threshold amount is the measure that we use to decide whether your earnings are high enough to

replace your SSI and Medicaid bene ts Your threshold amount is based on:

The amount o earnings that would cause your SSI cash payments to stop in your state; and

The average annual per capita Medicaid expenditure or your state

I your gross earnings are higher than the threshold amount or your state (see ollowing chart), you may still

be eligible i you have:

Impairment-related work expenses (seepage 18);

Blind work expenses (seepage 43);

A Plan to Achieve Sel-Support (seepage 21);

Publicly unded attendant or personal care; orMedical expenses above the state per capita amount

Do all states use the same Medicaid eligibility rules?

Most states use our SSI eligibility rules to determine Medicaid eligibility However, the ollowing states use their

own eligibilit y rules or Medicaid that are di erent rom our SSI eligibility rules:

Connecticut

Hawaii

Illinois

Indiana

Minnesota

Missouri

New Hampshire

North Dakota

Ohio

Oklahoma

Virginia

I you live in one o these states, you will continue to be eligible or Medicaid under section 1619(a) or 1619(b) iyou were eligible or Medicaid in the month beore you became eligible or section 1619

8/3/2019 The Red Book 2012

44/59

4

2012 State Threshold Amounts or Persons with DisabilitiesSSI eligible

STATE THRESHOLD

Alabama $25,253

Alaska $54,352

Arizona $36,921

Arkansas $29,587

Caliornia $36,423

Colorado $33,982

Connecticut $68,132

Delaware $39,015

District o Columbia $44,857

Florida $30,259

Georgia $28,347Hawaii $35,149

Idaho $39,775

Illinois $27,435

Indiana $35,280

Iowa $31,066

Kansas $35,225

Kentucky $28,086

Louisiana $30,157

Maine $33,919

Maryland $39,926

Massachusetts $37,685

Michigan $29,919

Minnesota $50,846

Mississippi $26,889

Missouri $33,175

STATE THRESHOLD

Montana $29,752

Nebraska $36,651

Nevada $30,346

New Hampshire $42,320

New Jersey $33,751

New Mexico $33,098

New York $46,318

North Carolina $34,318

North Dakota $38,564

Ohio $34,339

Oklahoma $27,521Oregon $32,440

Pennsylvania $30,953

Rhode Island $35,894

South Carolina $30,018

South Dakota $34,014

Tennessee $31,464

Texas $31,174

Utah $29,889

the red book 2012

Documents