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1 Public Benefits and Work Incentives: Basic Training Level 1B Training developed by Made possible with funding from: Presenter Kathy LaBarre, GSIL WIPA Program Director 1

2 Agenda Day 2 Review test, homework assignment and day 1 materials. Supplemental Security Income Financial Aspects of the program Work Incentives State Public Assistance Programs Financial Medical Introduction to Housing, IDA and Transportation Benefits and file management Case studies Review Final Exam 2

3 Introduction to Supplemental Security Income (SSI) Also know under the Social Security Act as Title XVI Established uniform eligibility criteria SSI is designed for low-income elders, and low-income children and adults with disabilities. Provides fiscal relief to states 3

4 Overview of SSI Eligibility The SSI check is for the person s basic needs SSI Eligibility Requirements: Meet the income and resource tests; AND BE Disabled Adult or Child (including newborns) or; Blind (20/200 or less in better eye with glasses or field of vision less than 20 degrees; 4

5 SSI Income & Resource Test The income limit for eligibility for SSI in 2012 Individual $698/month Couple $1,048/month The resource limit for eligibility for SSI is $2,000 for individual $3,000 couple 5

6 Definition of Disability Definition for those over age 18 Same as the definition for SSDI benefits 6

7 Under Age 18-Definition of Disability Definition for those under age 18 a person under the age of 18 shall be considered disabled if they have a medically determinable physical or mental impairment which results in marked and severe functional limitations and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 7

8 Making Application Face-to-Face, Phone, On-line Face-to-Face or Phone call for an appointment On-line go to NOTE: For SSI complete only the medical portion of application on line. For the reminder of information an applicant will be contacted by SSA representative 8

9 Types of Additional Information Needed to File for SSI Benefits Examples of additional documents that may be needed: Income: Pay stubs Award notice (unemployment, worker s compensation, private pension, alimony, etc) Resources: Current bank statements Insurance policies Current stock/bonds statements 9

10 Federal Benefit Rate (FBR) The maximum dollar amount that individuals or couples can receive in SSI cash benefits each month. The FBR changes annually. FBR for 2012: $698/individual, $1,048/couple The maximum benefit amount is affected by: Unearned income Earned income living arrangements and in-kind support Use of available work incentives such as IRWE, BWE and PASS 10

11 SSI Amount The monthly amount of a recipient s SSI check depends on the SSI calculation: the total countable income (earned and unearned) minus income exclusions No other income, individual will receive full $ Other income, individual will receive less SSI but total income will be $

12 More on Income, Resources and Living Arrangements 12

13 SSI Income The income limit for eligibility for SSI in 2012 Individual $718/month Couple $1,068/month Income can be deemed Parent to child (child under age 18 and living with parent) Spouse to spouse (living with spouse) Income can be Earned or Unearned 13

14 Earned & Unearned Income Earned income: Includes wages and self-employment Unearned income: Includes SSDI benefits, unemployment benefits, pensions, etc. DOES NOT INCLUDE CURRENT SSI OR APTD CASH ASSISTANCE Unearned income can also include the value of food and shelter that is provided to an SSI recipient. This is considered in-kind income. 14

15 In-Kind Income Based on Living Arrangements SSI recipient over age 18 - The maximum SSI benefit is reduced by one-third when an individual/couple lives in another person's household (including parents household) and receives both food and shelter from others living in that household. Maximum monthly SSI benefit for these recipients is $ in

16 SSI Income Exclusions SSA does NOT count: The first $20 per month of any income Parent s income once a child reaches age 18, regardless of student status; Food and shelter provided by a non-profit organization (soup kitchen, food bank, homeless shelter, etc.) There are other exclusions. 16

17 SSI Calculation Sheet Lets review the SSI Calculation Sheet. We will be using this throughout the examples of the SSI Work Incentives 17

18 Example Bridget receives SSDI of $600/month. She lives in her own apartment. What is her potential SSI benefit? Carl is 16 and lives with his mother. His mother receives survivor benefits for Carl on his deceased father s record of $690/month. He has a disability; he and his mother have no other income or resources. What is his potential SSI benefit? 18

19 SSI Resource Limit The SSI program has specific resource limitations that include real or personal property (including cash). Limits - $2,000 single / $3,000 couple The value of resources is looked at on the first day of each month Resources in excess will render individuals ineligible for SSI cash benefits for that month Ineligibility will continue until resources fall below allowable limits Eligibility for SSI will cease if excess resources continues for 12 consecutive months 19

20 SSI Resource Exclusions Home and adjoining property One vehicle Sibling s resources Parent s resources once a child reaches age 18, regardless of student status 20

21 Household Questionnaire If an SSI recipient is receiving the $ but is paying for some food and shelter cost, they should be advised to contact the Social Security Claims Representative. See the information about household expenses in the training manual 21

22 Example Margaret turned 18 in March She continues to live with her parents. She was getting SSI of $ per month. Since she turned age 18, the SSI was reduced to $ How would you explain this to Margaret? Can you help her? 22

23 SSI- Income Calculation/Recalculation SSI benefits are paid as soon as the person is found eligible. Any change in income or living situation requires a recalculation, it may take up to 3 months before the SSI benefit amount changes. This is due to - Retrospective Monthly Accounting (RMA). Social Security uses RMA to determine when changes in income or living situations affect the SSI check. Any change in living situation or income should be reported immediately to SSA 23

24 SSI Work Incentives The monthly amount of a recipient s SSI check depends on the SSI calculation. SSI considers total countable income (earned and unearned) minus income exclusions. Work Incentives are available as soon as SSI begins. Once on SSI, SGA is not an issue. SSI is never stopped due to SGA. 24

25 SSI Work Incentives Most of the work incentives are received through the SSI income calculation: Student Earned Income Exclusion (SEIE) $20.00 general income exclusion $65.00 earned income exclusion Subtract Impairment Related Work Expenses (IRWEs) from earned income Count only half of earned income Subtract PASS exclusions from counted income 25

26 Student Earned Income Exclusion (SEIE) Exclusion allows individuals under age 22 who regularly attend school exclude up to $1,700 of earned income per month (up to a maximum of $6,840 per year). This exclusion is applied before any other exclusions. Earnings received prior to the month of SSI eligibility do not count toward the $6,840 annual limit. Most students who use this exclusion will NOT SEE ANY reduction in their SSI benefit amount because of earnings 26

27 SEIE Example Alan, age 19 gets SSI and he started college last fall. He will be home for the summer break in May and will start work at Hannaford s on May 22. (His first pay check will be received on June 2 nd.) He will work 25 hours per week. His hourly wage will be $9.75/hour. Estimate his wages Complete SSI calculation sheet 27

28 SSI Example Treatment of Earned Income Linda receives a SSDI benefit of $463 and currently receives SSI. Linda lives on her own and does not have any other income. She is going to start work and earn $500 per month. $463 - $20 = $443 countable unearned income $500 - $65 /2 = $218 countable earned income $443 + $218 = $661 countable income SSI payment $698- $661 = $37 Total financial outcome $ $500 = $1,000/month 28

29 SSI IRWEs & Blind Work Expenses (BWEs) IRWEs are the same as SSDI Any SSI recipient whose primary diagnosis is blindness and who receives earned income is entitled to use Blind Work Expenses (BWE). BWE are only available to SSI recipients. See the handout about IRWEs/BWEs 29

30 Examples of SSI Calculations with IRWE Linda receives a SSDI benefit of $463 and currently receives SSI. She earns $500 per month and has IRWEs of $50 per month. $463 - $20 = $443 countable unearned income $500 - $65 - $50 IRWEs /2 = $192 countable earned income $443 + $192 = $635 countable income SSI payment $698- $635 = $63 Total financial outcome $ $500 - $50 = $1,026/month 30

31 SSI Break Even Point (BEP) At some amount of earnings, the SSI recipient s SSI checks will stop. This is called the Break Even Point For a person with no SSDI or other unearned income..their BEP is $1,481/m in 2012 For a person with other unearned income (SSDI, Alimony, In-Kind) the BEP would be less 31

32 SSI Eligibility & Medicaid Continuation: 1619(b) SSI recipients should qualify for APTD/ANB Medicaid but must file an application at DHHS If an SSI recipient does not have APTD/ANB Medicaid help them file At the time that SSI cash payments stop due to increased earnings, the recipient will continue to receive Medicaid coverage as long as his or her earnings remain under the annual state of NH threshold amount ($42,320 in 2012 ). 32

33 1619(b) Medicaid Needs Test Recipient must: Have used Medicaid within the past 12 months? or Expects to use Medicaid within the next 12 months? or Would be unable to pay the expected medical bills in the next 12 months without Medicaid coverage Must meet all other requirements for SSI payments other than earnings (resources must stay under $2,000). 33

34 Importance of 1619(b) Section 1619(b) protects not only individuals Medicaid coverage, but also maintains eligibility to receive SSI cash payments in future months that countable income falls below the allowable limits. The key is to establish APTD/ANB Medicaid eligibility prior to earning over BEP to ensure entry to 1619(b). 34

35 SSI and Work To summarize: As the SSI recipient works, he or she will see a gradual reduction is the SSI check amount, less than $1 reduction for every $2 earned The recipient will still remain eligible for Medicaid, through 1619(b) protection status. 35

36 Plan to Achieve Self Support (PASS) PASS is an SSI work incentive under which persons with disabilities can set aside income (earned, deemed or in-kind) and/or resources to be used to achieve specific work goals. A PASS can be established to cover the costs of obtaining an education, receiving vocational training, starting a business or purchasing support services. 36

37 Expedited re-instatement for SSDI/SSI For individuals who have stopped receiving benefits as a result of work and then at a later date find themselves unable to work because of their medical condition. Provides for up to six months of provisional benefits. Provides 5 years of coverage from month of benefit termination 37

38 Redetermination Reviews Redeterminations are non-medical reviews which are regularly completed. Conducted Updates: In Person - income or By Phone - resources, and - living arrangements Redeterminations are always done at age 18, along with a medical determination to see if the child now meets adult disability requirements 38

39 Continuing Disability Reviews CDRs for SSDI/SSI Periodically SSA conducts disability reviews to determine if the recipient has had a medical improvement. 39

40 Samples of CDR Questions Information is gathered from beneficiary using the following questions: Have you received medical treatment in the last two years? As compared to two years ago, do you feel the same? Better? Worse? Have you discussed working with your doctor? Has the doctor cleared you to work? In the last two years have you completed an educational program? Have you performed work in the last two years? 40

41 Age 18 Re-determination Child 18 Adult Application of Section 301 / 5113 (Sections 1631(a)(6) and 225(b) of the Social Security Act) Possible continuation of benefits 41

42 Continuation of Benefits Section 5113 of the Omnibus Budget Reconciliation Act of 1990 extended eligibility: Allows for continuation of benefit payments under both SSI and SSDI to individuals whose disability ceases due to medical recovery while participating in an approved vocational rehabilitation program 42

43 Resources for State Benefits See the DHHS website at the following address for general information and Manuals m 43

44 NH Public Benefits and Programs Programs for adults with dependent children and children: TANF (Temporary Assistance for Needy Families FAP (Family Assistance Program) NHEP (New Hampshire Employment Program) Healthy Kids Gold/Silver Programs based on age: Old Age Assistance Financial and Medical Assistance Programs based on disability: APTD/ANB (Aid to the Permanently & Totally Disabled/Aid to the Needy Blind) Financial and Medical Assistance MEAD (Medicaid for Employed Adults with Disabilities) 44

45 Introduction to NH State Public Benefits for Adults with Disabilities The New Hampshire Department of Health and Human Services, Division of Family Assistance (DFA) handles several programs for adults. Aid to the Permanently and Totally Disabled (APTD) - financial and medical assistance or medical assistance only Medicare Savings Plans Medicaid for Employed Adults with Disabilities (MEAD) Home & Community Based Care Services (HCBC) Food Stamps 45

46 Definition of Disability for APTD The definition of Disability for benefits through the State of NH: be between the ages of 18 and 64; be physically or mentally disabled to the extent the individual cannot engage in a substantial gainful employment activity; and have a disability that is a condition of physical or mental disease, impairment, or limitation which is likely to result in death, or can be expected to last for a continuous period of not less than 48 months. 46

47 Medicaid Programs for Adults Medicaid Programs for Adults Medical Assistance with cash benefits Medical Assistance Only (also called Medicaid In and Out or Medicaid with a spend-down) MEAD 1619(b) Home & Community Based Care Waivers 47

48 APTD Cash and Medical Assistance In addition to meeting the definition of disability the individual must: Have income low enough to receive state cash benefits then Medicaid is automatic (state calculates income against the state Standard of Need - SON) 2012 SON for one person: $712/month* Have resources below $1,500 Required to apply for SSDI/SSI benefits *Different based on living arrangement for DD/ABI population 48

49 Standard of Need In 2012 the Standard of Needs are: Living Independent $712 Subsidized Community Residence $774 Residential Care Facility $892 Unsubsidized Community Residence $834 Community Residence (Enhanced family care) $892 49

50 APTD Cash Benefit Changes effective July 1, 2011 For individuals who are receiving APTD cash benefit and do not receive SSDI or SSI benefits, they are required to pursue these benefits If the application is denied medically by Social Security, (& depending on their open status with APTD), DHHS will determine if cash assistance can continue. Applicable only to Cash Assistance. This change has no affect on APTD Medical Assistance 50

51 APTD and Social Security Individual s with an open status before July 1, 2011 Given 2 chances to be approved for Social Security Disability benefits. At least one of the two denials must be issued after July 1, Must continue to pursue SS eligibility if denied. July 1, 2011 July 1, 2011 Eligibility 2 SS denials Eligible 1 st SS denial 2 nd SS denial Not Eligible 1 SS denial Eligible 2 SS denials Not Eligible

52 APTD and Social Security Individual s with an open status as of July 1, 2011 Given 1 chance to be approved for Social Security Disability benefits. No APTD Cash Assistance eligibility if denied SS disability benefits, as long as the denial was issued after June 30, Must continue to pursue SS eligibility if denied. July 1, 2011 July 1, 2011 Eligibility 1 or more SS denials Eligible 1 or more SS denials 1 SS denial Not Eligible 1 SS denial Not Eligible

53 APTD Medical Assistance Only In addition to meeting the definition of disability or blindness the individual must: Be over income for financial assistance (over $712 countable income/month); OR Have resources over $1,500, BUT less than $2500: OR Both 53

54 Household Composition for APTD Applicant - Individual who is applying for assistance Applicant Spouse - Spouse of the client who lives with the client and is also applying for or receiving OAA, ANB or APTD Non-applicant Spouse - Spouse of the client who lives with the client and is ineligible or chooses not to apply for OAA, ANB or APTD 54

55 APTD/ANB Cash Benefits Changes Effective July 1, 2011 DFA and Deeming of parental income and resources when determining eligibility for a minor (under the age of 18) who lives with his/her parents for ANB cash benefits Cash benefits under APTD/ANB will be reduced if an individual lives with others and does not any food or shelter costs. 55

56 APTD Medicaid In and Out Program Individual is responsible for incurring a predetermined amount of his or her medical bills each month then Medicaid pays the rest of the month's bills. The amount the individual is responsible for is called a "spend down. The amount of each person's spend down is based on the type & amount of the individual's income. SSI is never counted as income in determining spend-down. 56

57 How To Calculate a Spend-down 1. Determine the NET case income. 2. Subtract the PIL from the net income. 3. The difference is the individual s monthly spend-down amount. 57

58 APTD Formula Handouts We will review the computation sheets for APTD Cash Assistance and for APTD Medicaid Only. 58

59 APTD Cash and Medical Assistance Example Determine financial eligibility for APTD Cash/MA for: APTD applicant who lives alone and earns $75.00 per week $ (monthly earnings) (earned income disregard) $ (1/2 remainder or $30, whichever is less) $ (minimum Employment Expense Disregard (if more, use actual amount) $ (adult standard disregard) $ (net income) Compare to SON for 1 ($712) $ (net income from above) $ APTD Cash benefit $450 and Must file for SSDI/SSI 59

60 APTD Medical Assistance Example APTD applicant who lives alone and earns $75 per week. Now gets SSDI of $700 per month Determine financial eligibility for APTD Cash/MA first: $ (monthly earnings) (earned income disregard) $ (1/2 remainder or $30, whichever is less) $ (minimum Employment Expense Disregard (if more, use actual amount) $ (SSDI benefit) $ (adult standard disregard) $ (net income) Compare to SON for 1 ($712) No Cash APTD NOW DETERMINE ELIGIBILITY FOR APTD MEDICAID ONLY (NEXT SLIDE) 60

61 APTD Medical Assistance Example Determine eligibility for APTD Medical Assistance and Spend-down: $ (monthly earnings) (earned income disregard) $ (1/2 remainder) $ (SSDI benefit) $ (adult standard disregard) $816.87(net income) Compare to PIL (Protected Income Level for 1 ($591) Eligible for Medical Assistance but will have a spend-down to figure the spend-down: $ (Net Income from above) (PIL) $ (Spend-down) 61

62 Home and Community Based Care HCBC is not a program; HCBC is a service. HCBC offers a variety of home and community-based services that each of these groups of individuals may need in order to prevent institutionalization. Choices for Independence Chronically Ill (CFI) Development Disabilities (HCBC-DD) and Acquired Brain Disorder HCBC-ABD 62

63 Home and Community Based Care (continued) Individual applying for HCBC Services must meet OAA, ANB, APTD or MEAD categorical requirements. An assessment of services needed must also be done. 63

64 Medicaid for Employed Adults with Disabilities- (MEAD) Allows those with a disability between the ages of to get Medicaid Same disability criteria as APTD except no SGA determination No spend-down or cost-of-care No minimum work requirement Higher income and resource limits 64

65 MEAD: Eligibility Criteria years old Must be employed or self-employed for pay and paying FICA taxes Must have some disabling condition that is likely to last for at least 4 years Net Income less than 450% of Federal Poverty Level ($50,265 per year in 2012) Resources below $26,

66 MEAD- Items Not Included in Resource Limit Retirement plans for the individual; but, ineligible spouse s still counts Medical Savings accounts Employability accounts 66

67 Protected Earned Income Accounts MEAD Protected Earned Income (EI) Account is not excluded from the resource limit while the individual is on MEAD However, this account would be excluded for other state Medicaid programs if no longer eligible for MEAD ( for example, individual turns 65) Must only put in earned income No deposits can be made to the account once off MEAD Withdrawals from the account will not count as income 67

68 If someone on MEAD loses their job: Individuals on MEAD who become unemployed can remain on program for up to 6 months* if: They lost their job for good cause and They intend to return to work within the next 6 months *additional 6 months (12 months all together) can be granted if a good cause has been established 68

69 1619(b) vs. MEAD SSI recipients who work should be eligible for Medicaid through 1619(b) and do not need MEAD as long as resources remain below the SSI resource limit of $2,000. Refer to 1619(b) vs. MEAD 69

70 HCBC and MEAD Applications for HCBC and MEAD are treated the same as for cash and HCBC. The income and resources of both spouses are used in determining eligibility and potential premium payments. If MEAD and HCBC, the individual is not required to contribute to the cost of care 70

71 Medicaid for Working Individuals The bottom line is.. People with disabilities who qualify for Medicaid and who work are very likely to remain entitled to their Medicaid coverage, as long as their disabling condition remains You should question the decision whenever a person with a disability loses Medicaid! 71

72 Other State Public Assistance Programs Medicare Savings Programs Food Stamps 72

73 Medicare Savings Programs QMB/SLMB Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiaries (SLMB) helps pay Medicare premiums, and/or deductibles and/or co-pays Eligibility based on income and resources. Refer to Handout Resource Limit $6,940 for individual; $10,410 for a couple in

74 SUMMARY Apply for Federal, State and local benefits Timely report all changes such as change of address, employment, etc. Refer to your training materials Refer your questions/issues to your agency Work Incentives Specialists or WIPA 74

75 Benefit and File Management Benefits Checklist Keep documentation in case file Earned Income across programs Examples Test 75