I know what they are... But not how to DO them! A HANDS-ON WORKBOOK USING THE SOCIAL SECURITY AND SSI WORK INCENTIVES

Transcription

1 I know what they are... But not how to DO them! A HANDS-ON WORKBOOK USING THE SOCIAL SECURITY AND SSI WORK INCENTIVES

2 Introduction The Social Security and SSI work incentives have been around for many years now, and most of us have sat through repeated trainings and forums to learn what they are and how to use them. Just the same, when it comes time to make a decision that includes work and benefits, many of us still feel lost and confused. Then, we either become paralyzed and decide we just can t work because of our benefits, or we decide to just go to work without dealing with the benefits issue. Either way, we get hurt in the end. This workbook is meant to support people in using the Social Security and SSI Work Incentives by providing fact sheets and work sheets to make the process more clear. It also provides guidance on what pieces you can do, and when to ask for assistance from more qualified specialists. This workbook only provides the basic level of information on each work incentive, but provides links to other resources for more in-depth information. The key purpose of this Workbook is to provide some handson tools to make the work incentives more useable for people on benefits and their supporters. 2

3 Table of Contents Chapter 1 Quick Facts on SSI & SSDI p Chapter 2 Working with the Work Incentives p Chapter 3 SSDI Work Incentive Overview & Trial Work Period (TWP) p Chapter 4 The Extended Period of Eligibility, Part 1: The Basics (EPE) p Chapter 5 The Extended Period of Eligibility, Part 2: Earning More And Counting Less (EPE) p Chapter 6 The Expedited Reinstatement Period (EXR) p Chapter 7 Extended Medicare Coverage (EMC) p Chapter 8 Transitions p Chapter 9 SSI Work Incentives p Chapter 10 I m 17 going on 18 p Templates Section p Resource Links p We are continually faced by great opportunities brilliantly disguised as insoluble problems. (Author Unknown) I hope this Workbook helps your Vocational Recovery Journey become a great opportunity rather than impossibility due to the barriers related to disability benefits. 3

4 Chapter 1: Quick Facts on SSDI versus SSI Before we can begin to talk about the Work Incentives, it s important to understand the two primary disability programs SSDI & SSI. It s easy to confuse the two programs. They re both administered by Social Security, have similar initials, have insurance that sounds alike (Medicare & Medicaid), and are both disability programs. For these reasons, people often think that SSI and SSDI are both part of a single program. SSDI and SSI are actually two very different programs that happen to be run by the Social Security Administration. There are key differences between the two programs, and these differences explain the how and why each program has 4

5 certain work incentives and how the Social Security Administration (SSA) evaluates work. Social Security Disability Insurance SSDI Social Security benefits, including SSDI, are WORKER benefits. Social Security is INSURANCE with people paying the insurance premium through the FICA taxes 1 taken out of the person s paycheck. All Social Security benefits stem back to a person who worked and paid FICA taxes. Because SSDI is an insurance program, a person: - Can have unlimited assets - Can have income other than wages - Must be disabled under Social Security rules 1 FICA Federal Insurance Contribution Act passed by Congress with the Social Security Act in 1935 as a way to fund Social Security benefits. 5

6 Social Security Definition of Disability: To be disabled, a person must be: Unable to do any significant work (substantial gainful activity) Due to a physical or mental impairment; That is documented by medical evidence; and Is expected to last at least 12 months or result in death. Other Quick Facts About SSDI Amount of Benefit The amount is based loosely on the worker s income when they were working. Work Incentives The work incentives are based on a set of timelines that look towards a gradual, linear movement from total disability to total self-sufficiency. Work Evaluation The amount and quality of work is evaluated to see if the person remains disabled under the rules. It has nothing to do with how much money the person is accumulating, but instead, if the person is doing or able to do substantial work which makes the person ineligible for SSDI benefits. Health Insurance Medicare, the same health insurance that retirees get, comes with SSDI benefits. So, in summary, workers can get SSDI if they ve paid into the system via FICA taxes and the person is disabled under the SSA rules. If a worker is disabled, he/she is entitled to SSDI, so factors such as the amount of savings, etc., aren t considered. When a person goes back to work, Social Security evaluates 6

7 if the amount of work means the person is no longer disabled and, therefore, no longer qualified for benefits. The work incentives become the avenue to try work without losing benefits. Supplemental Security Income SSI SSI is a benefit of last resort for people who have disabilities AND significant financial need. At one point, each state had it s own welfare program for people with disabilities. In the early 1970 s, all the programs were brought together as a single national program SSI as a cost-saving measure. Even though the Social Security Administration manages the SSI program in Social Security offices, SSI isn t funded by the Social Security Trust Fund and is not part of the Social Security program. It remains a welfare or needs-based program. It only supplements any other financial support available to the person in order to give him or her enough money to meet basic needs of food, shelter and clothing. This is why it s called Supplemental Security Income or SSI. SSI supplements income up to a cap, called the Federal Benefit Rate (FBR) that is set each year. This full FBR cap is for people that live on their own and have to pay all of their own expenses for housing, food and clothing. Alternative FBR rates, or caps, are created for people that live with other people or in institutions, situations in which people pay less than the full expenses for food, shelter and clothing. If all other available income is less than the SSI cap, a person with a disability is also eligible for an SSI check. For example, Mary lives with a roommate and her cap is approximately $ She gets a $ check each month from her inheritance from her grandmother. To bring her up to the cap, SSI gives her a $ check. Another example would be Sally. She also shares an apartment and has a cap 2 Figures in examples do not represent current SSI Federal Benefit Rates. They re being used for example only. 7

8 of $ She has a limited work history and gets $ in SSDI benefits. SSI supplements her $ up to the cap of $500.00, issuing an SSI check of approximately $ per month. As with SSDI, a person must be disabled under the Social Security rules. That is, the person must have a physical or mental impairment that also impacts his or her ability to do any significant work. Other Quick Facts About SSI Eligibility SSI requires that a person with a disability have financial need: o Person must have little to no income. o A person cannot have more than $2,000 in resources, and a couple must have less than $3,000. Resources are assets such as money in the bank, IRA s, stock and bonds, etc. There are some basic resources that are not counted, including a house that a person lives in, a car, and funds for burial ($1500). See htm for the full list of allowable resources. Amount of Benefit The amount is based on the Federal Benefit Rate (FBR) and a person s living situation. The SSI amount for a person living on their own and paying all the bills is more than for someone who is 8

9 living with others and paying only part of the total bills. The rate is based upon the Federal Benefit Rate and any state supplements (See for a chart of past FBR levels.) State Supplements - Some states provide additional funds to supplement the Federal Benefit Rate. In 2010, these states are California, The District of Columbia, Hawaii, Massachusetts, Nevada, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. See for more information on state supplements. Work Incentives The SSI work incentives are designed to encourage people to work if possible. In most cases, a person does better financially if they are working under the SSI rules. Work Evaluation Work is considered on two levels disability status and the amount of money a person is earning. SSI is a disability program, so the status of the person s ongoing disabled status is evaluated. Also, because SSI is a needs-based program, SSI constantly monitors a person s finances. However, SSI counts wages from work different from any other income, and people often end up with more in-pocket cash when they work. In summary, SSI is, first and foremost, a welfare program for people with disabilities. As such, the primary concern is how much money a person has. SSI and SSDI are very different programs, even though the SSA administers them both. As we begin to look at the work incentives, we ll see how each program evaluates work in relation to its primary purpose and goal. 9

10 Table 1: SSDI vs. SSI Eligibility Benefit Amount Goal Medical Insurance Purpose of work evaluation Social Security Disability Insurance The Worker s Insurance Disabled by Social Security Rules Substantial Work Background FICA tax pays premium Entitled to the benefit Based loosely on earnings To support worker with disability and immediate family members Medicare (after 2 years) Is the person still disabled under the rules? Does current work represent the ability to work at a substantial level? Supplemental Security Income For Those in $$ Need Disabled by Social Security Rules Little or no work background Must show financial need a federal welfare program Based on living situation and the Federal Benefit Rate To provide for basic needs of food, clothing, and shelter for people with disabilities Medicaid ((called different things in different states, e.g. MediCal in California) How much money does the person now have? Is the person still disabled under the rules? Adapted with permission from Stepping Into Work with the Social Security Work Incentives 2006, Legere, L., Kugler, R. and the Institute for Community Inclusion, Boston, MA. 10

11 Chapter 2: Working with Work Incentives What are Work Incentives? Let s think back to the definition of Disabled Under the social Security rules Before work incentives came into play, people would lose their benefits almost immediately if they started to work. Many people who wanted to work were afraid to even try, and very few people left the SSDI or SSI rolls once they had been approved for benefits. The Work incentives are specific provisions within the social security regulations created by Congress to give people opportunities to test out and experience work without losing benefits immediately. SSA had to create these work incentives because the definition of disability includes the inability to do any substantial... work. Some incentives reduce the amount of work income that SSA actually counts or considers when making decisions about your ongoing eligibility for benefits, while other incentives fully protect your ongoing SSI or SSDI benefits. Some incentives affect your cash benefits while others protect your ongoing health coverage under Medicaid or Medicare. They also provide a way to get credit for out-of-pocket money spent for disabilityrelated supports needed to get to and perform in your job. Communicating with Social Security Communicating with the Social Security Administration (SSA) 3 is the most important step to implementing the Social Security Work Incentives. There are 3 SSA Social Security Administration. This term generally means your local Social Security office. Because SSI is also administered through this office, it is referred to as SSA rather than social security. 11

12 things that you are required to tell SSA, as well as things that you want to tell them because it will benefit you. Important Things to Know: 1. SSA claims representatives tend to be overworked, especially in cities and large suburbs. This can mean: a. Long lines in offices; b. Getting answers that are confusing or too short to be helpful; or c. Misinformation because the person hasn t taken the time to assure that they have the correct information. 2. The SSA office is divided into two parts: SSDI and SSI. If you receive both benefits and have information to report, you need to do this with both the SSDI person and the person from SSI. 3. There are penalties and consequences for not providing information to SSA that you knew or should have known needed to be reported, so it s important to report everything about your work to them. TIP To ensure that you get credited for reporting information to SSA, send your information via certified mail, return receipt requested. When you send things this way, the receiver (SSA) signs a green card that is mailed back to you. Save a copy of your communications and this card. It is your proof that your information was received. Even if your local SSA office is small, you want to take this extra precaution to make things easier for you in the long run. TIP When you discuss information with SSA by phone or in person, you want to send a letter confirming the information and your understanding of it. This should also be sent certified with a return receipt for 12

13 your records. This simple step can help you to avoid many problems by giving you a clear record of what you reported, when, and to whom. It also gives SSA a chance to correct your understanding if you are wrong. Here s an example and there is a template for this letter in the Letter Templates section: December 3, 2010 Ms. Chin, Claims Representative Social Security Administration 10 Causeway Street, Suite 101C Boston, MA RE; Lyn Anderson, SSDI claim SSN: Dear Ms. Chin, I am writing to confirm our conversation on Monday, November 28 th. As you recall, we discussed my current work at Sunnybright Day Care Center. I told you that I received 5 paychecks in October, making it look like I had earned more than SGA this month. We agreed that my earnings should be averaged because they re the same each month. This means that I won t be over SGA even in a month with an extra paycheck, and I m still entitled to my SSDI check. If I misunderstood this information, please let me know right away. Otherwise, I will assume I ve understood this correctly. Thank you very much. Sincerely Lyn Anderson 47 Sunny Drive Happyville, MD landerson@hotmail.com 13

14 As you can see, this letter can help you remember what was discussed, and can address any misunderstandings later. The few minutes it takes can be a lifesaver in the long run!! Using Your Resources Knowing about the work incentives helps you to be in control of, instead of victim of, your benefits as you make choices about work. However, unless you work with these benefits all the time, they can be confusing. It s best to partner with someone who understands all the complexity of the rules. This person can explain the rules at different stages of the process, while you take steps on your own to assure that you re in the driver s seat with your benefits and work choices. WIPA Work Incentive Planning Assistance Every state has a program for benefits planning, called the Work Incentives Planning and Assistance project, or WIPA. Each WIPA is staffed with Community Work Incentive Coordinators (CWICs) who fully understand the SSI/SSDI rules, as well as how other benefits offered by the State or Federal government may benefit the person or be impacted by work. CWICs can create a benefits plan with you that takes into consideration all the benefits you currently receive, and can give you information to help you make informed choices about work. WIPAs are authorized to serve all SSA beneficiaries with disabilities, including transition-to-work aged youth, providing benefits planning and assistance services on request and as resources permit. For more information on WIPA programs and how to locate them in your state, go to Work Incentives Liaison Each SSA office or regional office is supposed to have a person know as the work incentives liaison. The level of skill of work incentive liaisons vary 14

15 office to office, so you want to make sure the person in your SSA office is knowledgeable about the work incentives. This person can be a support and ally if he or she understands them well. Filling out Forms SSA asks you to fill out forms from time to time. Most ask for information like name, who your doctors are, and other factual type of information. Occasionally, you will get a form that asks you more in-depth information about your work or about your daily activities. These forms are meant to gather information to help SSA make a decision, so it s important that you answer questions in detail. Example: Question: Are you able to clean your house and cook your meals? Bad Answer: Yes (thinking that I m physically able to do these things) Good Answer: I m physically able to do these things, but due to my depression, I have a hard time getting out of bed or doing anything in my house. I often don t eat, and when I do I just walk to the sub shop next door and get something to go. As you can see, forms are a way of giving SSA the best information about you, your disability, and your work. It s always best to connect with your resources when you have to complete a form that asks these types of questions. 15

16 Chapter 3: SSDI Work Incentives Overview and Trial Work Period SSDI Work Incentives Overview The SSDI work incentives are a series of timelines gradually reduce the amount of cash and medical insurance as you increase work activity. The SSDI work incentives were created from the mindset of physical conditions that were sustained in adulthood, after a period of working. These timelines anticipate a straightforward linear move from disability to wellness. The first timeline, the Trial Work Period, allows people to work and maintain their full check regardless of earnings. The second timeline, the Extended Period of Eligibility, follows the first. It allows people to work and continue receiving a check if their income is below a certain amount, but receive no check if the income is above. The Expedited Reinstatement period, the next timeline, allows people to return to benefits if needed due to an exacerbation of a person s condition. The final timeline is for Medicare coverage, allowing at least 7 1/2 years of coverage after the end of the Trial Work Period. 16

17 Each of the different time-lines, how they work, and how they benefit people who wish to work are briefly discussed. Each section also describes what you need to tell SSA, when, and provides sample letters for your reference. For a more detailed discussion of each of these timelines, see the highlighted links SSDI The Trial Work Period The trial work period (TWP) allows you to work without any changes in your cash or health benefits. A Trial Work Period consists of 9 months, not necessarily in a row, within a 5-year period during which a person earns above the trial work amount. SSA increases the Trial Work figure (TWP $) whenever there s an increase in the consumer price index. The figure for 2011 is $ Things to Do When you re thinking about getting a job 17

18 Look up the current TWP amount 4 and decide for yourself if this is a good time to use those months given your personal recovery. If you ve worked at some point since beginning to receive benefits (or even if you MAY have worked), call your local Social Security You only get ONE office to find out how many trial work months they have Trial Work Period. in the record for you. 5 Ask them to send you a printout Once you have used 9 months in a 5-year period, it has been completed, and you so you can check to make sure their information is correct. Once you know if any past work has counted towards your Trial Work, set up a chart so you can track your do not get another Trial Work from this point on. This allows you to make one. choices about your work as you proceed through your Trial Work. Date Place Wages TWP $$ Above TWP? TWP Month # (Chart for your use in the Templates Section) Example: Jade is considering returning to work. It s been a long time since she worked more than a few hours, so she wants to make sure that she doesn t jeopardize her benefits by returning to work. She knows she s done some work since she began getting benefits, and even though she doesn t think any of these would count as Trial Work, she calls Social Security to find out what their 4 To get TWP figures, go to 5 To find your local Social Security office, go to 18

19 records say. She s surprised to hear them say she s already used 4 Trial Work months, and asks for a printout. When she receives the printout, she agrees with the information and puts it into a table: Date Place Wages TWP $$ Above TWP? TWP Month # March, 2004 Dunkin Donuts $645 $580 Y 1 (per SSA) April, 2004 Dunkin Donuts $651 $580 Y 2 (per SSA) May 2004 Dunkin Donuts $486 $580 N -- August 2006 UMass $358 $620 N -- Sept 2006 UMass $525 $620 N -- Oct 2006 UMass $725 $620 Y 3 (per SSA) Nov 2006 UMass $725 $620 Y 4 (per SSA) Dec 2006 UMass $567 $620 N -- As you can see, plotting your Trial Work is pretty straightforward. If the gross earnings are above the TWP amount, it counts as one month. If it s below the amount, it doesn t count as a TWP month. Date Place Wages TWP $$ Above TWP? TWP Month # March, 2004 Dunkin Donuts $645 $580 Y 1 (per SSA) April, 2004 Dunkin Donuts $651 $580 Y 2 (per SSA) May 2004 Dunkin Donuts $486 $580 N NO WORK -- August 2006 UMass $358 $620 N -- Sept 2006 UMass $525 $620 N -- Oct 2006 UMass $725 $620 Y 3 (per SSA) Nov 2006 UMass $725 $620 Y 4 (per SSA) Dec 2006 UMass $567 $620 N NO WORK -- 19

20 2008 NO WORK NO WORK The Trial Work Period is also 9 months within a rolling 5-year period. What this means is that the first month of Trial Work and the 9 th month of Trial Work have to happen within 5 years. As you can see in Jade s chart, from 2004 to 2009 is 5 years and she s only worked 4 Trial Work months during this five years. If she were to work in 2010, the work from 2004 would no longer count as no 9 months of Trial Work occurred within 5 years. This window of fiveyears continues to move forward until a 9 th Trial Work month is worked, ending the Trial Work Period. During your Trial Work Period, you receive your full check, so you can work as many hours as you want and earn any amount. But remember that you only get one TWP, and completion of your 9 th TWP month will also start the next timeline. This means you really want to evaluate what you want and need to do with respect to continuing work, or continuing to work at the same level no later than your 8 th TWP month. Things to Do When you get a job Continue to use the Trial Work chart to track your TWP Evaluate your experience with working so you can make an informed choice as you near the end of your Trial Work Period (more about this below). Connect with your local WIPA for more in-depth information about the impact of work based on your own wages, etc. Write a letter to Social Security to inform them that you re working. How Do I Do This? 20

21 A simple letter will do the trick, along with 2 pay-stubs. Often, SSA will followup by sending you a letter for more information and sending a request for your wages to your employer. If you don t want Social Security to contact your employer, you can ask them to let you provide the wage information instead. If you don t follow-through, they will go to your employer. Example: It s January 2010, and Jade decides to get a job. Although she has used 4 of her Trial Work months, she realizes that the work from 2004 is now beyond 5 years ago, so these don t count anymore. In March, she got a parttime job at Boston University earning approximately $ per month. As this amount is below the TWP amount, she will not be using up any months. She notifies Social Security that she s working in the letter below. 6 April 3, 2010 Ms. Chin, Claims Representative Social Security Administration 55 Pleasant Street Any Town, USA RE; Jade Smith SSN: Dear Ms. Chin, I am writing to inform you that I have begun working. I am currently working at Boston University. I am working 10 hours per week, earning $15/ hour. Attached you will find that last tow (2) pay stubs to verify my earnings. As I have not disclosed my disability to my employer, I would appreciate your requesting further verification of my income directly from me. If you need any further information, please feel free to contact me. Thank you. Sincerely, 6 A blank template of this letter is available in Appendix 4. 21

22 Jade Smith There are letters in the Template Section that can be used as a guide to inform SSA of your working or not working, as well as increasing/decreasing your hours. The Trial Work Period is an opportunity to really try working without any fear of losing your cash benefits or medical coverage. As long as you keep track of where you are, you should be able to fully pace your return to work according to your own needs. Chapter 4: The Extended Period of Eligibility: Part I, The Basics What it is: The Extended Period of Eligibility is a 3-calendar-year safety net that immediately follows the Trial Work Period. It allows you to continue to work while staying on the Social Security rolls and receiving your Medicare benefits. Depending on how much you re earning, you may or may not also continue to receive your monthly Social Security check. How it Works: As you know, Social Security s definition of disabled is the inability to do any significant work, which they call substantial gainful activity. SSA assigns a money figure to represent this. If your earnings are above substantial gainful activity or SGA, you will not receive your SSDI check. If your earnings fall below this figure, you will receive your full check. The figure for SGA changes almost every year, so see the chart in the Templates Section for the amount each year. 22

23 Example: Jing and Alex, his peer support worker, have been working together. Jing has been focusing on his vocational recovery, and decides to get a job in a gym, providing fitness coaching. He earns $800/month, under the 2010 SGA figure, so continues to receive his monthly SSDI check. He really likes the gym he s working for, and they like him as well. Within just a couple of months, he s given a raise and increases his hours. He becomes concerned, however, when he realizes that his earnings are now over $1,100/month, over the SGA amount, and he is not entitled to his SSDI check. He cuts back his hours, but he and Alex also decide it would be best to check in with the local WIPA specialist to see if there are any other work incentives that will support Jing. See Extended Period of Eligibility, Part 2, to learn what might help Jing work more hours without losing his cash benefits. Things to Do Continue to inform SSA whenever you start or stop working. (See Templates Section for a sample letter) Stay aware of your earnings so you know if you re going over SGA. (See Chapter 5 for more information on SGA) 23

24 Chapter 5: The Extended Period of Eligibility: Part II Earning More & Counting Less: Taking Disability into Account As we know, the Extended Period of Eligibility is a 3-calendar-year safety net that immediately follows the Trial Work Period. A person receives their SSDI check if their countable earnings are below SGA, and does not receive an SSDI check if countable earnings are above SGA. Substantial Gainful Activity (SGA) We often think of this term as just being a level of work usually measured by dollar figure. But it s really more than just work. It must be work that is both Substantial and Gainful. 24

25 Substantial Work requires a significant amount of physical or mental energy to perform the job. Typically, there is a job description, or at least specific job expectations. There is an expectation that the person is working independently without any extra supports, such as a job coach, extra supervision, etc. It is work where the person s tasks, expectations and job structure are parallel to others in that role. The earnings are just one factor in determining whether or not a job is substantial work. The following jobs are not fully substantial regardless of a person s earnings: o TEPs o Supported Employment o Supported Workshop o Make work a specially created job that doesn t require independence or adherence to certain responsibilities and expectations, e.g. an uncle hiring his nephew to work in his Dunkin Donuts shop without any specific role other than helping out. o Peer Roles in certain settings Gainful Work is that which typically includes reasonable remuneration or pay for the work. Consequently, most volunteer jobs are not considered to be gainful. In addition, SSA takes into consideration the monies spent by a person with a disability to be able to work. A job may be gainful in terms of gross income, but by the time someone has paid out of pocket for needed medical expenses, it is no longer gainful. The SSA work incentives provide different policies and procedures to take into consideration the different factors that modify both the substantial and gainful nature of any job. To take each factor into consideration, SSA allows adjustments to your gross income, reducing the amount that SSA actually counts as your income. This works in a similar way to the way that annual taxes are computed. With taxes, people start with gross income and then take allowable deductions or credits that are subtracted from the gross income 25

26 to come to a lower taxable income, and lower is better! In SSA, each different factor gets translated into an earnings adjustment that also gets deducted from the gross income to come to a lower countable income. The SSDI work incentives that look at these factors during the Extended Period of Eligibility include Impairment Related Work Expenses, Job Coach Subsidies, and Employer Subsidies. SGA Adjustments Impairment Related Work Expenses: Also called IRWEs. These are expenses paid out-of-pocket for those items or services related to your impairment that help you go to work. To be an IRWE, the expense must be: Actually paid Paid out of pocket Non-reimbursable from any insurance coverage Related to the disability Related to the ability to work Common examples of IRWEs are: Co-payments for medications, medical appointments, lab tests, etc. Most medical services related to impairment are IRWEs because medical stability is necessary for ongoing employment. Payment for job coach, PCA, specialized transportation, etc. Most expenses for services that support the ability to work are IRWEs. Some services, such as a PCA, may serve many purposes. The portion that is directly related to work support is an IRWE. Halfway or group home expenses related to support. Most group residences collect monthly rent for room, board and support. The amount of the support that is related to your ability to work is an IRWE. For example, Jose 26

27 lives in a group home where he pays $1,000 per month. Of this, $500 is for room and board and $ is for services. Most of the time with his counselor at the house supports him in dealing with work, maintaining his wellness so he can work, and learning skills to get to work on-time etc. It s fair to say that about $ of the $ paid for counseling services is related to work and is, therefore, an IRWE. Computing IRWEs IRWEs are computed by adding up the total spent in a month. This total is subtracted from your gross income. Example 1: Alexei works three days per week, and earns $1, per month. This amount is above SGA. However, during the month, he has regular out of pocket payments (see below). Step 1: Adding Up the IRWEs $15.00 co-pay for 4 medications ($15 X 4) = $ $75.00 per visit for job coach, 2x/month ($75 X 2) $ PCA assistance, 3 $15/hr. = ($15 X 36) $ o 2 hrs. each am for prep & travel (24 hrs/mo) o 1 hr. each afternoon for travel (12 hrs/mo) TOTAL IRWEs $ Step 2: Making Adjustments to Gross Income Monthly Gross Earnings Subtract IRWEs $ Total Countable Income $ (Over SGA) $ (Below SGA) Example 2: Rosalie works as a bookkeeper 6 hours per day, 3 days per week. Her hourly pay is $18.00/hr., and she typically earns $ in a 4-paycheck month. She lives in a privately run residential home, where she pays $1,000 per month for rent. You learn from the residential facility that the rent is broken down as follows: $ shelter, $ food, and $ for residential counseling & support services. You re also able to verify that 75% of 27

28 the counseling and support she receives is related to increasing her skills in relation to work (coping with work, wellness, time management, etc.). She also has out-of-pocket co-pays for medication and doctor appointments. Step 1: Adding Up the IRWEs Counseling and Support Services $ o 75% of $ Medication co-pay, $15 each for three medications ($15 X 3) $ Psychopharmacology co-pay, 1 X per month $ Total IRWEs $ Step 2: Making Adjustments to Gross Income Monthly Gross Earnings $ (Above SGA) Subtract IRWEs $ Total Countable Earnings $ (Below SGA) Things to Do You need to inform SSA that you have monthly IRWE s (See letter in Templates Section.) If you have the same IRWEs every month, your claims representative at SSA may tell you that you don t need to send all the receipts in. In this case, you should hold onto all your receipts and send a confirming letter to SSA (See Templates Section). IRWEs are a way to reimburse yourself for the monies that you actually spend to allow you to go to work. Other adjustments allow you to get credit for the extra time you invest in being able to work 28

29 Job Coach Subsidy: A job coach subsidy is consideration of the amount of time spent with a job coach. Even if you pay for a job coach out of pocket and deduct it as an IRWE (see above), you can still consider a job coach subsidy as well. Traditionally, job coaches have been on-site, but it is worth arguing that an off-site job coach is the same thing for a person with a psychiatric impairment. A job coach subsidy is a simple computation: the number of hours per month spent with your job coach multiplied by your hourly pay. Example: Marietta works as a legislative aid. She works 22 hours per week, earning $12.00/hour. She meets with a job coach for 1.5 hours per week. In a 4-week month, she receives $ , over SGA. Step 1: Computing the Job Coach Subsidy Time with Job Coach/Month (1.5 hrs X 4.3 weeks)* 6.45 hours Marietta s Hourly Wage (multiply) $12.00 per hour Total Job Coach Subsidy $77.40 *4.3 is the average weeks in a month, even though we get paychecks on 4 or 5 weeks. Step 2: Making Adjustments to Gross Income Monthly Gross Earnings $ (Above SGA) Subtract Job Coach Subsidy $ Total Countable Earnings $ (Below SGA) Things to Do Inform SSA that you receive Job Coaching Services (See Templates Section for sample letter). In summary, a job coach subsidy is a way to take your time that you spend getting support to do your work into consideration. SSA also takes into 29

30 consideration the amount of time your employer invests in your success (but you get the credit!) Employer Subsidy: An employer subsidy exists when an employer provides supports and accommodations, and makes certain allowances to maximize a person s success. In Social Security lingo, an employer is subsidizing or paying the full salary of someone who is working under the value of that salary. Hence, if a person is working in a Supported Employment program, Transitional Employment Program, or any other program where additional support or variability in performance is allowed, it is considered to be subsidized. Unfortunately, the SSA regulations regarding employer subsidies, also called special circumstances, were drafted when sheltered workshops were common employment settings for people with psychiatric disabilities. The language in the regulations talk about comparing the value of work of people with disabilities versus those that don t in terms of productivity and performance. Because of this language, many people don t take advantage of this very valuable work incentive. By viewing this subsidy as being more about supporting a person s success rather than identifying how a person s work is of lesser value, the employer subsidy becomes usable in a way that doesn t strip a person of his/her dignity in the process. In reality, it s not about the employer, but the employee, and the question SSA is asking is, could this person with a disability successfully perform this job in another setting without the supports allowed in the current setting? If the answer is no, then a subsidy exists as the work might not meet the substantial level needed to be SGA. Common Examples of Employer Subsidies are: Extra breaks 30

31 Flexible schedules Working at home Extra supervision and support Instructions given in alternative formats Limited or no deadlines for work product Relaxation of sick time rules Allowing variability of performance An employer subsidy is calculated as a percentage of total work hours. The percentage is determined in one of two ways, depending on whether the time for the employer support is something that can be easily measured or not. Supports that can be measured by time: The amount of time spent by the employee, the employer or another employee supporting the person with a disability for extra breaks, extra supervision, creating instructions in alternative formats, etc., can be easily counted in time units. After figuring out how many hours are subsidized, this gets translated into the percentage of total hours (See Example 1). Supports that cannot be easily measured by time: Allowing flexibility in schedules, working at home, variability in performance, etc., can not be easily measured in concrete time units. These factors are also put into a percentage, but this is much more of a fuzzy math process, looking at the impact of these accommodations on the job as a whole (Example 2). Example 1: Lakisha works in the research department of the Boston University Center for Psychiatric Rehabilitation. She is a 20-hour per week employee, working 5 hours per day, 4 days per week, and earning $13.00 per hour. Her usual monthly earnings are $1040 (above SGA). They are fully aware of her disability and have made the following accommodations for her: She can take a 10-minute break every hour, and receives 15 minutes of supervision every day she works. (These supports are not available to her co-workers). 31

32 Step 1: Computing the Employer Subsidy Extra 10 minutes break per hour X 5 hours worked each day = 50 minutes Times 4 days worked per week = 200 Times 4.3 weeks per month = 860 Extra 15 minutes supervision X 4 days per week = 60 minutes Times 4.3 weeks per month = 250 minutes 860 minutes (or hours) 250 minutes (or 4.2 hours) Total Subsidized Time 1110 minutes or 18.5 hours Step 2: From Hours to Percentage Total Hours Worked per Month 86 hours Total Hours Subsidied 18.5 hours 18.5 Divided by 86 = 21.5% Total Employer Subsidy 21.5% of gross earnings $ X.215 = $ Step 3: Making Adjustments to Gross Income Gross Earnings $ (Above SGA) Employer Subsidy (minus) $ Total Countable Earnings $ (Below SGA) Example 2: Archie works in an RLC as a Certified Peer Specialist. He works 25 hours per week and earns $13.00 per hour. He has a variety of duties, including meeting with peers or providers who come to the resource center, helping to develop resource lists and networking with local service agencies. He has the lived experience of someone with a psychiatric disability, a requirement for the position. In his work, he has scheduled work hours, but these are flexible if needed. When on the job, it is understood that there will be variability in performance based on his degree of wellness, with some days being better than others. It is also understood that the peer specialists serve as peer supports for one another, even during work hours. There is a great 32

33 deal of latitude around his needs for getting to therapy and psychopharmacology appointments, and there is no rigid sick time policy applied to him, even though he will only be paid for a certain number of sick days. The environment as a whole is very specialized and both supports Archie s strengths, while allowing him the needed accommodations during times of distress. Step 1: Computing the Employer Subsidy As you can see, this is much more difficult. You can t just figure out what kind of time is related to these accommodations, and SSA doesn t provide any concrete guidance to help. It s a matter of looking at the job as a whole and trying to come up with a ballpark percentage of subsidy. Things to consider: o Flexible schedule o Variability in work performance day-to-day o Built in peer support on the job o Ability to leave for medical appointments o Flexible sick time These are significant accommodations, and if you imagine Archie trying to work in a different setting without these accommodations, you can see that it would be very difficult. This means that his work is not nearly as substantial as it looks at first from looking at his gross earnings, and this is where the subsidy comes in. It s a way to communicate with SSA that there are a number of disability related supports on the job that allow him to work. In a situation like Archie s, a subsidy between 30% to 40% might be do-able. But, as you can see, this is another place that you should be working with your resources. Gross Earnings (4 week month) $ (Above SGA) Subtract 40% subsidy (1300 X.4 = 520) $ Total Countable Earnings $ (Below SGA) 33

34 Things to Do Discuss the employer subsidy with your employer. The letter must come from your employer so you have to disclose, but in order to have any reasonable accommodations from an employer, you would have had to disclose your disability anyway. If your employer has never written a subsidy letter, give him/her a copy of the sample in the Templates Section. Reassure your employer that this is something that benefits you, not hurts you, so it s OK to be honest. It would be even better if you work on the letter together so your employer feels comfortable writing the letter. You can also reassure your employer that your Social Security file is not shared with other government agencies. Putting It All Together Example: Ramon has received mental health services for many years. Through working with his peer support specialist two years ago, he decided that he wanted to return to school and study computers. He also decided that he wanted to really focus on this goal, so would remain living in the community residence where he knows people, has a social community and gets a lot of support. He just completed his Associates Degree in Computer Sciences and got a parttime job providing IT support in a law firm. He works 5 days per week, 5 hours per day, and earns $20.00/hour. In a 4 week month, he earns $2,000.00, and averages $2,150.00/month (4.3 weeks) Step 1: Adding Up the IRWEs Ramon has ongoing support that requires out-of-pocket payments, including: Medication co-pays (3 $35.00 each) $ Group therapy $10 (4X10=$40.00) $40.00 Therapy co-pay (2 $15) $

35 Portion of rent to residence that provides employment $ support Total Impairment Related Work Expenses $ Step 2: Computing the Job Coach Subsidy Ramon worked with an educational/employment coach during school, and continues to work with him now that he s in a work setting. He sees his job coach 1 X per week. 4 weeks X 1x/week = 4 hours job coaching X hourly rate of $20.00 = Total Job Coach Subsidy $80.00 Step 3: Computing the Employer Subsidy Ramon disclosed his disability to his employer and made arrangements to have extra supervision for one hour each week, as well as an agreement that he can take extra breaks as needed, and do certain types of programming work from at home as long as there aren t any in-office IT needs during that time period. Extra supervision X 1 hour/week X 4 weeks per 4 hours monthly month Extra breaks Can t measure Flexibility of schedule Can t measure Estimated Employer Subsidy 20% 20% Subsidy Total Employer Subsidy, 20% of $2, $ Step 4: Making Adjustments to Gross Income Gross Income (4 weeks) $2, (Above SGA) Subtract IRWEs Subtotal $ Subtract Job Coach Subsidy Subtotal $ Subtract Employer Subsidy Total Countable Earnings $ (Below SGA) 35

36 As you can see, the SSDI work incentives give you the opportunity to pace your return to work. You can become in control of rather than victim of your benefits. But it does take being an active member of the process, as well as getting the supports you need. Chapter 6: Expedited Reinstatement Period The next timeline in the SSDI Work Incentives is called the Expedited Reinstatement Period or EXR. The EXR is another safety net that starts after the EPE and lasts for 60 months (5 years). 36

37 The EXR provides protection for people who have lost cash benefits due to work, but experiences a relapse of the original disabling condition. Rather than having to reapply for benefits, starting at the beginning of the process, you can apply for Expedited Reinstatement to benefits. In this process, benefits start back up immediately, and can continue for up to 6 months while SSA evaluates if you are again eligible for cash SSDI benefits. Even if SSA decides that you re not disabled, you do not have to pay the 6 months of benefits that you ve received. Example: Emmanuel was on benefits for many years and made many attempts to work. In July 2008, he was nearing the end of his Extended Period of Eligibility and had been working above the SGA level for about 6 months. He reflected upon his work, how he was feeling as a worker and how he wanted to proceed at this critical time. Because he knew about the Expedited Reinstatement Period, he chose to continue working at the same level, even though it meant that he would lose his cash benefits safety net with the EPE ending in October (2008). In September 2009, Emmanual had been working for several years. But over the past few months, his work setting was becoming more stressful and he found himself sinking deeper and deeper into his well-known depression. Knowing his own needs to best support his wellness and speaking with his supporters, he made the hard decision to take a medical leave from his work in December. He went into his local Social Security office and applied for Expedited Reinstatement. He was told that he should receive a check by February 3, 2011, and that he d receive a decision on his benefit application once they receive the updated medical information, etc. He s relieved that he will not have to worry about repaying benefits through July,

38 Things to Do Inform SSA that you re experienced a relapse with your condition requiring you to stop working. Complete the paperwork for an Expedited Reinstatement. Let your doctor s know that you will need them to provide medical support for a favorable SSDI decision that you ve returned to disabled status. Chapter 7: Extended Medicare Period For many of us, maintaining our Medicare medical benefit is as important, if not more important, than maintaining cash benefits. Luckily, this is a message that clearly got through to the SSA and become a key consideration when designing the work incentives. 38

39 Medicare, the insurance that comes with SSDI, has several parts: o Part A - o Part B - o Part C - o Part D - Inpatient coverage (Automatic no premium) Outpatient coverage (Premium paid monthly deducted before you receive your SSDI check) Coverage of all services through a behavioral health Organization (May or may not involve additional premium) Prescription coverage (May or may not involve additional premium) All of these different types and kinds of coverage are important to people, and necessary for recovery as well as employment. So, they are an integral part of the social security work incentives. When your earnings are above the SGA level as you enter your EPE period, you also trigger the beginning of your Extended Medicare Coverage (EMC). This coverage continues for at least 93 months, or 7 ¾ years, which means that Medicare coverage continues through the EPE and well beyond. Even when the EMC is completed, you can continue your Medicare coverage by paying the Part A premium (which, up to that point has been at no charge). During your EMC you continue to pay your Part B premiums as you ve been doing. (During the Trial Work Period and before, your Part B premium was taken out of your check.) Example: Synjoia has been working at various levels over many years. Her trial work period ended in March 2010 when she worked a 9 th Trial Work month 39

40 in a 5-year period. In April 2010, her EPE AND EMC began. Her EPE will end in February 2013 (3 years), and her EMC will end in January, Things to Do Continue to keep SSA informed about any changes in your work. Complete the paperwork for ongoing Medicare when you receive it If you do not receive information about ongoing Medicare coverage, contact your local Social Security office. Chapter 8: Transitions Now that we ve talked about what to do IN each time period that makes up the SSDI work incentives, let s 40

41 talk about those times when someone is transitioning from one time period to another, for example from the Trial Work Period to the Extended Period of Eligibility. These are the times when people often fall through the cracks, so we ll take them one-by-one. But first, let s think about how to approach all transitions. There are five bsic steps you want whenever you are within a three to six month window of transitioning to a new timeline, depending on how long the timeline runs. In other words, you want to review these steps around TWP month 5 or 6, about 2 ½ years into your EPE, about 4 ½ years into your EXR and about 6 months before your EMC coverage ends. 1. Track: In each SSDI timeline, we ve talked about the importance of knowing where you are within the timeline. This is the key to being supported by rather than victim of the SSDI work incentives. 2. Evaluate: Having tracked where you are within a timeline, you have the opportunity to do some self-evaluation BEFORE the end of the timeline. This is a time to reflect on the positive and negative aspects of how work impacts your disability, think about the supports you currently have that you may not have in the next timeline, and weigh and balance the pro s and con s of this upcoming shift in level of support. This will allow you to pace your return to work in a way that best fits your needs, and truly make an informed choice in how you utilize the SSDI work incentives. 3. When? It is important to know the month that you enter the next timeline so you can follow up on anything that you need to do. Because the SSA is so overburdened, they may or may not be aware that you re crossing into a new timeline. Being pro-active in contacting SSA can save you many headaches later down the road. 4. What Now? There may be special rules that only apply to a month or two within the transition period, so it s important to know what these are. 41

42 5. What s Next? It s also important to know what the rules are within the upcoming timeline because each has its own distinct set of rules. What was required, when you would get checks, etc., change from one timeline to the next. Now that we know how to approach the transitions, let s discuss each one individually. Trial Work Period (TWP) to Extended Period of Eligibility (EPE) During the Trial Work months, the 9 months do not necessarily run consecutively, and you receive your full check regardless of how much you earn above the TWP amount for that year. The transition from TWP to EPE begins in the 9 th month of Trial Work. The 9 th Trial Work is always followed immediately by the 1 st month of the EPE, and you are in a new timeline with different rules. As you go into the EPE, the most important earnings level becomes the SGA amount rather than the TWP amount. The SGA level is always higher than the TWP level, so you may have been working over TWP and using these months, but still not be over SGA. SSA will not send you a letter telling you that you re about to leave your TWP or that you just entered the EPE, so you want to figure out your status for yourself. This decision tree can help. 42

43 If you are working over the SGA limit after deducting any IRWEs or subsidies that may apply, you become disabled but working or working while disabled. Remember that the definition of disability under the SSA rules says that you must be unable to perform any substantial gainful activity This special status created by the work incentives allows you to continue trying to work and stay on the SSDI rolls. The safety net provided by the EPE lets you continue to work, but when your work is above SGA you don t get a check for that month. The transition from the Trial Work Period where you are receiving checks regardless of earnings to the EPE where you won t receive checks when you re over SGA is a threemonth grace period. The first month is the cessation month and the following two months are grace period months. You continue to be eligible for checks during these months. Starting the next month, you are not eligible for a check during any month that your countable earnings are above SGA. 43

44 More often than not, SSA will not realize that you aren t eligible for TIP checks until sometime later, even though you ve notified them of all your work. This means you will still receive checks after you re eligible for them. Things to Do Write a letter to SSA reminding them that you should no longer be receiving checks and ask them to stop sending them. Create a separate bank account and put any SSDI checks in there so you can immediately repay these funds when SSA catches up. Extended Period of Eligibility to Expedited Reinstatement Period The EPE provides a safety net for 3 calendar years. If you re working above SGA, you stay on the rolls, maintain your Medicare benefit, but don t receive a monthly check. But if you re working below SGA, you also receive your monthly SSDI check. When you come to the end of the 3-year EPE period, you will either continue on with your benefits or benefits will end, depending on whether you re working and how much you re working. End of EPE While Not Working If you are in your EPE, you were working at least above the TWP for 9 months and may have also worked above SGA for some period of time. However, if you stopped working and are not working as the EPE ends, you will continue to receive your cash and Medicare benefits uninterrupted, even though you are leaving the EPE. You can continue to receive your benefits indefinitely until you work and go above the EPE. 44

45 If you work above SGA, your cash benefits will end. However, your EXR safety net will kick in at that point giving you another 5 year safety net (See Chapter 6, Expedited Reinstatement Period). Things to Do You do not have to do anything if you leave your EPE while you re not working. If you return to work at some point, you should contact SSA and let them know you ve returned to work. End of EPE While Working Below SGA You may come to the end of the EPE while you re working, but working under SGA. The same as above, you ll continue to receive your cash and Medicare benefits uninterrupted, even though you are leaving the EPE. Here, too, you can continue to receive your benefits indefinitely until you work and go above the EPE, when the EXR protections kick in. (See Chapter 6, Expedited Reinstatement Period). Things to Do You do not have to do anything if you leave your EPE while you re working below SGA, as long as you ve informed them already about your work. If you increase your hours, you should report this to SSA. End of EPE While Working Above SGA The EPE provides a significant amount of time to really return to work at a pace that makes the most sense for 45

46 you. Hopefully, you ve been tracking your EPE so you can make informed choices about moving forward. If you ve been working over SGA as you near the end of the EPE and choose to continue working at this level as your EPE ends, you will no longer be entitled to your SSDI cash benefits. However, your EXR period begins, giving you added protection, and you may still be eligible for Extended Medicare Coverage (See Chapter 7, Extended Medicare Coverage). TIP SSA may not realize that you aren t eligible for checks until sometime later, even though you ve notified them of all your work. This means you will still receive checks after you re eligible for them. Things to Do Write a letter to SSA reminding them that you should no longer be receiving checks and ask them to stop sending them. Create a separate bank account and put any SSDI checks in there so you can immediately repay these funds when SSA catches up. As you can see, the SSDI work incentives require you to stay on top of the timelines that are involved. If not, you can easily accrue an overpayment from receiving checks that you weren t entitled to. But if you keep track and work with your resources, the SSDI work incentives can be a powerful support in your vocational recovery. Chapter 9: Supplemental Security Income (SSI) Work Incentives As noted at the beginning, SSI is very different from SSDI. The work incentives are also very different. With SSI, there are no timelines to consider, only income each month. Most of the time, SSI recipients benefit from working, with increased money in their pockets and ongoing medical insurance coverage. 46

47 When people on SSI work, their earnings are reviewed each month using the same formula each time. This math calculation looks at how much income you had from all sources, what adjustments will apply to lower how much SSA counts for the month, and what your monthly SSI check will be. Let s look at the overall format first. The first step is to compute your Countable Income. This is what SSA ends up counting as your earnings for the month. The same formula is used if someone just has a small job or if they have a job, get SSDI, and have other deductions or adjustments that are allowed by SSA. Adjustments refer to certain deductions you re allowed to use, reducing the amount (on paper, not out of pocket) that SSA actually counts as your income. This works in a similar way that you compute your annual taxes. When people complete their tax forms, they start with gross income and then take allowable deductions or credits. These are subtracted from the gross income to come to a lower taxable income, and lower are better! SSA gives SSI recipients who work some deductions. With SSI, you start with your gross income and, after deductions, get to your countable income. Lower is better here, too, because the final number is what SSA counts as your 47

48 earnings, even if you made quite a bit more in both gross and net (take home after taxes) pay. The SSI deductions that are allowed are the Work Deduction, the General Deduction, Impairment Related Work Expenses (IRWEs), PASS, and Student Earned Income Exclusion. Let s look at a simple example. Example: Josh receives SSI and recently started working. He works 2 days per week for 3 hours doing some extra gardening for his neighbor who pays him $15.00 per hour. As you can see, even though Josh actually earns $ in the month, SSA will only count $ Now, let s look at the second step finding out how this will impact Josh s SSI check. This part of the formula looks like this: 48

49 Example (Josh Continued): Josh lives in Massachusetts, a state that adds a state supplement to the SSI Federal Benefit Rate (FBR). Josh lives alone, so he gets the highest SSI amount, $ His countable income, as we determined in the steps above, is $ So let s put it together: In the end, Josh ends up with his $ check from work plus his SSI check of $ Now, instead of getting $ a month, he gets $ and continues to get his Medicaid medical insurance coverage. Things to Do Report your work to SSA when you begin to work or change your hours. See the sample letter in the Templates Section. If your hours or pay vary month-to-month, your SSI check will change as well. If you re not phobic about doing math, it always helps to keep track of your income and SSI deductions each month in the blank form provided in the Templates Section. TIP SSI is configured using what s called Retroactive Monthly Accounting or RMA. What this means is that your SSI check that you receive is based on your financial status two months ago. For example, if you get a check in April, it represents your financial status in 49

50 February. If you re tracking your earnings and the amount of your check, you should be figuring two months earlier. Allowable SSI Deductions/Adjustments General and Work Deductions These are freebies automatically given by SSA. The $20.00 general deduction can be applied when a person has income of any sort. If the income is specifically from work, the $65.00 work deduction can also be applied. Impairment Related Work Expenses (IRWEs) IRWEs are out-of-pocket expenses related to a person s impairment that assist a person to be able to work. (See the full explanation of IRWEs in Chapter 5, Extended Period of Eligibility, Earning More and Counting Less). Examples of common IRWEs include co-payments for medications, medical visits, and therapy and group therapy sessions. IRWEs can also include the portion of payment for PCA assistance and residential services that directly support someone s ability to work. Example: Evelyn has been working a part-time job, but is surprised to see how small her SSI check is. She calls her WIPA and they review her income as well as her expenses, and this is what they learn. Evelyn works 15 hours per week and makes $12.50/hour. In a month with 4 paychecks, she gets $ per month. When there s a 5 th paycheck, she receives $

51 She also has medical expenses each month. She has co-pays for prescriptions ($2.00 for 3 prescriptions, and $75.00 per month for a prescription not covered under the Medicaid prescription plan), and co-pay for her monthly blood test for her Depakote ($25.00). Her total IRWEs are $ When IRWEs are deducted, Evelyn gets an SSI check of $508.39, a paycheck of $ and continues to get her Medicaid coverage. Things to Do If you have IRWEs, you need to report these to SSA. There is a sample letter that you can use in the Templates Section. SSA may require you to send them each month, or they may tell you to only send in the receipts when something changes. Even in this case you should keep all your receipts. If you have a conversation with your claims representative about holding your 51

52 receipts, you should send a confirming letter (see Templates Section). Student Earned Income Exclusion (SEIE): This is a deduction or write-off for people receiving SSI who are students under the age of 22. This applies to a student who is attending school (grades 7 12), a college or university. In 2011, a student can deduct up to $1, per month up to a maximum of $6, per year. (The amount of the deduction changes each year there s a cost of living increase, so see for the current rate.) The yearly limit applies to a calendar year, not a school year or the previous 12 months. You may not spread out this exclusion over the year by including only a portion of your earnings each month. Example: Angela is a 19 year-old woman who has been on SSI for the past 10 years. Last fall, she began attending her local Community College. As part of her financial aid, she got a part-time job at the college. She works 10 hours per week and earns $15.00 per hour. Her earnings since September, 2010 are as follows: Month Earnings (up to $1640/mo) Balance from Max ($6,600.00) September 2010 $ $6, October $ $ November $ $ December $ $ NEW YEAR Start Again $6, January, 2011 $ $ Angela has been earning under the maximum allowed each month so she continues to receive her full SSI check. If she continues to work at the same level, she will reach the maximum for the year in August, Her work for September December will get calculated in the usual way. But then, in January, a new calendar year begins, and she will again have the Student Earned Income Exclusion. 52

53 Things to Do If you are a student who is claiming the Student Earned Income Exclusion, it s important to let SSA know that you re a student. They will get a record of your earnings from the IRS and will not know that you re eligible for this write-off if you don t let them know. (See the Sample letter in the Templates Section.) Program to Achieve Self Support (PASS) A PASS allows people to set aside income to be used to achieve a specific work goal, such as starting a business, going to school, or taking a course to increase marketability. The money that is set aside is deducted from the person s gross income after other deductions and the $1 for $2 calculation is applied, in essence replacing all of those funds in the person s special SSI check. A PASS Plan (SSA Form 545) is like a proposal that you make to SSA that explains your work or business goal, your steps to accomplish the goal, the expenses related to achieving the goal, and the timeline milestones to get to your goal. Completing the PASS plan takes some work, but this is a very useful tool for your own planning, and then for selling your plan to SSA. Example: Juan has decided to start a business painting cars. He s very artistic and is often asked by people to decorate their cars with special stripes, etc. In his pass plan, he outlines his plan and what he will need to accomplish it. The expenses related to his plan include: Rent for first 6 months of sharing garage space ($4, approx) Computer ($2,000.00) Down payment for truck or van to transport materials ($3,000.00) Materials for start up ($5,000.00) Supplies for start up ($2,000.00) Shelving ($300.00) Phone ($100.00) TOTAL $16,

54 His plan is to put $ aside each month. In the first year, the $6, will be put in the bank while he continues to work free-lance as he s been doing. By mid-way of year two, when he has $9, in savings, he plans on purchasing his computer and some basic business supplies, such as invoicing hardware, etc. and pay for the rent at the garage, which will allow him to increase the amount of work he does per month. Then he has plans to slowly increase the business over the next three years. Unearned Income SSDI $ Earned Income Job add $1, Subtotal $1, Work Deduction minus $65.00 General Deduction minus $20.00 Subtotal $ IRWEs minus $78.00 Subtotal $ for 1 Divide by 2 $ PASS Plan Set-Aside minus $ Countable Income $82.00 Maximum SSI $ Countable Income minus $82.00 Special SSI Check $ In the meantime, he will have his earnings, his SSDI check of $ and will be putting $ in savings each month. Because he has a PASS plan, he will be able to exceed the usual $2, limit on savings. As you can see from this example, people with both SSDI and SSI can also utilize PASS plans. In some cases, a PASS plan will also work for people who only receive SSDI benefits and don t receive SSI benefits, even though the PASS plan is an SSI benefit. PASS plans are incredibly helpful, and yet they can be complicated. This is another place that you your local WIPA can be a great support. Here are some other great resources on PASS plans at: 54

55 TIP Vocational experts are another good resource for creating PASS plans. First of all, they re skilled at creating these kinds of plans. In addition, when you submit a plan, SSA evaluates if the plan is likely to succeed. They will often defer to the expertise and opinion of the VR counselor in terms of both the quality of the plan and the likelihood of success. In Massachusetts, you can meet with a VR counselor through the Mass. Rehabilitation Commission, t&l2=departments+and+divisions&l3=massachusetts+rehabilitation+commissio n&l4=vocational+rehabilitation+area+offices&sid=eeohhs2 Any Employment Network that s part of the Ticket to Work program will also have vocational rehab counselors. What About my Medicaid? Going back to work not only involves our cash benefits, but also medical coverage. This is often more important to people as they consider working. SSA was well aware of this need, so made several provisions to ensure that people will have ongoing medical coverage. TIP Medicaid is the formal name of the insurance that comes with SSI. However, some states call it by a different name. For example, it s 55

56 called MassHealth in Massachusetts, MediCal in California and TennCare in Tennessee. So long as you are eligible for an SSI check, even if it s only for $1.00, you continue to be eligible for your Medicaid. However, even if you lose entitlement to cash benefits due to your work, you can still maintain your Medicaid coverage under the 1619b regulations. 1619b This provision continues Medicaid coverage for most working SSI beneficiaries even after earnings become too high to allow a cash benefit. To qualify for this incentive the person must: Have been eligible for SSI cash payment for a least one month. Still be disabled under the SSA rules Meet the Medicaid needs test. This means that you have an ongoing need for the medical coverage that you couldn t meet through your earnings at work. Have GROSS annual earned income less than the current state "threshold amount." See for the annual threshold level per state. Have countable unearned income (for example, SSDI) of less than the current FBR and resources under the current limit for SSI recipients. CommonHealth In Massachusetts, like several other states, there is a program called a Medicaid buy-in. It s called CommonHealth, and gives people the opportunity to purchase Medicaid at a premium rate far lower than most insurance policies. For more information about CommonHealth, see OR 56

57 L2=Insurance+(including+MassHealth)&L3=MassHealth+Coverage+Types&L4=Appl icants+and+members+aged+65+and+older+living+at+home&sid=eeohhs2&b=ter minalcontent&f=masshealth_consumer_covtypes_trad_commonhealth&csid=eeo hhs2 As you can see, SSI work incentives are much easier to calculate, without any timelines or shifting figures to keep track of. There are many opportunities to increase the amount of cash that you can have each month, while maintaining your Medicaid coverage. 57

58 Chapter 10: I m 17 going on 18 If you started receiving either SSI or SSDI benefits as a child, the rules may change for you as you turn 18. SSI children s benefits and the SSDI benefits available for people under 18 are very different from one another (See Chapter 1, Quick Facts on SSI and SSDI), so we ll look at each of these separately. SSDI Benefit Changes, aged 17 to aged 18 SSDI benefits, as you will remember, are an insurance that is always related to a worker. Dependent benefits typically end when you reach 18. However, these can continue until you reach 19 if you are unmarried and a fulltime student in a secondary or elementary school (high school, not college). Your parent should get a notice 3 months before you turn 18 saying that your benefits will stop in three months. To continue benefits, you have to contact SSA to let them know you re still in school. This will allow you to continue receiving benefits until you either finish school or turn 19. If you turn 19 before finishing school, you will get two grace period months of checks after your birthday and then they will end. Things to Do student to submit to SSA. Watch for the letter three months before turning 18. If it doesn t come, contact SSA on your own to let them know you re turning 18, but are still in school. Get a letter from your school certifying that you are still a Submit letter to SSA as early as possible so there s no disruption in your checks. (See the section in Chapter 2 about Communicating with SSA). 58