SOCIAL SECURITY Understanding Disability Programs and Return to Work
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Information Needed (SSDI/SSI) Social Security Number Proof of age/citizenship/alien status Names/addresses/phone numbers of doctors, hospitals where treated Record numbers Dates of treatment Medications/treatment received Basic description of job duties For SSI - proof of income/resources and living arrangements
Social Security Statement The Statement provides you with estimates of monthly Social Security retirement, disability and survivors benefits for which you and your family may be eligible. The statement provides a year-by-year display of your earnings so you can make sure that they are accurately reported on your Social Security record. The Statement should be sent three months before your birthday if you are working. It may also be requested online at www.socialsecurity.gov, or by phone at 800-772-1213.
Two Disability Programs Social Security pays disability under two programs: The Social Security Disability Insurance Program (SSDI) for workers and their families; The Supplemental Security Income (SSI) program for people with little income or resources.
Social Security - Eligibility Criteria (1) Disabled Worker under age 65 Disabled Widow/widower age 50-60* Disabled Adult Child, age 18 or older (onset prior to age 22)* Other family benefits are payable to children under age 18, spouse with child under 16, and spouse over age 62.* * Benefits are payable on the record of a retired, disabled or deceased worker.
SSDI - Eligibility Criteria (2) Generally you need 20 credits earned in the last 10 years before you become disabled. Younger workers may qualify with fewer credits. before age 24-6 credits age 24-31 - credit needed for working half the time between age 21 and the time disabled Waiting period 5 full months; starts after work stops
SSDI - Eligibility Criteria (3) Payments based on earnings offset for workers compensation or government pensions May receive retroactive benefits up to one year before application No resource or income limits Checks are paid one month behind (e.g. June check is for May) Eligible for Medicare 24 months after eligibility
Supplemental Security Income - Eligibility Criteria (1) Disabled, blind or 65 Needs based program Low income Any income affects benefits Limited resources under $2,000 individual under $3,000 couple (Exclusions apply to both) No family benefits payable - only individual entitlement
SSI Eligibility Criteria (2) Not funded from Social Security taxes funded from general revenues No work requirement (except for legal aliens admitted after 8/22/96) US citizen or permanent residency Other restrictive requirements Note: Payments are based on income and living arrangements
SSI Eligibility Criteria (3) No waiting period Only paid as of first day of month following month of application Checks are paid for the month in which they are received Most states offer Medicaid eligibility for people on SSI
Definition of Disability A medically determinable mental or physical impairment which can be expected to result in death or which prevents the individual from engaging in substantial gainful activity for a period of a year. This definition is the same for both SSDI and SSI.
HIV Criteria -1 Documentation of HIV infection or its many manifestations through: laboratory evidence; other acceptable medical information; medical history, clinical data, lab data and diagnostic information. AND
HIV Criteria - 2 One of the following (This is a partial list): Bacterial, Fungal, Viral or Protozoan Infections Malignant Neoplasms Certain Skin Conditions not responsive to Treatment Hematologic Abnormalities Neurological Abnormalities HIV Wasting Syndrome Other Types of Infections Repeated Manifestations of HIV Infections with restricted daily, social activities
Presumptive Payments for HIV Claims - SSI Only All HIV infection claims receive priority handling. Medical diagnosis of symptomatic HIV infection - up to six months of SSI benefits pending a final decision This presumptive decision may be made at the local Social Security office; or at the DDS, depending on the kind of evidence available. If it is determined that the individual is not disabled SSI presumptive payments are not overpayments.
Presumptive Eligibility Criteria To qualify for presumptive payment: A medical source must confirm that the HIV infection is severe enough to meet Social Security criteria; The individual must meet the other SSI nonmedical eligibility requirements; The individual must not be doing substantial work. Note: SSA has a special form for presumptive payments; NYC (through DAS) also has special procedures for services.
Continuing Disability Reviews Continuing Disability Reviews (CDRs) We review all disability cases periodically to determine if there is medical improvement, or the ability to work The review takes place when medical improvement is expected; or every three years if improvement is possible; or every seven years if improvement is not expected
The Challenge: Going Back to Work Work incentives are special rules that provide cash benefits and Medicare to a disabled beneficiary who wants to return to work Both SSDI and SSI have work incentives
SSDI Work Incentives Impairment Related Work Expenses Trial Work Period Extended Period of Eligibility Continuation of Medicare Medicare for People Who Work Medicaid buy-in (of Medicare premium) Subsidy and Special Conditions Unsuccessful Work Attempts
Trial Work Period(TWP) SSDI Only A TWP provides the opportunity to test work skills and receive full benefits regardless of the amount of earnings. The TWP begins the first month of eligibility to SSDI or the application month (whichever is later) The TWP is a period of nine months of work, not necessarily consecutive. The nine months of work must occur within a 60- month period.
Extended Period of Eligibility(EPE) (SSDI Only) At the end of the nine-month TWP, a 36- month EPE begins. During this time benefits can be received for any month in which earnings are below the Substantial Gainful Activity (SGA) amount. SGA in 2003, $800; $1330if blind)
Expedited Reinstatement (SSDI Only) If you become unable to work again because of your medical condition within 60 months after your extended period of eligibility has ended, and your benefits were stopped because of your earnings, you may request reinstatement of benefits without filing a new application. You can receive up to six months of benefits while a new decision is made on your claim. It may be more advantageous to file a new application. The Social Security representative will discuss this with you.
Continuation of Health Coverage SSDI If SSDI payments stop because of earnings above the SGA level, but a person is still disabled, Medicare can continue for at least 93 months after the nine-month TWP. After that you can buy Medicare coverage by paying a monthly premium. If you get Medicare and have low income and few resources your state may pay your Medicare premiums.
Impairment Related Work Expenses (IRWE) SSDI Expenses for things you need because of your impairment in order to work may be deducted when determining if you are performing substantial work. COST of the item or service must be paid by the person with the disability NO REIMBURSEMENT AVAILABLE MUST BE RELATED TO IMPAIRMENT NEEDED FOR WORK EXAMPLES: ATTENDANT CARE SERVICES SOME TRANSPORTATION COSTS MEDICAL DEVICES (WHEELCHAIRS,RESPIRATORS) PROSTHESIS ROUTINE DRUGS/MEDICAL SERVICES
Other Work Incentives Subsidy and Special Conditions Supports received on the job that may result in more pay than the actual value of the work performed. Unsuccessful Work Attempt - This is an effort to do substantial work which stopped or was reduced to below SGA after a short time (six months or less) because of an impairment.
SSI Work Incentives Impairment Related Work Expenses Earned Income Exclusions Blind Work Expenses PASS (Plan for Achieving Self-Support) Section 1619 Work Incentives Student Earned Income Exclusions Property Essential for Self-Support Subsidy and Special Conditions If you work you may continue to receive payments until the income we count exceeds the SSI limit.
Impairment Related Work Expenses (IRWE) SSI Expenses for things you need because of your impairment in order to work may be deducted when determining if you are performing substantial work. COST of the item or service must be paid by the person with the disability NO REIMBURSEMENT AVAILABLE MUST BE RELATED TO IMPAIRMENT NEEDED FOR WORK EXAMPLES: ATTENDANT CARE SERVICES SOME TRANSPORTATION COSTS MEDICAL DEVICES (WHEELCHAIRS,RESPIRATORS) PROSTHESIS ROUTINE DRUGS/MEDICAL SERVICES
Other Work Incentives Earned Income Exclusion (SSI) We do not count most of an individual s earnings when we figure the SSI payment. We exclude the first $65 in a month, plus ½ of the remainder. Special Rules for People Who are Blind Earnings that demonstrate a substantial level of work are $1330 (in 2003) for people who are blind. This is higher than for non-blind disabled workers. There are a number of Blind Work Expenses under SSI. These exceed the impairment related work expenses available to all disabled workers, including federal/state/local/social security taxes; helper animal expenses; translation of materials into Braille, etc.
PASS - Plan for Achieving Self-Support (SSI Only) Set aside income/resources for a specific period of time Vocational/Work Goal Does not affect SGA determination Must be in writing Be approved by SSA
Continuation of Health Care SSI Medicaid continues for working disabled SSI recipients if they are still disabled, meet technical factors of eligibility, need Medicaid in order to work and are unable to afford health care coverage. (1619B)
Section 1619 (a) and (b) SSI 1619(a) Receive SSI cash payments even when earned income is over the substantial amount. Be eligible for an SSI payment at least one month before work at or over the substantial amount. The individual must still be disabled. The individual must meet all the other eligibility rules. 1619(b) Medicaid coverage continues even if earnings are too high for payment if the above rules are met, and Medicaid is needed to work. 2003 threshold amounts NJ - $27,144 NY - $34,136
Other Work Incentives - SSI If you are blind, most work expenses you have (not just those related to your disability) may be deducted from your income. Student Earned Income Exclusion Under age 22, not married Regularly attending school (college - 8 hours/week; grades 7-12 - 12 hours/week; training for employment - 12 hours/week) In 2003 We do not count up to $1,340 of earned income per month ($5,410 per year) when we figure the SSI payment amount
Ticket to Work and Work Incentives Improvement Act Legislation passed in 1999 Purpose To help people with disabilities achieve independence by helping them to take advantage of employment opportunities To provide improved work incentives to help claimants enter/re-enter the workforce by protecting cash payments and health care Expand the universe of service providers available to Social Security and SSI disability benefits to help them obtain services necessary to find, enter and retain employment
What is the Ticket to Work? The ticket will be issued to most Social Security and SSI disability beneficiaries. The ticket may be used for: Case management Work Incentives Planning Career Planning/Development Vocational Assessment Job Placement
Ticket to Work - Program Provisions Work Incentive Improvements Improvements to Medicare and Medicaid Expedited Reinstatement Continuing Disability Review Changes Increases in SGA (substantial gainful activity) and TWP (trial work Period) amounts Increase in student earned income exclusion
Health Care Enhancements under Ticket Extends Medicare Part A premium free coverage for an additional 4 1/2 years beyond current limit for disability beneficiaries who return to work (included in the 93 months) Provide Medicaid to people with disabilities who work Permit working individuals with incomes above 250% of federal poverty level to buy-in to Medicaid State buy-in currently in effect in New Jersey; in New York effective date is 2003 Provide demonstration projects for those too disabled to work
Benefits of Using a Ticket Increase beneficiary choice in obtaining vocational services Remove barriers that require people with disabilities to choose between health care coverage and work Assures that Americans with disabilities have the opportunity to participate in the workforce and lessen their dependence on public benefits
Ticket to Work and Self-Sufficiency Program PROGRAM MANAGER - MAXIMUS Manage the Ticket Program Recruit/monitor/recommend ENs Facilitate beneficiary access to ENs Facilitate payments to ENs Resolve disputes among ENs and beneficiaries www.yourtickettowork.com
Employment Network Any qualified state, local or private entity Can be a single entity or an association of organizations combining resources Assumes responsibility for coordination and delivery of employment services Develops work plan with claimant Claimant Choice to use/remain with EN
Work Plan REQUIRED WRITTEN DOCUMENT: VOCATIONAL GOAL OUTLINES SERVICES AND SUPPORTS NEEDED TO REACH THE GOAL TERMS AND CONDITIONS RELATED TO THE PROVISION OF SERVICES RIGHTS AND REMEDIES RIGHT TO MODIFY
Continuing Disability Reviews SSA CANNOT INITIATE A MEDICAL REVIEW WHILE A BENEFICIARY IS USING A TICKET EFFECTIVE JANUARY 1, 2002 WORK ACTIVITY CANNOT BE USED AS A BASIS FOR A CDR