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					1
Enhancing the Employment
Outcomes of SSI/SSDI
Beneficiaries
ARCA 50th Anniversary Educational Conference
November 10, 2007


This presentation is provided through the Department of Correctional Service’s System Change Initiative at
Cornell University’s Employment and Disability Institute funded by the New York State Developmental
Disabilities Planning Council in collaboration with the New York State Department of Correctional Services
and Division of Parole.



                                                                                                             2
Employment and Disability Institute                                                  www.edi.cornell.edu
So what is the current employment outlook for
people with disabilities in the U.S. ?




                                            3
                 The American Community Survey

            • Much of the following statistics are derived from the
              American Community Survey (ACS) which is a new
              continuous data collection effort conducted by the
              U.S. Census Bureau.
            • The ACS is used to produce annual estimates at the
              national, state and local level on the characteristics of
              the United States population.
            • The ACS collects information on an annual basis
              from approximately 3 million addresses in the US and
              36,000 addresses in Puerto Rico.
Calculations by the Rehabilitation Research and Training Center on Disability Demographics and Statistics   4
(StatsRRTC) using the 2006 ACS Public Use Microdata Samples (PUMS).
                 ACS - Employment Rates
            • In 2006, the employment rate of working-age
              people with disabilities was 37.7 in the US
            • In 2006, the employment rate of working-age
              people without disabilities was 79.7 in the US
            • In 2006, the gap between the employment rates
              of working-age people with and without
              disabilities was 42.0 percentage points in the US


Rehabilitation Research and Training Center on Disability Demographics and Statistics. (2007).   5
2006 Disability Status Report. Ithaca, NY: Cornell University.
                  CPS - Labor Market Activity
                  The labor market activity rate is the percentage of men and women,
                  aged 18-64 in the United States who worked more than 52 hours in
                  the prior calendar year from 1981 - 2004
                                with work limitation                                       w/out work limitation




Houtenville, A. J., Erickson, W. A., Lee, C. G. (2005, April 4). Disability Statistics from the Current Population Survey
(CPS). Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and            6
Statistics (StatsRRTC). Retrieved September 17, 2007 from www.disabilitystatistics.org
                 ACS- Household Income
            • In 2006, the median household income of
              working-age people with disabilities was $36,300
              in the U.S. as compared to $65,400 for those
              without disabilities.




Rehabilitation Research and Training Center on Disability Demographics and Statistics. (2007).   7
2006 Disability Status Report. Ithaca, NY: Cornell University.
                 ACS – Poverty & SSI
            • In 2006, the poverty rate of working-age
              people with disabilities in the US was 25.3%
              as compared to 9.2% without a disability
            • In 2006, the percentage of working-age
              people with disabilities receiving SSI
              payments was 16.5% (n=3,699,000) in the
              U.S.



Rehabilitation Research and Training Center on Disability Demographics and Statistics. (2007).   8
2006 Disability Status Report. Ithaca, NY: Cornell University.
  The Longitudinal Study of Vocational
  Rehabilitation Services Programs
• Stapleton and Erickson (2005) documented that
  SSDI and SSI beneficiaries attain lower
  employment and earnings outcomes than other
  VR clients.
  – SSDI and SSI beneficiaries were more likely to work
    part-time as compared to other VR clients.
  – Mean weekly hours worked were 26.5 for
    beneficiaries as compared to 35.8 for other VR clients.
  – Mean hourly income showed a $2.56 difference
    between beneficiaries and other VR clients.
  – Beneficiaries were less likely to have jobs with
    employer-sponsored healthcare.                     9
So, what would it take to improve the
employment outlook for SSI and SSDI
beneficiaries?




                                        10
  Variables Impacting Employment
  Outcomes
• Disability benefits and other entitlements
• Current policy barriers to work
   – Proving inability to work
   – Making work pay
   – Unintended consequences across programs
• Expectations
   – Livable wages and quality jobs
   – Belief in full employment
   – Greater economic independence through an earning offset

                                                               11
  SSA Organizational Structure

• The Social Security Administration (SSA) is a
  federal agency.
• SSA administers two benefit programs for
  people with disabilities:
  – Social Security Disability Insurance (SSDI)
  – Supplemental Security Income (SSI).



                                                  12
  Definition of Disability for Adults

• The inability to engage in any substantial
  gainful activity (SGA) by reason of medically
  determinable physical and/or mental
  impairment(s) which can be expected to last
  for a continuous period of not less than 12
  months or result in death.



                                                  13
   Five-Step Sequential Analysis
• STEP 1. Is the applicant engaging in
  Substantial Gainful Activity (SGA)?

• STEP 2. Does the applicant have a severe
  impairment?

• STEP 3. Does the applicant suffer from an
  impairment which meets or equals the
  severity of a listed impairment?
                                              14
• STEP 4. Does claimant have the residual
  functional capacity (RFC) to perform his/her
  past relevant work (work performed in the last
  15 years)?

• STEP 5. Does the claimant have the RFC to
  perform any other work that exists in
  significant numbers in the national economy?
  Burden of proof shifts to SSA at step 5.
                                                   15
  Substantial Gainful Activity (SGA)

• SGA threshold changes every year. In 2007
  it is $900/month and will be $940 in 2008.
• SGA threshold for blind SSDI applicants in
  2007 was $1500/month and will be $1570 in
  2008. No SGA test for blind SSI applicants.
• If self-employed, look at net income after
  business deductions; value of work to
  business.                                     16
  Continuing Disability Reviews

• CDRs are a critical part of the SSI disability
  program. CDRs insure that those entitled
  recipients continue to receive benefits and
  those who “medically improve” do not.
• CDRs maintain the credibility of the program
• CDRs occur in ALL disability cases.


                                                   17
   Continuing Disability Reviews

• The CDR process occurs at 3, 5 or 7 year
  intervals depending upon the disability
  involved and “medical improvement”
  standard.
• SSA must prove that there has been medical
  improvement and that this medical
  improvement relates to the ability to work.

                                                18
Social Security Disability Insurance




                                       19
  SSDI

• SSDI benefits are paid to individuals and their
  dependents after the individual has worked
  and paid Social Security taxes.
• Benefits are paid upon retirement and
  disability. Survivors benefits may be
  available upon the death of the insured
  worker.

                                                    20
  SSDI Eligibility Overview
• Called SSDI, Disability Insurance Benefits
  (DIB), or Title II.
• Must have “insured status” which is gained
  by working and paying FICA taxes and
  earning credits or “quarters of coverage.”
  $1000/QC in 2007 and will be $1050 in ‘08.
• Insured wage earners may be eligible for
  retirement benefits and disability benefit.
• No income or asset limits.

                                                21
  SSDI – Overview Continued

• Medicare will provide health care coverage to
  retired workers upon retirement. Disabled
  beneficiaries will begin Medicare coverage in
  month 25 of SSDI eligibility.
• Benefits are payable, after application is filed,
  beginning 5 months after the “onset date,”
  but not more than 1 year prior to the date of
  application
                                                      22
  SSDI Work Incentives
• Trial Work Period

• Extended Period of Eligibility

• Vocational Rehabilitation Program

• Impairment-Related Work Expenses

• Subsidies and Special Conditions


                                      23
        Trial Work Period
         • Unless medical recovery is an issue, beneficiaries
           are entitled to a TWP
p. 49    • Opportunity to test work skills while maintaining full
           cash benefit
         • SSA will evaluate work activity and earnings after
           the 9th month is completed.

         • Annually indexed ($640 in 2007 / $670 in 2008)




                                                              24
          Receives Benefits
          (SSDI & Medicare)                                  Goes to Work




                                Trial Work Period (9 non-consecutive months within 60 cons. months)
                                • Receives wages + full benefits
                                • Starts with first month earnings over allowed limits


                                                                                    $590/80          $640/80
                               $570/80 hr. rule               $580/80 hr. rule      hr. rule         hr. rule

        Regular      Jan ’03   Oct ’03   Nov ’03   Dec ’03   Jan ’04   Feb ’04   Mar ’05   Apr ’05   Sept ’07
p. 67   Employment   $782      $812      $908      $800      $597      $940      $875      $998      $700

        Self         Jan ’03   Oct ’03   Nov ’03   Dec ’03   Jan ’04   Feb ’04   Mar ’05   Apr ’05   Sept ’07
        Employed     81 hrs    88 hrs    99 hrs    107 hrs   88 hrs    81 hrs    95 hrs    91 hrs    147 hrs


                               9 months of earnings meeting TWP/income criteria



                                                                                    In the 10th month, continuing
                                                      End of TWP
                                                                                    disability review. Look at SGA.
                                                                                    Still medically disabled?


                                                       Extended
                                                       Period of
                                                       Eligibility




                                             Extended Medicare Coverage
                                                                                                                      25
   Extended Period of Eligibility

• The EPE begins in the month immediately
  after the completion of the 9th trial work
  month.

• The EPE continues for 36 consecutive
  months.

• The recipient will be eligible to receive a full
  benefit payment in each month that income
  drops below the current SGA level.                 26
                   Extended Period of Eligibility (for persons still medically disabled) 36 cons. mos.
                   •       Begins the first month after the 9th TWP month
                   •       Receives no cash benefits for months earning over SGA (2003-$800/$1,330) after the three
                           month grace period
                   •       If work stops or earnings drop below SGA, receive benefits and any earnings.




        WAGES                                                      36 months
        BENEFITS              Cessation
p. 68   MONTHS
                       Not
                       SGA
                               Month
                               SGA
                   $500       $820    $800    $760   $860    $800    $820    $390   $500    $600    $650    $860      $810   $800   $850
                    +          +       +        +     +       +       +        +      +       +      +       +         +      +      +
                    SS         SS      SS      SS     0       0       0       SS     SS      SS      SS      0          0     0      0
                       1        2         3     4       5      6       7       8      9      10      11      12       13     14…     36

                                 Grace Period



                                                                  End of EPE
                                                             (36th month of EPE)


                                     No SGA                                                Earned SGA



                   Social Security Benefits Continue                        First month of SGA after EPE benefits
                                                                                         discontinued


                                                                            If work cessation is because of disability
                                                                                 within 60 months, can file for
                                                                                    reinstatement of benefits                              27
      TWP/EPE Exercise
      JAN    FEB    MAR    APR    MAY    JUN    JUL   AUG    SEPT   OCT    NOV    DEC

 00    0      0      79    210    100     78    80    150     80    70     120    210

 01   220    210     0     210    800     0      0     0      0      0      0      0

 02    50     50     50     50    70      70    70    70      70    60      0      0

 03    70     70     70     18    50     100    150   150    220    50     50     50

 04   590    650    760    960    455    970    900   700    350    820    950    800

 05   950    850    650    1188   1290   1310   900   830    800    900    1190   1295

 06   1600   1600   1489   1245   950    850    870   870    870    870    900    900

 07   1650   1700   1689   1690   990    990    920   1750   1697   1670   1700   1710

 08   1710   1710   1710   1710   1710   1729   920   1725   1735   1725   1758   1760


Identify the beginning and ending of: TWP, EPE, and the Grace Period
                                                                                         28
 TWP / SGA Amounts

• TWP               • SGA
  –   2000 / $200     –   2000 / $700
  –   2001 / $530     –   2001 / $740
  –   2002 / $560     –   2002 / $780
  –   2003 / $570     –   2003 / $800
  –   2004 / $580     –   2004 / $810
  –   2005 / $590     –   2005 / $830
  –   2006 / $620     –   2006 / $860
  –   2007 / $640     –   2007 / $900
  –   2008 / $670     –   2008 / $940

                                        29
  Vocational Rehabilitation Programs
• Upon a determination that a recipient has
  medically improved, participation in a
  vocational rehabilitation program will allow
  benefit payments to continue until the
  program is completed if:
   *  the plan will be completed in a “reasonable time”
      and
   * completion is likely to result in the elimination of
      the need for benefits.
   This provision is commonly referred to as the
      section 301 exception.                              30
   Section 301 Improvements

• New regulations, effective July 25, 2005,
  improve §301 and apply the provisions to
  children in transition.

• An individual will be considered “participating” in
  a program despite a disability related break
  provided the “break” last no more than 3 months.

• A “child” will be eligible for cash benefits
  continuation if participating in an IEP.       31
  SGA Determinations: SGA Levels

• The SGA level now changes every calendar
  year.
  – In 2007, SGA is set at $900/1,500 per month.

  – In 2008, SGA is set at $940/1,570 per month.




                                                   32
  SGA Tools

• Unsuccessful Work Attempt (UWA)
• Income Averaging
• Impairment-Related Work Expenses (IRWE)
• Subsidy
• Un-incurred business expenses and unpaid
  help for self employed individuals


                                             33
  Unsuccessful Work Attempt

• A Unsuccessful Work Attempt (UWA) is an
  effort to do substantial work in employment
  or self-employment which is discontinued or
  reduced to the non-SGA level after a short
  time (no more than 6 months) because of the
  individual’s impairment that are essential to
  the further performance of work.


                                              34
  Income Averaging

• Applied when earnings after TWP fluctuate
  above and below the SGA guideline and
  UWA criteria do not apply.
• Averaging is unnecessary and should NOT
  be applied when work is consistently above
  or below SGA or when work is determined to
  meet UWA criteria.
• NOT used when counting TWP months or
  during EPE after cessation month.            35
 Income Averaging

• If gross wages may be reduced by the value of
Impairment-Related Work Expenses, or
Subsidy, the earnings are averaged after these
deductions are applied. Averaging is performed
on “countable” earnings, not gross earnings.




                                              36
  Impairment-Related Work Expenses
• SSA allows deductions from gross wages for
  disability related expenses, services and/or
  items necessary to the recipient’s work
  effort.
• These expenses are used to reduce gross
  wages before SSA makes an SGA
  determination.



                                                 37
  Impairment Related Work Expenses

• An IRWE is an expense that meets all of the
  following conditions:

   *   it enables the recipient to work,
   *   it is paid for by the recipient,
   *   it is not reimbursable by any source,
   *   the cost is “reasonable,”
   *   it is needed because of an impairment, and
   *   it is necessary to perform the job.
                                                    38
  IRWE Calculation

• Jeff begins working on December 1, 2006,
  and will have monthly income of $1,250 per
  month. He has made home modifications to
  his bathroom and front door area needed to
  allow him to work. He has paid $6,000 for
  this work. His current SSDI benefit is $950
  monthly.
• Is Jeff performing SGA?
                                                39
  IRWE Calculation
STEP ONE     $1,250.00 Gross Monthly Earnings
           – $ 500.00 Minus IRWE
             $ 750.00 Equals Adjusted Gross
                       Earnings (Non-SGA)

STEP TWO     $1,250.00   Gross Monthly Earnings
           + $ 950.00    Plus SSDI
           = $2,200.00   Equals Monthly Income
           – $ 500.00    Minus IRWE
             $1,700.00   Equals Total Usable Income

                                                      40
  Subsidies



• A recipient receives a SUBSIDY when the
  recipient’s work requires either:

  * more supervision than other equally paid
    employees doing the same job, or
  * fewer or simpler tasks than other equally paid
    employees doing the same job.

                                                     41
  Subsidies

• Production Subsidy – Production
  expectation is lowered yet wages remain a
  higher rate.
• Employer Subsidy – An expense to the
  employer for having the recipient on the
  job…e.g., additional on-the-job
  training/supervision.


                                              42
  “Special Conditions”

• A “special condition” exists when a recipient
  receives a service necessary to work and that
  service is paid for by a third party.
• The service cannot be considered an IRWE
  as the recipient has not paid for it.
• The service cannot be considered a subsidy
  as the employer has not paid for it.

                                                  43
 “Special Conditions”

• An example of a “special condition” is a job
  coach provided by a non-profit or VR agency.
  Neither the employee nor employer bears any
  cost for the job coach.
• In this type of circumstance SSA will consider
  the job coach to be a “special condition”.



                                                   44
Valuing a “Special Condition”

• A “special condition” is also valued differently by
  SSA when determining deductions from gross
  monthly earnings.
• The value of a special condition in a job coach
  situation is determined by multiplying the
  number of hours of job coach services by the
  hourly wage of the employee.
• This deduction is taken where general subsidy
  deductions are used when determining SGA.       45
  Calculating Effect of Employer Subsidy

• Julie begins working on November 1, 2006,
  at a monthly wage of $1,000. Her hourly
  wage is $5.85. She will have one extra hour
  of supervision by her employer each
  morning. The supervisor earns $19.00 per
  hour.

• Is Julie performing SGA?

                                                46
Calculating Effect of Employer Subsidy

STEP ONE           20 Hours of extra sup each month
           x $ 19.00 Multiply by hourly wage of the
                      supervisor
           = $ 380.00 Equals monthly subsidy

STEP TWO     $1,000.00 Monthly gross earnings
           – $ 380.00 Minus monthly subsidy
           = $ 620.00 Equals total gross wages
                       counted/SGA


                                                      47
   Medicare

• Hospital Insurance / Part A
   – financed through FICA
   – pays for inpatient hospital care and certain follow-up
• Medical Insurance / Part B
   – pays for doctor’s services and variety of other medical
     services not covered under Part A
   – voluntary and financed through monthly premiums paid
     by beneficiaries opting for coverage ($93.50 in 2007
     and $96.40 in 2008)
• Medicare Advantage Program / Part C
• Medicare Prescription Drug Plan / Part D
                                                               48
    Medicare

• 24 month qualifying period for Medicare coverage.
• Cash benefits must be received.
• Months needn’t be accumulated consecutively.
• Months accumulated can be applied to subsequent
  case should entitlement cease due to SGA and
  entitlement be re-established.
• If 24 months of cash payments are received prior to
  losing entitlement and entitlement is re-established
  within 5 years (7 for CDB) a new 24 month waiting
  period is not required.
                                                         49
Extended Medicare and Buy-In

• Extended coverage is for a minimum of 39
  months following the conclusion of the TWP
• Beneficiaries can buy into the Medicare
  program once the extended Medicare
  coverage is exhausted.
• They must no longer be entitled to benefits
  because of having earnings in excess of the
  amount permitted and must have worked a full
  48 months (nine-month TWP and 36-month
  EPE) having exhausted their extended period
  of Medicare eligibility.                       50
TTWWIA Extended Medicare
• Extended coverage (Part A free) is for a minimum
  of 93 months following the conclusion of the TWP
• Beneficiaries can buy into the Medicare program
  once the extended Medicare coverage is
  exhausted. (Medicaid may help pay Part A
  premium if under income threshold)
• They must no longer be entitled to benefits
  because of having earnings in excess of the
  amount permitted and must have extended period
  of Medicare eligibility.
                                                 51
   Extended Medicare

• If SGA after TWP and prior to 14th month of EPE and
  SGA again in the 16th month then Medicare can
  continue for 78 months following the 15th month of the
  EPE.
• If SGA after TWP and prior to 14th month of EPE and
  no SGA in the 16th month then Medicare can continue
  for 77 months following that individuals first month of
  SGA after the 16th month of the EPE.
• If first month of SGA after the TWP is after the 13th
  month of the EPE, Medicare ends the last day of the
  80th month following the first month of SGA in the
  EPE.                                                      52
Did SGA occur prior to                              Did SGA occur after
the 14th month of EPE                               the 13th month of the
    after the TWP?             NO                           EPE?



         YES                                                YES


                                                                         Start counting 80
   Did the individual
                                                                      months beginning with
perform SGA in the 16th
                               NO                                       the month following
        month?
                                                                      the first month of SGA
                                                                      after the 13th month of
                                                                       the EPE to determine
                             Did SGA occur after the                     when the person’s
         YES                 16th month of the EPE?                       Medicare ends.



  Begin counting 57                                                         Or if later
  months off starting                 YES
 the month following
  completion of the
  EPE to determine
  when the person’s                                                  The date of the benefit
                              Start counting 77 months                termination notice
   Medicare ends.
                              beginning with the month                   + one month
                             following the first month of
                              SGA after the 16th month
                                to determine when the
     Or if later
                               person’s Medicare ends.

 The date of the benefit
  termination notice
     + one month


  NOTE: In all three cases, Medicare would end the last day of the month as specified above
  and terminate the first of the following month.
                                                                                                53
Supplemental Security Income




                               54
  Supplemental Security Income
  Eligibility Overview

• Called SSI or Title XVI.
• Categorical Eligibility – Aged, Blind, Disabled.
• Low income – Countable income less than
  the maximum SSI payable to that individual.
• Low Resources – Countable resources of
  less than $2000 for an individual and $3000
  for a married couple.
                                                     55
  SSI – Overview Continued

• SSI pays a monthly cash benefit depending
  upon the recipient’s categorical status and
  living arrangement.

• The maximum monthly payment is set each
  January by the Social Security
  Administration. FBR is $623/$934 in 2007
  and will be $637/$956 in 2008.

                                                56
   SSI – Overview Continued

• Earliest possible payment date is the first of
  the month after the month of application.
• Medicaid coverage is awarded automatically
  upon the award of disability and payment
  status.



                                                   57
   SSI Income Rules

• Types of Income:
   – Earned = from employment
   – Unearned = from other sources, e.g.,
     SSDI, alimony, pension, inheritance
   – Deeming = counting portion of someone
     else’s (parent, spouse, sponsor) income
     as SSI recipient’s.
   – In-kind = shelter or food received free or at
     reduced cost.
                                                     58
  Resources

• SSI limits the amount of countable resources
  an SSI recipient can own.
• An individual recipient can hold only $2000 in
  countable resources.
• A married couple can hold only $3000 in
  countable resources.


                                                   59
  Resources

• A resource is cash on hand, other personal
  property, or real property that an individual:
   – owns or has an ownership interest in;
   – has the legal right to dispose of and
     convert to cash; and
   – is not legally restricted from using for
     support
• Income remaining after the month received
  becomes a resource.                              60
SSI Work Incentives

•   Earned Income Exclusion
•   1619(a) – Special Cash Benefits
•   Impairment-Related Work Expenses
•   Blind Work Expenses.
•   Plan for Achieving Self-Support
•   Student-Earned Income Exclusion.


                                       61
Earned-Income Exclusion


• The “original” work incentive.
• Basic earned income counting formula used
  in the SSI program.
• First $65 plus one-half of remainder is
  excluded.
• Remainder is “countable” income for SSI
  budget purposes.
                                              62
Earned-Income Exclusion
Calculation Example

     $1085   Earned income
   – $ 65    Earned income exclusion
   – $ 20    General exclusion
     $1000   Divided by 2
   = $ 500   SSI countable earned income


                                           63
Earned-Income Exclusion
Financial Benefit

    $ 603   2006 FBR
  – $ 500   Countable earned income
    $ 103   SSI payable
    $1085   Total earned income
  + $ 103   SSI benefit
    $1188   Total monthly income
                                      64
The 1619 Program
• Provides significant benefit to those
  disabled SSI recipients who return to work
  and perform at SGA levels.
  To be eligible a recipient must:
   – have been eligible for SSI in a month before
     SGA,
   – continue to be disabled, and
   – meet all income and resource requirements of
     the SSI program.

                                                    65
Section 1619(a)
Special Cash Benefits

•   1619(a) Special cash benefits replace 1611
    benefits when the recipient begins to perform
    SGA.
•   Using the basic “earned income” budget
    formula of the SSI program, 1619(a) will see
    cash benefits decrease as earned income
    increases.
•   “Cash out” – 1st 1619 Threshold.
                                                    66
Impairment-Related Work Expenses


• SSA allows deductions from gross wages for
  disability related expenses, services and/or
  items necessary to the recipient’s work effort.

• These expenses are used to reduce gross
  wages before SSA makes a monthly SSI
  award determination.

                                                    67
       The Basic SSI Formula
       STEP ONE:                                      STEP THREE:

       Unearned Income                    $           Countable Unearned Income   $
       - General Income Exclusion (GIE)   $   20.00   + Countable Earned Income   $        .
       = Countable Unearned Income        $           = Countable Income          $
p.88                                                  - PASS                      $        0
       STEP TWO:                                      = Total Countable Income    $

       Gross Earned Income                $           STEP FOUR:
       - SEIE                             $      0
       = Remainder                        $           Base SSI Rate (FBR):        $
       - GIE if not used above            $      0    - Total Countable Income    $         .
       = Remainder                        $           = Modified SSI Payment      $
       - Earned Income Exclusion          $   65.00
       = Remainder                        $
       - IRWE                             $      0
       = Remainder                        $
       Divide by 2                              /2
       = Remainder                        $
       - BWE                              $      0
       = Total Countable Earned Income    $

                                                                                      68
   Blind Work Expenses

• A blind recipient is entitled to a deduction from
  countable earned income equal to the cost of actual
  expenses reasonable attributable to work. “Blind Work
  Expenses” are NOT necessarily related to work.
• Examples of BWEs:
   – Guide dog expenses,
   – Transportation to and from work,
   – Fed, state and local taxes,
   – Social security taxes,
   – lunch                                            69
       The Basic SSI Formula
       STEP ONE:                                      STEP THREE:

       Unearned Income                    $           Countable Unearned Income   $
       - General Income Exclusion (GIE)   $   20.00   + Countable Earned Income   $        .
       = Countable Unearned Income        $           = Countable Income          $
p.88                                                  - PASS                      $        0
       STEP TWO:                                      = Total Countable Income    $

       Gross Earned Income                $           STEP FOUR:
       - SEIE                             $      0
       = Remainder                        $           Base SSI Rate (FBR):        $
       - GIE if not used above            $      0    - Total Countable Income    $         .
       = Remainder                        $           = Modified SSI Payment      $
       - Earned Income Exclusion          $   65.00
       = Remainder                        $
       - IRWE                             $      0
       = Remainder                        $
       Divide by 2                              /2
       = Remainder                        $
       - BWE                              $      0
       = Total Countable Earned Income    $

                                                                                      70
  Plan for Achieving Self Support

• PASS is a grossly underutilized SSI
  program which permits the SSI recipient to
  shelter income and/or resources which
  would otherwise be countable for SSI
  purposes.

• A recipient is permitted to enter into a
  written plan designed to work toward a
  “feasible vocational goal” with the ultimate
  goal being “financial independence.”           71
       PASS

• A PASS must meet these requirements:
   -   be designed for the individual,
   -   be in writing,
   -   be approved by SSA,
   -   be designed for an initial period of no more than 18 months,
   -   show the specific, feasible vocational goal,
   -   show what income and/or resources will be “sheltered” and how
       they will be held,
   -   list “milestones”
   -   contain a business plan if self-employment is goal.

                                                                  72
       The Basic SSI Formula
       STEP ONE:                                      STEP THREE:

       Unearned Income                    $           Countable Unearned Income   $
       - General Income Exclusion (GIE)   $   20.00   + Countable Earned Income   $        .
       = Countable Unearned Income        $           = Countable Income          $
p.88                                                  - PASS                      $        0
       STEP TWO:                                      = Total Countable Income    $

       Gross Earned Income                $           STEP FOUR:
       - SEIE                             $      0
       = Remainder                        $           Base SSI Rate (FBR):        $
       - GIE if not used above            $      0    - Total Countable Income    $         .
       = Remainder                        $           = Modified SSI Payment      $
       - Earned Income Exclusion          $   65.00
       = Remainder                        $
       - IRWE                             $      0
       = Remainder                        $
       Divide by 2                              /2
       = Remainder                        $
       - BWE                              $      0
       = Total Countable Earned Income    $

                                                                                      73
Student-Earned Income Exclusion

• SEIE allows a significant amount of
  monthly/annual income to be excluded for the
  purposes of determining a monthly SSI award.

• A student is defined as an individual regularly
  attending school (as defined by the
  regulations) who is under the age of 22.

                                                    74
Student-Earned Income Exclusion


• In 2007, the SEIE is $1510 monthly /
  $6100 annually.

• In 2008, the SEIE will increase to $1550
  monthly / $6240 annually.



                                             75
       The Basic SSI Formula
       STEP ONE:                                      STEP THREE:

       Unearned Income                    $           Countable Unearned Income   $
       - General Income Exclusion (GIE)   $   20.00   + Countable Earned Income   $        .
       = Countable Unearned Income        $           = Countable Income          $
p.88                                                  - PASS                      $        0
       STEP TWO:                                      = Total Countable Income    $

       Gross Earned Income                $           STEP FOUR:
       - SEIE                             $      0
       = Remainder                        $           Base SSI Rate (FBR):        $
       - GIE if not used above            $      0    - Total Countable Income    $         .
       = Remainder                        $           = Modified SSI Payment      $
       - Earned Income Exclusion          $   65.00
       = Remainder                        $
       - IRWE                             $      0
       = Remainder                        $
       Divide by 2                              /2
       = Remainder                        $
       - BWE                              $      0
       = Total Countable Earned Income    $

                                                                                      76
    Continuation of Medicaid for SSI
    Recipients: 1619 (a) and (b)

•   SSI recipients do not lose Medicaid until their annual
    gross earned income exceeds the state’s
    individualized threshold:
    – Eligibility for 1619 (a) or (b):
       • Recipient has received at least 1 month of SSI
           payments,
       • Continues to have original disabling
           impairment,
       • Currently meets income and resource test,
       • Reason income is higher is due to earnings.
                                                             77
    1619 (b)

•    1619 (b) Continued Medicaid eligibility:
    – Individual’s income exceeds breakeven point,
    – Continues to have original disabling
      impairment,
    – Needs Medicaid in order to work,
    – Cannot replace cost of medical care with
      earnings, and
    – Meets all other requirements for SSI
      payments other than earnings.
                                                     78
  Medicaid Use Test

• The following will be considered when SSA
  determines if continued Medicaid coverage is
  necessary to a recipient’s work effort
  – has Medicaid been used w/in past 12 months,
  – will Medicaid be needed w/in next 12 months,
  – is there an affordable replacement for Medicaid.




                                                       79
    1619 (b)


•    State Threshold is: average annual SSI
     Breakeven point plus state per capita
     Medicaid payment.
•    Individuals with higher-than-average
     Medicaid costs can have a higher threshold.
•    1619 is available to disabled individuals 65
     years or older.
                                                    80
  Individualized Threshold


• If an individual has high medical expenses,
  the individual can request an “individualized
  threshold.”
• The individualized threshold will be
  determined by using the state’s 1619(a) and
  adding the past year’s Medicaid expenses of
  that recipient. This total is the individualized
  threshold for that recipient.
                                                     81
     Medicaid Buy In: BBA Rules

 The Balanced Budget Act of 1997 created the
  Medicaid Buy in option for adults with disabilities
  who are employed –
   • Not required to have been SSI eligible, but must meet
     SSI eligibility criteria, except for earnings,
   • Eligibility up to 250% of FPL, after income exclusions,
   • SGA doesn’t matter,
   • Medicaid resource limit can be as high as $14,000,
   • States can charge premiums and other cost-sharing.
                                                               82
   Medicaid Buy In: TTWWIA

TWWIIA expanded the Buy In options for states:
   – Higher Income cap than BBA- up to 450% of FPL,
   – Same SSI eligibility criteria as BBA,
   – Cannot define minimum earnings to qualify for Buy In,
   – State can charge premiums within certain program limits,
   – Can charge full premium for persons with incomes over
     $75,000 per year.
   – 41 states have now implemented or are planning to implement
     a Buy In program.



                                                               83
  Ticket to Work Act
• Purposes of the Act are:
  – to provide health care and employment
    preparation and placement services to
    individuals with disabilities.
  – to encourage State to adopt an expansion
    of Medicaid availability.
  – to expand Medicare availability.
  – to establish the Ticket to Work program to
    support efforts to obtain and regain
    employment and reduce dependency on
    cash benefits.                               84
Additional Protections and Safety Nets




                                    85
  Ticket to Work

• A disabled recipient will be provided a “ticket
  to work” which will allow that individual to
  obtain employment services, vocational
  rehabilitation or other support services. SSA
  will pay for all services provided in order to
  assist the individual return to work. Each
  recipient will develop an “individual work
  plan” for this purpose.

                                                    86
TWWIIA CDR Protections

• Effective January 1, 2001, SSA will not initiate
  a medical CDR while an SSDI beneficiary is
  “using” a Ticket.

• WHAT DOES “USING” A TICKET MEAN?



                                                     87
  CDR Protections

• “Using” a ticket requires that:
    – the ticket be assigned,
    – the recipient must be actively making
      progress following their approved plan,


Employment Networks (ENs) monitor
progress and the Program Manager (PM)
determines if the recipient’s ticket is in “use.”

                                                    88
  CDR Protections

• SSA cannot initiate a medical CDR if the
  recipient’s ticket is in “use”.
• However, if the ticket is assigned after a
  medical CDR has begun, the medical CDR
  will be completed.




                                               89
  CDR Protections

• If an SSDI recipient has received 24
  monthly payments, SSA will not be allowed
  to initiate a CDR based on work activity
  alone.




                                              90
  Expedited Reinstatement (EXR)

• TWWIIA-established safety net
• Effective January 1, 2001
• 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                                91
   EXR
• Provisional benefits are paid upon the filing of
  an EXR application and will be paid for a
  maximum of 6 months or until SSA
  determines eligibility for EXR, whichever is
  sooner.
• Provisional benefits will NOT be considered
  an overpayment unless fraud is involved.


                                                     92
   EXR
• In order for an individual to be reinstated via
  EXR the impairment must:
  – Be the same or substantially related to the
    previous impairment giving rise to eligibility,
    and
  – the recipient must prove the inability to perform
    SGA due to disability.




                                                        93
    Work Incentives Planning
• Any recipient wishing to return to work can take
  advantage of free work incentives planning
  services.
• Work incentives planning will allow the recipient
  to learn what will happen to their benefits (SSI,
  SSDI, housing, health, food stamps, etc.) during
  the return to work process.
•   www.socialsecurity.gov/work/ServiceProviders/WIPADirectory.html


                                                               94
    Advocacy Services

• Protection & Advocacy agencies in each state
  and territory have been funded to provide legal
  representation to any recipient who faces a
  barrier to the return to work effort. This program
  is known as PABSS – Protection & Advocacy
  for Beneficiaries of Social Security.
•   http://ssa.gov/work/ServiceProviders/pafactsheet.html



                                                            95
Questions?




             96
  Don’t Forget to Visit the
Work Incentives Support Center!


http://www.workincentives.org


                                  97
Thomas Golden
Employment and Disability Institute
Cornell University
ILR School
201 ILR Extension Building
Ithaca, New York 14853

t. 607.255.7727
f. 607.255.2763
ilr_edi@cornell.edu

www.edi.cornell.edu

                                      98

				
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