I Can’t Work, I Can’t Lose Benefits

Overcoming Tough Benefits Issues & Over-Payments

Marilyn Morrison, CWIC, WISA, WICmmorrison@vaaccses.org

Teresa Mullins, CWIC, WISAteresa-mullins@comcast.net

What are the Work Incentives Specialist Services?

Information and Referral Problem solving and advocacy Benefits planning –analysis and advisement Benefits assistance – support planning, management Application Assistance WE CAN SEE ANYONE INTERSTED IN WORKING! IS

WORKING! OR CHANGING JOBS!

We do not Provide Legal Representation or serve as Rep Payees Provide Tax or Investment Advice Provide Employment Assistance other than EN referrals Function in the role of SSA claims Representative

Supplemental Security Income (SSI)

A cash benefit paid to individuals who meet medical disability and financial needs criteria.

The maximum Federal Benefit Rate is $ 721 Associated with Medicaid Resource Limit of $2000.00

2015 – FBR - $733.00

Impact of Wages on Monthly SSI Payments

The SSA reduces the person’s max SSI by a portion of his/her total countable income each month.

One always gains more in wages than one loses in SSI payments.

No earnings limits.

SSI Work Incentives

• Student Earned Income Exclusion • Continuation of Medicaid (1619 B)• Impairment Related Work Expenses• Plan for Achieving Self-Support (PASS)• Medicaid Buy-in (Medicaid Works)

Continuation of Medicaid (1619B)

• Medicaid coverage to continue even if SSI cash benefit is reduced to $0

• Needs Medicaid in order to work, and has annual earnings not greater than the state threshold amount ($32,000 +)

IRWE – Impairment Related Work Expenses

½ of the money spent on these items does not count against the monthly SSI amount.

Attendant care services, certain transportation costs, medical devices, medications, residential modifications, and more.

Student Earned Income Exclusion

• Allows individuals under the age of 22 who regularly attend school to exclude earned income up to a certain amount (as of January 1, determined each year) in a month (with a maximum per year, also determined each year).

Both amounts are automatically adjusted annually

based on increases in the cost-of-living index. Individuals not able to claim the full amount in a month can carry

the balance over to the next month.

2015 limits: $1780.00 month/ $7180.00 year

Medicaid Waivers

Allow the provision of long term care services in home and community based settings under the Medicaid Program.  These have specific earnings thresholds.

300% of the FBR ($733.00) or $2199.00 in earnings.

There might be a “patient pay” fee applied to unearned income.

Case Study: JAMES (AGE 20)

• Receives $480.00 in SSI benefits. • Regularly attends school. • Working at Safeway earning avg. $550.00 • Working for 12 months. • Overpayment notice of $2790.00• James wants to stop working NOW!!!!

Calculation sheet

Plan for Achieving Self-Support

An approved PASS helps the individual pay for items or services they need to achieve an occupational goal.

Allows for resources above $2000.00 limitation

Social Security will increase his/her monthly SSI checks to match or nearly match what they aside.

Virginia’s Medicaid Buy-In Program:MEDICAID WORKS

• Disabled

• 16 through 64 years of age

• Meet all requirements of Medicaid group with income ≤ 80% of

poverty ($766/mo. in 2014)

• Employed or have letter from employer

This plan option allows enrollees to have annual earnings as of

Nov 2014 - as high as $75,000 & resources up to $33,862.

Macey

Just started working earning $30,000 a year.

Receives SSI ($733.00)

Needs Medicaid in order to work

Wants to save money and get a car with her earnings.

What should she do?

Title II SSDI (Disability Income)

A cash benefit paid from individuals who have worked and paid into Federal Insured Contribution Act (F.I.C.A.).

Disability diagnosed before the age of 22. (CDB)

Medicare is associated with Title II benefits.

Medicare

Federal medical assistance program for Title II and retirement beneficiaries.

May be a waiting period before benefit begins.

Coverages:• Part A: Hospitalization (no premium)• Part B: Medical (monthly premium)• Part D: Prescription drug plan

Substantial Gainful Activity (SGA)

The performance of paid work in which a month’s countable income is $1070 or more for the disabled and $1,800 for the blind.

An earnings test for continued eligibility for SSDI and CDB payments.

2015: $1090.00

Selected Title II Work Incentives

Trial Work Period Extended Period of Eligibility Impairment Related Work Expenses

(IRWE) Subsidies and Special Conditions Extended Medicare Ticket to Work

Trial Work Period (TWP)

Allows individuals to earn as much as they want and not be penalized for trying to work.

When he first starts working, he will get his full disability check and Medicare benefits no matter how much he earns during this period.

This period ends when he has earned $780 or more (in 2015) in nine different months, over a 60 month rolling period.

Extended Period of Eligibility (EPE)

A 36-month period, following the TWP, in which the beneficiary is eligible for Title II cash payments only when countable earnings average less than SGA.

After the EPE, the beneficiary loses Title II cash payments for good the first time he performs SGA.

Three-Month Grace Period

But, the first time that he does perform substantial work (after his TWP ends), he’ll still get his disability check for that month plus the next two consecutive months.

Expedited Reinstatement

If he has to stop or drastically reduce employment because of his disability within 5 years of losing his Title II cash payment, his benefits may be reinstated without a new application.

He will receive provisional benefits while the SSA determines his eligibility.

Impairment Related Work Expenses (IRWE)

All the money the individual spends for these items does not count against that $1090 per month SGA amount.

Attendant care services, certain transportation costs, medical devices, medications, residential modifications, and more.

Metro Access or local Para-transit is considered an IRWE. This needs to be reported!

Subsidies and Special Conditions

Supports that are received on the job may result in more pay than the actual

value of the work you perform.

Could reduce the amount of Countable Earned Income that SSA considering when determining if an individual has

earned over SGA ($1090.00)

Medicaid QMB/SLMB/QII

Also known as Medicare Savings Program

QMB: $1001.00 Individual/$1348.00 Married

SLMB: $1,197/$1613.00

QI - $1345/$1813 – 1st come/ 1st serve

Resource levels for all of these:

$7280/$10,930.00

CASE STUDY: SHARON (DAC)

• Was receiving SSI but then switched to SSDI now receiving $1100.00 from SSDI as a DAC

• Earning $1400.00 a month from her job in the mail room at a Fed site

• She is receiving Waiver services and you have been notified that her waiver services will be cut!

Ticket to Work

Gives the beneficiary access to Employment Networks that might be

able to provide the following services:

Skills Testing, Interest Testing

Resume Prep, interviewing skills, Job search and Job placement services, Work Incentives

Counseling, Job Coaching &

ongoing services

CASE STUDY; DAN

SSDI recipient

Earning $50,000 a year gross

Used all TWP and EPE

Overpayment notice of $60,000 and termination of benefits.

Possible loss of Medicare benefits.

CASE STUDY: SUZIE

• Wants to be self-Employed as a freelance artist – Graphic design

• SSDI Recipient/ $900.00• Has not used Trial Work Period• Receives Medicaid QMB• Medicare Part A, Part B and Part D

Contacts

VaACCSES Project: Marilyn Morrison

1-877-822-2777 Information Central

mmorrison@vaaccses.org