SSDI and SSDAC More Information Than You Feared Possible

1
SSDI and SSDAC More Information Than You
Feared Possible

• Presented on June 8th, 2006
• by Scott Leonard with KCDDD, and Joanne ONeill
  with
• the Arc of King County
• Department of Community and Human Services
• Developmental Disabilities Division

2
Before we start

• This is part 2 of a three-part series.
• There will be specific opportunities throughout
  the presentation to ask questions.
• Commonly used acronyms and terms are marked in
  red.
• Whats in your folder.

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Title II Benefits

• The Basics
• Medicare
• Questions

4
Social Security Title II Benefits

• Two common types of Title II benefits that will
  be discussed in this training
• Social Security Disability Insurance, or SSDI
• Social Security Disabled Adult Child, or SSDAC.
  Also referred to as Childhood Disability Benefits
  (CDB), or simply DAC.

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Eligibility for Title II

• In order to be eligible for Title II benefits,
  you must
• Be determined medically disabled
• Either not be working or earning less than SGA
• Have insured status with Social Security,
  where
• You have sufficient past work history
  contributing to Social Security (SSDI) or,
• You are 18 or older, became disabled prior to age
  22, and are a child of an insured worker who is
  deceased, disabled, or retired (SSDAC) or
• You are a disabled widow/widower of a deceased
  spouse (DWB).

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Insured Status

• A determination of whether or not a person has
  insured status is based on the age of the person,
  when the disability began, and the number of work
  credits earned.

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SSDI vs SSDAC

• A disabled individual is eligible for SSDI based
  on his/her own work history.
• A disabled individual is eligible for SSDAC based
  on a parents work history.
• SSDI and SSDAC operate almost identically, with
  the exception of one key issue with Medicaid (to
  be discussed later in the training).

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SSDI/SSDAC vs SSI

• People who receive Title II benefits are called
  beneficiaries. People who receive SSI are called
  recipients.
• SSI is a need-based program. Title II benefits
  are not based on economic need. Eligibility for
  Title II benefits and the size of the checks are
  unaffected by
• Other Unearned Income
• Resources
• SSI amounts can fluctuate, depending upon other
  income. SSDI/SSDAC are all-or-nothing checks.
• With wages, SSI looks at gross earnings received
  in a month SSDI/SSDAC looks at gross earnings
  earned in a month (not including vacation and
  sick time).

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When Do Payments Begin?

• A person must wait 5 months after becoming
  eligible by SSA before receiving the first SSA
  benefit check.

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How Title II Benefits Work The Short, Somewhat
Inaccurate Version

• A beneficiary of Title II is eligible for
  benefits until he/she
• No longer has a medically determinable
  impairment or
• Can demonstrate that he/she is no longer so
  disabled that he/she cannot successfully work.

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How Title II Benefits Work The Short, Somewhat
Inaccurate Version

• SSA determines successful work by using SGA
  (Substantial Gainful Activity) as a measurement.
• SGA can be viewed many ways the most common is
  way is by designating a dollar amount and
  labeling it as SGA.
• In 2006, SGA is 860. This figure can grow each
  new year.
• Title II benefits are all-or-nothing, so, in
  simplified terms
• If gross wages earned in a month are less than
  860, you keep your entire SSDI benefit check.
• If your gross wages earned in a month are more
  than 860, you lose your entire SSDI check for
  that month.
• This will be discussed in more accurate detail
  later in the training.

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Medicare

• If you are eligible for Title II benefits, you
  may become eligible for Medicare.
• Medicare begins 24 months after your disability
  cash benefits begin (Medicare Qualifying Period).

13
Medicare

• Medicare is health insurance.
• In 2005, there were two basic parts
• Hospital Insurance (Part A)
• Part A is free, but the beneficiary will have to
  pay a deductible and co-payments if hospitalized.
• Medical Insurance (Part B)
• Part B pays for some doctors services and some
  medical services and supplies not covered by Part
  A.
• Part B is voluntary
• Enrollment costs money A monthly premium
  (78.20) will be deducted from each monthly
  Social Security benefit check.

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Medicare Part D

• In 2006, Medicare Recipients will also receive
  Medicare Part D Prescription Drug Coverage.
• With Part D, you will pay
• A yearly deductible (no more than 250 in 2006)
• A monthly premium which varies according to your
  plan
• A co-payment for prescriptions.

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Medicare Part D

• Part D is sometimes referred to as a doughnut
  coverage
• After the deductible, you pay 25 of prescription
  costs, Medicare pays for 75.
• When total drug costs for the year reach 2,250,
  you are responsible for 100 of the costs this
  is called the coverage gap.
• Once the annual total spent on drugs reaches
  5,100, Medicare begins picking up most of the
  bill.
• Actual costs depend upon the drug plan

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Medicare Part D

• If you have limited resources and limited income,
  you can receive extra help to pay for Part D.
• To apply for extra help, you must contact SSA
• http//www.ssa.gov/prescriptionhelp/

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Medicare Part D

• Everyone with Medicare needs to choose a
  Prescription Drug Plan (PDP).
• Not all PDPs offer the same coverage some offer
  more coverage for a higher cost, for ex.
• Failure to choose a PDP will result in one being
  randomly assigned to you.

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Medicare and Medicaid

• If you receive both Medicare and Medicaid, you
  will
• Use the Part D prescription coverage under
  Medicare and,
• No longer receive prescription coverage under
  Medicaid.
• For Part D, you will have no premium, no
  deductible, and pay little (if any, in WA) for
  prescriptions.
• You will continue to receive all other typical
  Medicaid coverage benefits.

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Medicare Part D

• You can
• Learn about the new Medicare prescription drug
  coverage
• Find and compare prescription drug plans that
  meet your personal needs
• Enroll in the prescription drug plan that you
  select..
• ..by logging on to Medicares website
• http//www.medicare.gov/pdphome.asp

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Questions?
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SSDI/SSDAC and SSI

• The Issue With Medicaid

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SSI and SSDI/SSDAC

• Many people who currently receive SSI may one day
  receive SSDI or SSDAC, because
• They will have a work history and will have
  contributed to Social Security and/or
• They will have a parent die, retire, or become
  disabled.

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SSDI, SSI and Medicaid

• Review
• 1619b if a person on SSI stops receiving SSI
  checks due to wages, that person maintains SSI
  and Medicaid Eligibility (as long as wages stay
  below a yearly threshold).
• Social Security looks at Unearned Income before
  looking at Earned Income in determining the size
  of persons SSI check.

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SSDI, SSI, and Medicaid

• If a person stops receiving SSI solely due to
  becoming eligible for SSDI, that person
• Loses SSI
• Loses Medicaid
• In this situation, there is probably no other way
  to become re-eligible for SSI again unless you
  write a PASS.

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SSDAC, SSI, and Medicaid

• This is the key area where SSDAC and SSDI differ
  from one another
• If a person stops receiving SSI solely due to
  becoming eligible for SSDAC, that person remains
  eligible for Medicaid as if he/she was still
  receiving SSI.
• The switch must have occurred after July, 1988 in
  WA. (July, 1987 in other states)

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Example 1

• Thor has been working, earning about 660 gross /
  month. Thor receives SSI in the amount of
  315.50. Thor also receives Medicaid.
• Thor has worked enough to now have earned an
  insured status.
• SSA reviews his case, and decides he is eligible
  for 400 SSDI.

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Example 1

• Social Security will calculate his new SSI
• First, SSA will look at unearned income
• 400 SSDI
• 20 exclusion
• 380 countable unearned income
• 603 FBR
• 380 CUI
• 223 SSI

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Example 1

• Next, SSA will look at Earned Income
• 660 wages
• 65 exclusion
• 595
• 595 / 2 297.50 Countable Earned Income
• 223 SSI
• 297.50 CEI
• 0 SSI

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Example 1

• Based on this scenario, Thor will no longer be
  receiving SSI checks.
• Because the checks have stopped due wages, he
  enters 1619b status.
• Thor will remain eligible for SSI and Medicaid.

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Example 2

• Lily is earning 700 in wages, and is receiving
  an SSI check in the amount of 295.50. Lily also
  receives Medicaid.
• Lily becomes eligible for a 640 SSDI check.
• 640
• - 20 exclusion
• 620 Countable Unearned Income
• 603 SSI - 620 CUI 0 SSI

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Example 2

• Lily has lost her SSI due to too much Unearned
  Income, specifically SSDI therefore
• Lily is not protected by 1619b status.
• Lily loses her SSI checks and Medicaid Coupon.
• Lily no longer has any resource restrictions.

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Example 3

• Joseph is earning 700 in wages, and is receiving
  an SSI check in the amount of 295.50. Joseph
  also receives Medicaid.
• Josephs father retires. Joseph now becomes
  eligible for SSDAC in the amount of 950 / month.
• Joseph loses SSI due to too much unearned income,
  specifically SSDAC however, he will keep
  Medicaid.
• Joseph still maintains a 2000 resource
  restriction because he still keeps Medicaid as if
  he was eligible for SSI.

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Lilys Options

• Lily needs Medicaid, as she relies on Medicaid
  Personal Care, and she utilizes Medicaid to pay
  for therapy. Without Medicaid, she will not be
  able to work.
• Can Lily refuse to accept the SSDI?
• No. SSA is required to award a person the
  largest benefit check for which he/she is
  eligible.
• Lily decides to purchase Medicaid through
  Healthcare For Workers with Disabilities.

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Healthcare For Workers With Disabilities

• Healthcare For Workers With Disabilities, also
  called HWD or the Medicaid Buy-In, is part of the
  Ticket-To-Work and Work Incentives Improvement
  Act.
• HWD is relatively new in WA.
• HWD is an optional State program.

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Healthcare For Workers With Disabilities

• The Medicaid you purchase through HWD is CNP
  Medicaid.
• When you purchase Medicaid through HWD, you no
  longer have a resource restriction.

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How Much Does It Cost?

• The cost of Medicaid through HWD will be based on
  your earned and unearned income.
• Unearned Income is weighed more heavily than
  Earned when calculating your cost.
• The most it can cost you is 7.5 of your total
  income.

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Healthcare For Workers With Disabilities
Eligibility

• You must be a Washington State resident
• You must be at least 16 and under 65 years old
• You must meet the income requirements have
  monthly net income that does not exceed 220 of
  the federal poverty level (FPL). This is 1,707
  for a single person or 2,290 for a married
  couple.
• You must meet federal disability requirements
  and
• You must be employed full or part time (including
  self-employment)
• Once approved, you must pay your monthly premium
  to continue to qualify for the HWD program.
• These numbers are based on a calculation, which
  is described in the HWD FAQ handout included in
  your packet.

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Questions?Break?
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SSDI / SSDAC The Long Version

• How wages impact SSDI and SSDAC

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Trial Work Period

• When people first begin receiving SSDI/SSDAC,
  they become eligible for a Trial Work Period
  (TWP).
• TWP is a period when a person can test his/her
  work skills without worrying about losing any
  benefits.
• You can earn as much as you can during your TWP
  and not lose SSDI/SSDAC benefits!

41
Trial Work Period

• A person is entitled to 9 months of completed
  Trial Work Period Months.
• Social Security designates a lesser standard than
  SGA to a Trial Work Period Month.
• In 2006, if you earn 620 gross or more in one
  month, you have completed one Trial Work Period
  month. (If self-employed, 80 hours / mo is one
  TWP.)
• These 9 months do not need to be consecutive.
• The 9 months are looked at in a rolling 5-year
  period.

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Trial Work Period Example

• Hank started receiving SSDAC in January, 2002.
• Hank has worked some since Jan 2002.
• He earned 570 gross for 4 months 2002
• He earned 400 gross for 12 months in 2003
• He earned 625 gross for 4 months in 2004
• He earned 700 gross for 1 month in 2005.
• How many TWP months has Hank completed?

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Trial Work Period Example

• Hank has worked 9 TWP months.
• TWP amounts change each year. In 2002, the TWP
  month was 560.
• Hank has performed all 9 TWP months within a 5
  year period. His TWP is now over.

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TWP Ends

• When a persons TWP ends, a Continuing Disability
  Review (CDR) is triggered.
• The person immediately enters the next phase
  The Extended Period of Eligibility (EPE).

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Extended Period of Eligibility

• The EPE is a 36-consecutive-month period.
• During the EPE, individuals receive SSDI/SSDAC
  benefit checks only during months when they are
  performing below SGA.
• If a person performs at or above SGA anytime
  during the EPE, SSDI/SSDAC benefits will stop at
  the end of the 36-month period.
• If a person never performs at or above SGA during
  the EPE, the EPE simply continues on a
  month-to-month basis until SGA is performed.

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Extended Period of Eligibility

• Averaging, Unsuccessful Work Attempts, and Work
  Incentives can all impact SGA determination
  during the EPE
• Averaging if work is fairly consistent, an SSA
  Claims Representative may choose to average
  earnings over a year to determine if the person
  is performing at SGA. With averaging, one or two
  months that peak over SGA may not count as SGA if
  the average for the year is below SGA.

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Extended Period of Eligibility

• Unsuccessful Work Attempt When work for less
  than 3 months where SGA is achieved ends due to
  the persons disability, the SSA Claims
  Representative may determine that SGA was not
  performed. 3 to 6 month periods can also be
  considered.
• Work Incentives To be discussed next training,
  Work Incentives such as IRWEs and Subsidies are
  means to demonstrating the true value of
  someones work in relation to SGA.

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EPE Example

• Mr. Blue finished his TWP 12/2005, and started
  his EPE 1/2006. Based on his monthly wages
  earned, in which months would he not be eligible
  for SSDI? Assume SGA is always 860 / month, and
  this chart begins with 1/2006.
• Jan Feb Mar Apr May
  Jun Jul Aug Sep Oct
  Nov Dec

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EPE Example Year 1

• Jan Feb Mar Apr May Jun
  Jul Aug Sep Oct Nov Dec
• In the first year, Mr. Blue only slightly earns
  over SGA a couple of months, and his earnings are
  fairly consistent. SSA could make the decision
  that no SGA was performed this year.

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EPE Example Year 2

• Jan Feb Mar Apr May Jun
  Jul Aug Sep Oct Nov Dec
• In the second year, Mr. Blue appears to clearly
  earn over SGA beginning in July. In months he
  is performing over SGA, he will not be eligible
  for SSDI, with an exception

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EPE Example Year 2, cont.

• Jan Feb Mar Apr May Jun
  Jul Aug Sep Oct Nov Dec
• Mr. Blue will actually receive SSDI checks for
  July, August, and September. SSA awards people a
  3-month grace period when SGA is first
  performed.

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EPE Example Year 3

• Jan Feb Mar Apr May Jun
  Jul Aug Sep Oct Nov Dec
• Mr. Blue will continue to receive SSDI checks
  during those months he performs below SGA.
• Technically, this should happen what actually
  happens will be discussed in detail later.

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EPE Example Year 3

• Jan Feb Mar Apr May Jun
  Jul Aug Sep Oct Nov Dec
• December of Year 3 is the last month of Mr.
  Blues Extended Period of Eligibility.

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Medicare

• Though Mr. Blues benefits have stopped, Medicare
  will continue for many more months.
• The exact calculation is very complicated and
  beyond the scope of this training.
• Medicare eligibility can last for up to 93 months
  (and possibly longer).

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Expedited Reinstatement of Benefits

• Mr. Blue loses his job a few months after his EPE
  ended. As such, Mr. Blue goes back to SSA and
  asks for an Expedited Reinstatement of Benefits
  (EXR).
• While Mr. Blues case is being considered, he is
  eligible for up to 6 months of provisional
  benefits.
• If he is found to not meet the EXR criteria, he
  will not owe this money back to SSA (unless he
  dishonestly knew he would not be eligible.)

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EXR Eligibility Criteria

• In order to be eligible for an Expedited
  Reinstatement of Benefits, Mr. Blue
• Must have lost benefits due to performing SGA
• Must be performing below SGA due to his
  disability
• Requests reinstatement within 60 months of the
  last month of his EPE
• Has a disability that is the same or related to
  his original disability claim, and it keeps him
  from working SGA.
• or, possibly, the last month a benefit check was
  received.

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EXR Approved

• If Mr. Blues EXR case is approved, he will begin
  receiving SSDI again.
• After 24 months of reinstated benefits, Mr. Blue
  can have a new
• TWP
• EPE
• 60-month period to ask for another EXR

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EXR Denied

• If Mr. Blues EXR case is denied, he will need to
  go through an entirely new application process.
• Mr. Blues recent demonstration that he can
  perform above SGA may impact his ability to be
  eligible for benefits.

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Questions?
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Tracking and Reporting
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Tracking

• When receiving SSDI / SSDAC, it is important to
  track your monthly earnings!
• A simple grid is provided use it to track wages
  for each month
• Record the gross wages earned each month -
• Record the amounts earned according to dates, not
  when the check was received
• Keep track of sick time and vacation. They do
  not count towards SGA
• Track the yearly TWP and EPE. The amounts
  typically change each year know those changes!

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Reporting

• Often, Social Security will request to review
  beneficiaries wages only at the end of the year.
• SSA may make this decision to based on
  projections of current earnings for ex.
• If Juan is earning 650 each month, and wages are
  not anticipated to increase, SSA may tell Juan
  not to report income until the end of the year
  (as he is not near SGA).

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Reporting

• But what if SSA makes this request in January,
  and in March, Juan receives a raise and begins
  earning 900 / month?
• Juan wont report income, because he was told not
  to by SSA.
• If Juan is in his EPE, then he could be in an
  overpayment situation - he could owe SSA some or
  all of the SSDI checks he received between March
  and December.

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Reporting

• If you are tracking your wages, and you begin to
  earn over SGA, let Social Security know!
• Be insistent!
• Typically, you cannot bring checks for which you
  know you are not eligible back to your local SSA
  office they usually will not take them.
• If you mail in wage documents and you suspect
  they are not being processed properly, hand
  deliver your wage stubs to your local office.
• Be sure to get a copy stamped as received for
  your records!

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SSDI and SSI Reporting

• If you receive both SSI and SSDI/SSDAC, you
  should be reporting income on a monthly basis.
• The Claims Reps for SSI and the Claims Reps with
  Title II do not always share information.
• The wage stubs you mail in to SSA may be only
  reviewed by your SSI Claims Representative.
• If you begin earning at or above SGA, be sure
  that the Claims Rep for your Title II benefits is
  made aware of this development!

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Questions?
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Thank You!Please fill out the evaluation before
you leave.

• Department of Community and Human Services
• Developmental Disabilities Division