Disability Program Navigator Training A Joint Initiative of the U.S. Department of Labor and the Social Security Administration

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Disability Program Navigator TrainingA Joint
Initiative of theU.S. Department of Laborand
theSocial Security Administration

• SSA Work IncentivesAt A Glance
• Sharon Brent, Program Associate, Law Health
  Policy Disability Center

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Learning Objectives

• To understand the value of the Work Incentives to
  the beneficiary earning income
• To understand which Work Incentives belong to
  both SSI and SSDI
• To understand how each Work Incentive can be
  applied to benefit the individual

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What Are Work Incentives?

• Work Incentives make it possible for people with
  disabilities receiving SSI and/or SSDI to work
  and still receive monthly payments and Medicare
  and/or Medicaid while they test their ability to
  work.
• The Goals of the Work Incentive Programs are to
  assist individuals to achieve gainful employment,
  increase independence, facilitate empowerment,
  and acquire self-support.

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Work Incentives Attached to SSI and SSDI

• Impairment Related Work Expenses
• The out of pocket cost of certain items and
  services required by individuals in order to
• Enable a person to work
• A person needs the item or service because of a
  disabling condition
• A person paid the cost and are not reimbursed by
  another source, such as Medicaid, Medicare,
  service agency
• The cost is reasonable (it represents the
  standard charge for the item or service in a
  persons community) and
• A person paid the expense in a month that there
  was employment.
• (Sometimes work expenses may be used before the
  first or after the last month of work activity.)

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Impairment Related Work Expense(IRWE)Example

• Kathy is medically defined by SSA as having an
• intellectual disability. She is receiving
  220.00 per
• month from SSDI as a SSCDB beneficiary and
• 352 SSI. She is earning 865.00 gross wages
• each month. She is paying out of her own pocket
• 100.00 a month (IRWE) for transportation costs
• because due to her disability she is unable to
• navigate public transportation and is required to
• use door-to-door-transit services.

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Value to SSDI and SSI usingImpairment Related
Work Expense

• The value of the 100 (IRWE) to SSDI is reducing
  the 865 which is considered SGA (810/2004) to
  765 countable gross income.
• The value of the 100 (IRWE) to SSI is when
  calculating the SSI monthly payment and getting
  credit for the out-of-pocket expense.
• 220.00 SSDAC
• - 20.00 General Exclusion
• 200.00 Unearned Income
• 865.00 Gross Wage
• - 65.00 Earned Income Exclusion
• - 100.00 IRWE
• by 2
• 350.00 Earned Income
• ________________________
• 550.00 Total Countable Income (TCI)
• New SSI benefit payment Current Federal Benefit
  Rate TCI
• 2.00 SSI payment

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SSDI Work Incentives

• Subsidies and Special Conditions
• Subsidy and Special Conditions are SSAs
  names for support a persons receives on the job
  that may result in a person receiving more
  earnings than the actual value of the services
  performed on the job.
• Subsidy is the support provided by an employer
• Special Conditions are generally provided by
  someone other than an employer, like Vocational
  Rehabilitation, One-Stop, or Service Provider.
• SSA considers the existence of subsidy and
  special conditions when making an SGA decision.
  Only the earnings that represent the actual value
  of services performed is considered when making
  an SGA determination.

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Subsidy Example

• A beneficiary receives more supervision than
  other workers doing the same or a similar job for
  the same rate of pay
• A beneficiary has fewer or simpler tasks to
  complete than other workers doing the same job
  for the same rate of pay
• A beneficiary has a job coach who helps the
  person perform the tasks of the job.

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SSDI Work Incentives

• Unincurred Business Expense
• APPLIES TO SELF-EMPLOYMENT ONLY
• These are contributions made by others to
• support the self-employment effort.
• It must be an item or service that IRS would
  allow as a legitimate business expense if the
  beneficiary has paid for it and
• Someone other than the beneficiary paid for it.

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SSDI Work Incentives

• Unincurred Business Expenses Example
• The State Vocational Rehabilitation agency gives
  a person a computer for the business and/or
• A friend works for the business as unpaid help.
• SSDI - An SGA decision is made after SSA deducts
  unincurred
• business expenses from the net earnings to
  determine an accurate
• measure to the value of work.
• SSI - SSA does not deduct unincurred business
  expenses from
• earnings when they figure the SSI payment amount.

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SSDI Work Incentives

• Unsuccessful Work Attempt
• This is a work attempt to work at substantial
  gainful work that a person stops or reduces below
  the SGA level after a short time (6 months or
  less).

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Unsuccessful Work AttemptExample

• A persons disability prevents the continuation of
  the employment by
• Leaving the job
• Reducing the amount of hours
• Eliminating some of the job tasks and
• Removing the special conditions related to the
  impairment upon which further work performance is
  required.
• SSDI-Does not count earnings in months that are
  identified and unsuccessful
• SSI-Does not consider unsuccessful work attempts
  when figuring the SSI payment.

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SSDI Work Incentives

• Section 301Continuation of benefits Under a
  Vocational Rehabilitation Program
• When SSA finds a persons disability no longer
  impairing the ability
• to earn SGA due to medical improvement the
  monthly payment
• usually stops
• However
• If a person is participating in a vocational
  rehabilitation program
• benefits may continue until the program ends,
  participation stops,
• or SSA determines continued participation will
  not increase the
• likelihood of permanent removal from benefits.

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Section 301Example

• A person must be participating in an approved
  vocational rehabilitation program before
  disability was determined improved
• State Vocational Rehabilitation or approved
  non-state VR program
• Contracted an Employment Network for services
• SSA must review the participation and determine
  the likelihood of permanent removal from the
  disability benefit rolls.

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Work Incentives Attached to SSDI ONLY

• Trial Work Period (TWP) allows a person to test
  their ability to work for at least 9 months.
  During the TWP a person will receive their full
  amount of benefit payment regardless of how much
  earned income a person might earn as long as the
  person is still determined disabled.
• The TWP months do not need to be consecutive
  months but earned in a rolling 60 month period
• We currently consider a beneficiarys work to be
  services if they earn more than 580/month (in
  2004) or work more than 80 self-employment hours
  in a month. (The dollar amount is adjusted each
  year based on the national average wage).

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Trial Work Period (TWP)Example

• A person starts with the first month of
  eligibility under SSDI and earns 700. The first
  TWP has been earned. If income continues each
  month at that level or higher he continues to
  earn a TWP each month.
• If a person goes below the annually TWP amount
  (580/2004) it will not be counted as a TWP
  month.
• Once 9 TWP months are earned within a rolling
  60-month period, the beneficiary has completed
  the trial work period and starts the extended
  period of eligibility.

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SSDI Work Incentives

• Extended Period of Eligibility (EPE)
• At the conclusion of the TWP, as long as the
• individual continues to be disabled, the EPE will
• begin in the following month. The EPE can
• continue indefinitely depending on the
• individuals work. The first 36 months are called
• the re-entitlement period. During this time,
• benefits are paid without a new application for
  months
• work below the SGA level. Benefits are suspended
• for months where earnings are above the SGA
  level.
• After the end of the re-entitlement period,
  benefits will
• terminate the first month that the beneficiary
  earns
• above SGA.

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Extended Period of EligibilityExample

• Kathy has completed her TWP and is now starting
  her EPE earning 750 per month. She is still
  receiving her full benefit check because she has
  been determined NOT to be earning SGA. The next
  6 months she earns the 750. In the 7th month of
  her EPE she now is earning 875 per month her
  first month at SGA (2004/810). Her first month
  at SGA level earnings is her cessation month
  and she still is receiving her full benefit check
  for month 7, 8, and 9 of her EPE (the grace
  months). She continues earning the 875 per
  month and now is no longer eligible for her SSDI
  benefit check due to earnings of SGA. She
  continues to earn SGA. At the 20th month of her
  EPE she is no longer able to work. Since she is
  still in the re-entitlement period, she is
  eligible again for her full SSDI benefit check
  without reapplying. Her benefits stop in the
  first SGA month after the end of the
  re-entitlement period.

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SSDI Work Incentives

• Continuation of Medicare
• Most people who work will continue to receive at
  least 93 consecutive months of Medicare
  coverage both Part A and B (if they took the
  option).
• The cash benefit may have stopped due to
  earnings of SGA the Medicare coverage
  continues.
• The 93 months starts after the month the last TWP
  is earned.
• A person must continue to have a medical
  impairment that has not improved.

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SSDI Work Incentives

• Medicare for People with Disabilities who Work
• After premium free Medicare coverage ends (93
  months of Continuation of Medicare) due to work,
  some people who have returned to work may buy
  continued Medicare coverage as long as they
  remain medically disabled.

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Medicare for People with Disabilities who
WorkExample

• A person not yet age 65
• A person who continues to have a disabling
  impairment
• A persons Medicare stops due to earned income
  (working)
• A persons Medicare stops due to earned income
  (currently working)
• A person can buy Premium Hospital Insurance (Part
  A) at the same monthly cost that uninsured
  eligible retired people pay (316 for 2003) or at
  a 45 reduction if the beneficiary has 30 QCs
  (174 for 2003) Most people will have 30 QCs if
  they continued working after their benefits
  stopped.

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SSI ONLYWork Incentives

• Earned Income Exclusion
• SSA will not count the first 65 of a persons
  earnings each month then only ½ of the remainder.
• If a person has no unearned income in a month
  (SSDI, VA, Workman Compensation, etc.) then the
  20 General Exclusion will be added to the 65.00
  to make the firs 85 of earnings not counted.

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SSI Earned Income Exclusion Example

• Kathy is receiving 552 each month from an SSI
  payment. She is now earning 865 from her job.
  As she reports wages to the local field office
  each month SSI will calculate her earnings as
  follows
• 865.00 Gross Monthly Earnings
• - 85.00 General and Earned Income Exclusion
• 780.00
• by 2 390 This is what SSI counts of Kathys
  
• wages of 865.00
• 552.00 Current SSI payment
• -390.00 Countable Earned Income
• 162.00 New SSI payment

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SSI Work Incentives

• Student Earned Income Exclusion (SEIE)
• If a person is 22 and under, not married nor
  head of household, and regularly attending
  school, when the student starts to earn income
  an amount of that earned income is excluded from
  the SSI calculation when figuring the SSI
  payment. There is a monthly maximum amount
  1,370/2004, and an annual maximum amount
  5,520/2004, determined annually based on the
  cost-of-living adjustment.
• This exclusion is applied before the general or
  earned income exclusion.

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Student Earned Income ExclusionExample

• Regularly attending school means that a person is
  taking one or more courses of study and attend
  classes
• In a college or university for at least 8 hours a
  week
• In grades 7-12 for at least 12 hours a week
• In training course to prepare for employment for
  at least 12 hours a week
• If less time than indicated it must be beyond the
  students control
• If a person is home taught studying a course or
  courses given by a school (7-12), university, or
  government agency or have a home visitor or
  tutor who directs the study.

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SSI Work Incentives

• Blind Work Expense (BWEs)
• SSI does not count any earned income that is
  used to meet expenses that are needed to earn
  that income when deciding a persons SSI
  eligibility and payment amount.
• A person must be under 65
• A person 65 or older and receiving SSI payments
  due to blindness
• The expense does not have to be related to the
  blindness
• Items identified are treated as BWE rather than
  IRWEs (Impairment Related Work Expenses)

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Blind Work ExpenseExample

• Some examples of BWE expenses might be
• Guide Dog expenses
• Transportation to and from work
• Federal, State, and local income taxes
• Social Security Taxes
• Attendant Care Services
• Visual and sensory aids
• Translation of materials into Braille
• Professional association fees
• Union dues
• This is not an all inclusive list an individual
  may have other items that would qualified as a
  Blind Work Expense

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SSI Work Incentives

• Plan for Achieving Self-Support (PASS)
• The program allows a person to set aside income
  and/or resources for a specific time for support
  in reaching a SSA-approved work goal
• SSI will not count income, resources, or unearned
  income (SSDI) in determining the SSI payment when
  his money is set aside to reach the objective.
• A PASS can help a person establish or maintain
  SSI eligibility and could increase the SSI
  payment currently received.
• The SSI PASS Cadre must determine if the goal
  described on the PASS is a valid, attainable
  goal. SSA has a form SSA-545 that can be used to
  submit to the Cadre what is the goal,
  expenditures and time line to reach objective.

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Plan for Achieving Self-SupportExample

• Kathy has decided she wants to be an
  Administrative Assistant. In order for her to be
  able to apply for a job in this capacity she must
  have computer skills and understand multiple
  software programs to become qualified.
• She is receiving 320 per month from her previous
  work history of SSDI and 252 per month of an SSI
  cash payment.
• Kathy will need to go to a technical school to
  learn the computer, she may need to have a tutor,
  a computer to practice, transportation support,
  and books and supplies.
• She wants to use her 320 per month of her SSDI
  to fund the PASS for 18 months to help with the
  above expenditures to help her reach her
  objective.

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PASS Example CONTINUED

• She fills out the SSA 545 BBK form for PASS and
  submits it to the PASS Cadre in her Region.
• The Cadre may accept it just the way it is or
  they may call Kathy and talk to her about some of
  the items.
• The Cadre accepts the PASS as submitted.
• Kathy will save in a separate bank account 300
  each month of her 320 SSDI. Because SSI has
  approved her PASS they will now exclude 300 of
  her SSDI for 18 months when figuring her SSI
  payment and now send her 552 of SSI instead of
  252 she was getting prior to submitting the
  PASS.
• She will be required to have it reviewed
  periodically by SSI and show how she has utilized
  the money in the PASS showing receipts.

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SSI Work Incentives

• Property Essential for Self-Support (PESS)
• Some resources that are essential to a persons
  means of self-support may be excluded when SSI
  determines initial and continuing eligibility to
  SSI.

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PESSExample

• SSI does not count property that is used in a
  trade or business (inventory) or use for work as
  an employee (tools, equipment, truck). How else
  these items are used does not matter.
• SSI does not count up to 6,000 of equity value
  of non-business property that a person uses to
  produce goods or services essential to daily
  activities (produce, livestock for consumption
  only for personal household)
• SSI does not count up to 6,000 of equity value
  of non-business income-producing property
  (rental). If the property yields an annual rate
  of return of at least 6.
• A note SSI does not consider liquid resources
  (stocks, bonds, notes) as a PESS, unless a person
  uses them as part of a trade or business.

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SSI Work Incentives

• Special SSI payments for People Who Work-Section
  1619 (a)
• A person can receive SSI cash payments even when
  earned income (always gross or net earnings from
  self-employment) is at SGA (810/2004 level).
  This is instead of a trial work period or
  extended period of eligibility (which applies to
  SSDI).
• Eligibility for 1619 (a) enables an individual
  who continues to be disabled to receive an SSI
  cash payment when earning SGA.
• Individuals must continue to have the original
  disabling condition
• Individuals must meet all other resource and
  income tests.

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1619 (a)Example

• Kathy is receiving an SSI cash payment of 552
  each month. She starts earning income of
  785/gross each month. She will continue to
  receive an adjusted SSI payment and stays in
  regular SSI payment status. Kathy then starts to
  increase earnings to 850/gross each month
  (SGA/2003). She is still eligible for an
  adjusted SSI payment and moves into 1619 (a)
  payment status. If Kathy goes below the current
  SGA level and continues to meet all other SSI
  eligibility requirements she moves back to
  regular SSI payment status with a continued
  adjusted SSI payment due to earned income.

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SSI Work Incentives

• Continued Medicaid Eligibility-Section 1619 (b)
• Provides for continued Medicaid eligibility for
  individuals whose income is too high to qualify
  for an SSI cash payment, but is not high enough
  to fund the loss of Medicaid or publicly funded
  attendant care.
• Individuals will be eligible for 1619 (b) status
  if the only cause for the cessation of the SSI
  payment is due to earned income. If the loss of
  SSI is due to excess resources or other income
  1619 (b) does not apply.
• Individuals must have been eligible for an SSI
  cash payment for at least 1 month and
• Individual is still disabled and needs Medicaid
  to work.

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1619 (b)Example

• Kathy receives 564 SSI cash payment and has
  Medicaid. She starts earning income of 750 each
  month. Her SSI is adjusted due to earned income
  and she continues to be eligible for Medicaid.
  Kathy gets a raise and increases her hours and
  now earns 1300/gross each month. When SSI
  adjusts her SSI payment she no longer is eligible
  for a cash payment but remains in SSI eligible
  status and qualifies for 1619 (b) status.
• 1619 eligibility is conveyed via the State Data
  exchange and the State Medicaid office determines
  Kathy is eligible for continued Medicaid coverage
  with no spend down or share of cost for her
  Medicaid eligibility to continue through 1619
  (b). (If necessary, the beneficiary could bring a
  Benefits Query statement from SSA showing NO1 to
  the State Medicaid office.)

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SSI Work Incentives

• Special Benefits for People Eligible Under
  Section 1619 (a) or (b) who enter a Medicaid
  Treatment Facility
• If a person is eligible under Section 1619 and
  goes into a public medical or psychiatric
  facility or Medicaid facility the person can
  receive an SSI cash benefit for up to 2 months.

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SSI Work Incentives

• Reinstating Eligibility Without a New
  Application
• If a person has been ineligible for an SSI
  benefit for 12 months or less for any reason
  other than medical recovery, they may be able to
  restart an SSI cash payment and/or continued
  Medicaid coverage without a new application.
• It is important to always contact SSA about
  changes to a situation.

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Work Incentive Tips to Remember

• More than one Work Incentive may be used at the
  same time
• Individual application of supports will vary from
  person to person and job to job
• Resources in the community are available to help
  beneficiaries understand and access Work
  Incentives
• SSA 1-800-772-1213
• Local SSA Field Offices
• BPAO System (Benefits Planning, Assistance and
  Outreach Program)
• The SSA Work Incentive Liaisons, Work Incentive
  Specialists, and the Area Work Incentive
  Coordinators
• Protection and Advocacy Program

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This training has been designed and developed by
theLaw, Health Policy Disability Center
(LHPDC) of the University of Iowa College of
Lawdisability.law.uiowa.edu