Easter Seals North Texas WIPA Program

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Easter Seals North Texas-WIPA Program

• Removing the Barriers-Using Social Security Work
  Incentives

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Working While DisabledProblems and Goals
Defined

• Problems
• Dispelling the myths
• Believing that they can
• Fear of losing health insurance
• Goals for Quality Services
• Offered verified and accurate information
• Pursue all applicable work incentives
• Offer long-term support and follow up services
• Collaborate with other professionals

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Using ALL of the Work Incentives

• SSA Work Incentives
• Details on the Benefit Planning Query (BPQY)
• Verification of other benefit programs and
  exemptions
• Writing and Tracking Benefits Summary and
  Analysis (BSA) and Work Incentives Plan (WIP)

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What are Social Security Benefits?

• There are two types of benefits
• Title 2 Disability
• Social Security Disability Insurance (SSDI),
  Childhood Disability Benefits (CDB), and Disabled
  Widows Benefits (DWB)
• Retirement and Childs Benefits are not related
  to disability
• Based on a work record of a person who is either
  retired, disabled or deceased.
• Title 16
• Supplemental Security Income (SSI)
• Based on the economic need of the family

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Title 2 Work Incentives

• Trial Work Period (TWP)
• Extended Period of Eligibility (EPE)
• Cessation and Grace Period
• Impairment Related Work Expenses (IRWE)

• Special Conditions Employer Subsidies
• Section 301
• Continuation of Medicare

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Trial Work Period (TWP)

• Allows a beneficiary to test his/her ability to
  work
• SSA does not reduce or suspend the Title 2 check
  during this period, regardless of the amount of
  wages earned
• In 2009, SSA monitors the monthly gross wages to
  see how long it takes him/her to gross over 700
  per month, nine times
• SSA verifies that the individual completed all
  nine months within a five year period
• No work incentives can be used during the TWP

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Extended Period of Eligibility (EPE)

• Continues for 36 consecutive months immediately
  following the end of the Trial Work Period
• Continues to be medically disabled
• Receive a Title 2 check for each month that they
  have gross wages under Substantial Gainful
  Activity SGA
• SGA for 2009 is 980/gross per month
• Work Incentives can now be used

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Cessation and Grace Period

• The first month after the Trial Work Period, a
  beneficiary goes over the SGA level and is able
  to maintain that level of earnings for a period
  of time
• Individual will receive his Title 2 check for
  that first month and the following two months
• SSA looks at unsuccessful work attempts and
  other work incentives during this time

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Impairment Related Work Expenses (IRWE)

• Any out of pocket expense that is related to your
  disability
• Not reimbursed by anyone (insurance, DARS, etc)
• Purchased so that you could continue to work
• The dollar amount of the IRWE is subtracted from
  the GROSS monthly earnings of the beneficiary,
  potentially reducing their SGA

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Subsidy

• When an employer pays workers with disabilities
  more in wages than the reasonable value of the
  actual services performed or assistance is
  provided by an employment service, a subsidy may
  be present
• The dollar amount of the subsidy is subtracted
  from the GROSS monthly earnings of the person,
  potentially reducing their SGA

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Medicare

• Our countrys health insurance program for people
  age 65 or older, certain people with disabilities
  who are under age 65, and people of any age who
  have permanent kidney failure
• Provides basic protection against the cost of
  health care, but does not cover all medical
  expenses or the cost of long-term care

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Who is Eligible for Medicare?

• Individuals who are
• Age 65 and insured for retirement benefits either
  through their own work record, or through a
  spouses work record
• Receiving SSDI who have met the 24-month
  qualifying period for Medicare
• Receiving CDB who have met the 24-month
  qualifying period for Medicare, no earlier than
  the persons 18th birthday
• Entitled to DWB or Medicare on a deceased
  workers record and who have met the 24-month
  qualifying period

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Medicare Parts

• Medicare Part A
• Hospital Insurance
• Helps pay for care in a hospital or skilled
  nursing facility, home health care and hospice
  care
• Medicare Part B
• Supplemental medical insurance
• Helps pay for doctors, outpatient hospital care
  and other medical services

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Continuation of Medicare

• Medicare Part A can continue, at no cost, for at
  least 93 months following the end of the Trial
  Work Period (TWP) if the individual is still
  medically disabled
• Part B may be purchased and billed quarterly at
  the monthly premium of 96.40

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Medicare Part D Prescription Coverage

• Voluntary prescription drug program was
  effective 1/1/2006
• Individuals who have Part A and/or Part B, may
  voluntarily enroll in the voluntary prescription
  drug program
• SSA does not process Part D enrollments
• Enroll with a participating approved Medicare
  Part D Prescription Drug Provider or a Medicare
  Advantage plan that offers prescription drug
  coverage
• Plans are developed and operated by private
  insurance companies that contract with Centers
  for Medicare Services (CMS)

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Title 16 Benefits Supplemental Security Income
(SSI)

• Other details to remember
• Unearned Income
• Deeming
• Credits
• Federal Benefit Rate (FBR)
• Age 18-Redetermination
• In-kind Support and Maintenance
• Resources
• Retrospective Monthly Accounting
• 12-Month Suspension Period

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SSI Work Incentives

• General Income Exclusion (GIE)
• Earned Income Exclusion (EIE) and divide by 2
• 1619 a and b
• Student Earned Income Exclusion (SEIE)

• Plan for Achieving Self-Support (PASS)
• Blind Work Expense (BWE)
• Impairment Related Work Expenses
• Section 301

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1619 (b)

• Medicaid coverage can continue, at no cost, even
  if your earnings become too high for an SSI cash
  payment, as long as
• 1. You need the Medicaid in order to work
• 2. Meet other eligibility requirements
• Texas State Threshold for 2009 - 29,152
• Individual Threshold look at your individual
  use of Medicaid, which could be much higher than
  the state threshold

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1619 (b) and Eligible Couple

• Unfortunately, if only one members 1619(b)
  status is being considered, then the earned
  income is only disregarded for that one person,
  not the spouse
• Since 1619(b) is considered a work incentive, it
  is only available to persons who are working. The
  worker receives 1619(b) , but the spouse who is
  not working, goes into suspension and is
  terminated after 12 consecutive months in this
  status

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Student Earned Income Exclusion (SEIE)

• If you are under the age of 22 and ALL of the
  below
• Regularly attending school (high school, college,
  trade school, etc)
• SSA does not count up to 1,640 of earned income
  per month in 2009
• The maximum calendar year exclusion is 6,600 in
  2009
• January-December is the calendar year

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Impairment Related Work Expenses (IRWE)

• Out of pocket expense
• Related to your disability
• Not reimbursed by anyone
• Purchased so that you may continue working

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Blind Work Expenses (BWE)

• Documented expenses a person who has statutorily
  blindness as his or her primary disability with
  SSA
• Incur the expense because the item(s) are needed
  for work
• These expenses do not have to be related to
  blindness, just to work

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Plan for Achieving Self-Support (PASS)

• PASS will allow recipients to set aside income
  and or resources for vocational training, self
  employment or educational costs.

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Section 301

• Allows for the continuation of benefit payments
  under both Title 2 and Title 16 to individuals
  whose disability ceases due to medical recovery
  while participating in an approved vocational
  rehabilitation program
• Not expected to medically recover at the
  beginning of the program, but does recover
• Actively participating in a VR program
• Determination that completion of the program will
  significantly increase the likelihood of
  permanent removal from the disability roles

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Ticket to Work (TTW)

• New TTW regulations went into effect July 2008
• Eligibility for the TTW program expanded to
  include all adult beneficiaries ages 18-64. Prior
  to this, certain beneficiaries were not eligible
  to receive a Ticket until they had completed
  their 1st Continuing Disability Review (CDR)

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General Overview

• A Title 2/Title 16 beneficiary receives a
  Ticket
• Ticket holder contacts an approved Employment
  Network (EN)
• EN and the Ticket holder agree to work together
  and develop an Individual Work Plan (IWP) that
  outlines the mutual commitment they are making to
  each other

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Overview Continued

• The IWP must be approved by Maximus (the
  contractor who facilitates the TTW program)
• Once approved, the EN will provide the agreed
  upon services needed to return to work
• The Beneficiary performs the agreed upon actions
  to go back to work
• Beneficiary will not be subjected to a CDR review
  as long as the beneficiarys Ticket is assigned
  or in use, and the beneficiary is making timely
  progress towards self-sufficiency

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Ticket Conclusion

• Once the Ticket holder is working at a level that
  justifies a payment to the EN, the EN submits a
  request for payment to Maximus.
• Under the TTWP, the EN and/or the Ticket Holder
  may contact Maximus in writing if they wish to
  discontinue the working relationship. The Ticket
  Holder may then submit their Ticket to another EN

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What VRCS Need to Know About TTW

• VR is no longer required to have Ticket
  assignment to submit a case for Cost
  Reimbursement
• New TTW regulations created a new status IN USE
  for those cases where VR is serving a beneficiary
  under the traditional Cost Reimbursement Program
• Clients still get the same CDR protections that
  go with Ticket assignment
• When a Ticket is IN USE it is not available for
  other EN assignment

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Partnership Plus

• VR and an EN may both serve the same beneficiary
  and both parties collect payments they must
  provide services sequentially, not concurrently
• VR may submit for cost reimbursement when the
  beneficiary reaches 9 months of net SGA (980)
  within a 12 month period
• The EN provides job retention services and would
  then be eligible for Phase 2 Milestone payments
• Phase 2 payments are made when a beneficiarys
  gross earnings are above SGA and the beneficiary
  is in a zero cash payment status
• This Partnership is likely to result in more
  individuals returning to work at the 9 month
  level of SGA, leading VR to submit more cases for
  Cost Reimbursement

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Medicaid Buy In Program

• The Medicaid Buy-In Program offers affordable
  health care coverage to people with disabilities
  who work and earn a paycheck.
• Premiums range from 0 to 500 a month based on
  countable income

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Medicaid Buy-In Program
Source http//www.dars.state.tx.us/edc/medicaidb
uyin.shtml
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Medicaid Buy-In ProgramQualifications
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Medicaid Buy-In ProgramHow to Apply
Source http//www.dars.state.tx.us/edc/mediaidapp
ly.shtml
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WIPA and YOU!

• WIPA (Work Incentives Planning and Assistance) is
  FREE!
• We are here to assist you understand up front how
  working will impact both your cash and your
  medical health insurance benefits
• We provide a detailed report on the various work
  incentives available to you and how to utilize
  them
• We also provide follow up services to ensure
  that you are using all of the applicable work
  incentives

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How to Reach Us

• The Easter Seals North Texas WIPA Project serves
  19 counties in the North Texas area and has 5
  Community Work Incentives Coordinators (CWIC) to
  serve you. Call the CWIC in your area to schedule
  a consultation at no charge.

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Community Work Incentives Coordinators

• Cindy A. Herzog
• WIPA Project Director
• Dallas and Denton Counties
• 1-888-617-7171 ext 1038
• Direct [phone]
• cherzog_at_ntx.easterseals.com
• James Artre, Senior CWIC
• Clay, Erath, Hood, Jack, Johnson,
• Montague, Palo Pinto, Parker
• Sommervell and Wise Counties
• 1-888-617-7171 ext 1039
• Direct [phone]
• jartre_at_ntx.easterseals.com

• Mary Beth Niver, Senior CWIC
• Tarrant County
• 1-888-617-7171 ext 1023
• Direct [phone]
• mbniver_at_ntx.easterseals.com
• Lucy Endermark, Senior CWIC
• Collin, Cooke, Grayson and Hunt
• Counties
• 1-888- 617-7171 ext 1040
• Direct [phone]
• lendermark_at_ntx.easterseals.com
• Laurie Truesdell, CWIC
• Dallas, Ellis and Rockwall Counties
• Direct [phone]
• ltruesdell_at_ntx.easterseals.com

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Questions and Answers