Transcript I Can`t Risk Losing My Services & Benefits!

I Can’t Work, I Can’t
Lose Benefits
Overcoming Tough Benefits Issues &
Over-Payments
Marilyn Morrison, CWIC, WISA, WIC
[email protected]
Teresa Mullins, CWIC, WISA
[email protected]
What are the Work Incentives
Specialist Services?
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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
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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)
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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
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2015 – FBR - $733.00
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Impact of Wages on Monthly SSI
Payments
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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
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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)
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Medicaid coverage to continue even if SSI
cash benefit is reduced to $0
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Needs Medicaid in order to work, and has
annual earnings not greater than the state
threshold amount ($32,000 +)
IRWE – Impairment Related Work
Expenses
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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)
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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
Without SEIE
With SEIE and Rent payment
$550.00 Monthly Gross Pay
$550.00
-$20.00 GIE
-$20.00
-$65.00 EIE
-$65.00
$465.00 Total Countable Earnings $465.00
Divided by 2 = $232.50
$480.00 SSI amount
- $232.50
$ 247.50 – revised SSI amount
$550.00 Work
$797.50 Total of SSI and Work
Full Benefit SSI - $733.00
$550.00 Work
$1283.00
Plan for Achieving Self-Support
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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
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Disabled
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16 through 64 years of age
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Meet all requirements of Medicaid group with income ≤ 80% of
poverty ($766/mo. in 2014)
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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)
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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
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Federal medical assistance program for Title
II and retirement beneficiaries.
May be a waiting period before benefit
begins.
Coverages:
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Part A: Hospitalization (no premium)
Part B: Medical (monthly premium)
Part D: Prescription drug plan
Substantial Gainful Activity (SGA)
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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
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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)
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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)
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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)
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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
[email protected]
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