04/19/23 1

Navigating SSA Work Incentives and Employment

Work Incentives Planning and Assistance (WIPA) Project and the Freedom to Work ProjectBrooke Lusk

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Cash Benefits Programs for People with Disabilities

Social Security Disability Insurance Supplemental Security Income Same definition of disability used to

qualify for both programs. SSA determines what, if any, program

a person qualifies for and how much the cash benefit will be.

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Definition of Disability

Inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

SSA’s Adult Sequential Evaluation

1. Are you working at or above SGA?

2. Are your impairments severe?

3. Do you meet or equal a listing?

4. Can you do your past relevant work?

5. Can you do any other work?

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Social Security Disability Insurance

Insurance system Individual must have relevant work history or

be related to somebody (child, spouse, former spouse, parent) who is disabled, retired, or deceased with work history.

Benefit will vary depending on when relevant work income earned and the amount earned.

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More on the SSDI Benefit Assets and amount of unearned income are

irrelevant. Can vary in amount enormously. For SSDI on own account, first check begins on 6th

month after entitlement and SSA can award benefits retroactively for up to 12 months prior to application.

Wages count when earned, not necessarily when paid.

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SSDI on Own Work Record

Individual worked and paid into the system. Individual earned sufficient amount in a

sufficient amount of quarters at the relevant time.

Number of quarters of coverage needed differ depending on age.

Minor children or spouse can receive a dependent benefit.

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Disabled Adult Child/Childhood Disability Beneficiary

18 or older Disabled by SSA’s definition before the

age of 22. Child of insured workers who are either

disabled, retired, or deceased. If adult child marries, benefits will cease

unless marriage is to another Title II beneficiary.

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Disabled Widow/Widower Must be widow/widower or surviving divorced

spouse. Must be found disabled before a prescribed

period of time. Payments are not payable prior to age 50.

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SSDI Beneficiary: Medicare

SSDI beneficiaries are eligible for Medicare after 24 month waiting period.

Waiting period begins with the first month in which person is eligible for check.

Many have already passed waiting period when they receive first check because case was pending for so long.

Some SSDI beneficiaries are eligible for Medicaid assistance in paying for the Medicare premiums.

Supplemental Security Income Needs based program. Strict asset and resource guidelines. Countable income includes both earned and

unearned income. Any money coming in could count, even gifts!

Also considers the income of other relatives in certain cases (deeming).

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Why Two Cash Systems? SSDI is only for people who paid into the

system or related to somebody who paid. What about those with same exact disability

who were not able to pay into the system or do not have the “right” relative who is retired/disabled/deceased?

SSI system was created later and helps fill in this gap.

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SSI fills in this gap, but……….. SSI is very different from SSDI in key

aspects. SSI is best thought of as a “payer of

last resort.” So, everything you receive or have

could potentially count against the SSI check.

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Supplemental Security Income Federal Benefit Rate – standard amount of SSI in

2011 is $674 for individual and $1011 for couple. The amount you actually receive may vary if there

has been an overpayment or other income is being counted.

Usually received on the 1st of the month. Can supplement a low SSDI check. Both children’s SSI and adult SSI.

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Supplemental Security Income – Resource Rules

Asset limit is $2000 for single, $3000 for couple.

Home in which person resides does not count.

One car does not count. Long list of other exceptions in the Program

Operating Manual System (POMS).

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Supplemental Security Income – Counting Other Income

Almost all unearned income counts against the check.

Less than ½ of earned income counts. In-Kind Support and Maintenance can be

considered. Income of certain relatives can be

considered.

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Supplemental Security Income - Medicaid

In South Dakota, Medicaid eligibility is automatic when SSI is approved.

This is not the case in all states.

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What is the Difference Between Medicare and Medicaid?

Medicare is run by feds, Medicaid is run by states within parameters set by federal.

They can cover different services or cover its cost sharing in different ways.

They have different rules for how they are impacted when a person has employment income.

Doctors may take one and not the other. And on, and on, and on…………………

Shifting Gears…..Work Incentives Social Security’s definition of disability involves

inability to engage in substantial gainful activity. Once in the system, there are rules and policies

called “work incentives” to encourage beneficiaries to work!

Some incentives have been around a long time and others were created through the Ticket to Work and Work Incentives Improvement Act of 1999.

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Work Incentives Policy Term used for policies and procedures created to

address barriers to employment caused by benefits eligibility.

Some remove the barrier, while others encourage working by rewarding employment activity.

Work incentives have changed and improved significantly over time.

The Ticket to Work and Work Incentives Improvement Act was the latest and largest work incentives policy shift.

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Program Rules are Different

Rules for SSDI and SSI when you go back to work are different.

Often, beneficiaries and their service providers get confused as to which rules apply.

If person receives both checks, one set of rules applies to one check and the other set of rules applies to the other check.

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Impact of Unearned Income on SSDI?

NONE! Receiving alimony Child support Gifts Dividends Interest or Even winning the lottery will not have ANY

impact on receiving a SSDI check

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Impact of Earnings on SSDI SSDI is an ALL or NOTHING program.

The amount of the check is not reduced – a person either gets their check or they do not get a check.

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Trial Work Period An individual is eligible to receive a total of 9

Trial Work Period (TWP) months. Over a rolling 60-month (five-year) period. The Trial Work Period amount for 2010 and

2011 is $720.00 or 80 hours of work in self-employment.

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Trial Work Period An individual is not required to use these

nine TWP months consecutively.

During the Trial Work Period phase, a beneficiary is entitled to keep their SSDI cash benefit regardless of how much is earned.

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Substantial Gainful Activity (SGA)

SSA determines the amount each year 2010 and 2011 SGA: $1,000 in

countable earnings 2010 and 2011 SGA for people whose

primary disability is statutory blindness: $1,640

Important to remember deductions such as IRWE and Subsidy!

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Extended Period of Eligibility The Extended Period of Eligibility (EPE) is a 36-

month continuous period following the Trial Work Period.

When in the EPE, an individual can receive a SSDI cash benefit when countable earnings are less than SGA (2010 and 2011 - $1,000 a month or $1,640 Blind).

However, any month in which countable earnings are above SGA, an individual will not receive a SSDI cash benefit.

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Impairment Related Work Expenses (IRWE) Enables SSDI beneficiaries to recover some

of their out-of-pocket expenses incurred as a result of their disability to support their work.

IRWE’s expenses are subtracted from a person’s earnings.

By reducing countable income, IRWEs result in a decrease in the amount counted towards SGA; a beneficiary can use an IRWE to remain eligible for SSDI cash benefits.

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Possible IRWEs -- Examples Medical appointment co-payments Prescription co-payments Prosthetic devices Certain transportation costs Costs of adaptive devices for motor vehicles

by persons who cannot drive an unmodified vehicle

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Example of IRWE Mary works and earns $1,000.00 per month.

However, she pays co-pays on her medications of $80 per month. Mary’s countable income is: $1,000 per month during TWP. $920 per month after TWP. Mary’s SSDI cash benefit will continue because

she is earning under SGA!

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Subsidy & Special Conditions Support received on the job that may

result in you receiving more pay than the actual value of the services performed.

“Subsidy” is support provided by the employer (extra breaks, more time to finish work)

“Special conditions” are something provided by someone other than the employer (VR pays for a job coach)

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Example of a SubsidyBill has finished his TWP. He earns $8.00 per hour and works 30 hours per week

($1,039.20). He receives 16 hours a month of support on the job from the employer.

Step 1: Hours of job coach intervention on site16 hours per month or number of hours of additional supervision

x $8.00 hourly wage of worker=$128 monthly subsidy

Step 2: $1,039.20 Monthly Gross Earings - 128.00 Monthly Subsidy = $911.00 Monthly Gross Wages Counted towards SGA

Bill had earnings over SGA but with a subsidy, his countable income of $911 is less than $1,000 (SGA). Bill would be entitled to an SSDI cash benefit.

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Expedited Reinstatement (EXR) Must apply within 5 years of the last time

eligible to receive a SSDI cash benefit or last month of the EPE, whichever is later.

Stopped receiving benefits because of work. Must continue to meet the medical definition

of disability and not be earning over SGA. Use medical improvement standard. Decision is made quickly. Eligible for 6 months provisional benefits

while a decision is pending.

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Remember!Report Income Every Month!!!!!

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STOP

Will Medicare Continue When Person Gets a Job? Medicare continues as long as you get a

disability check.

Even if the disability check stops, most individuals who work will continue to receive at least 93 consecutive months of Medicare after the Trial Work Period.

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Supplemental Security Income Federal Benefit Rate – standard amount of

SSI in 2011 is $674 for individual and $1011 for couple.

The amount you actually receive may vary if there has been an overpayment or other income is being counted.

Usually received on the 1st of the month. Can supplement a low SSDI check. Both children’s SSI and adult SSI.

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(Almost) Everything Matters Purpose of SSI is to help you obtain food

and shelter. Any factor impacting this (who you live with,

how much you make, how much you have, etc) may impact SSI.

Rules are complicated and complex. Always look at the Program Operating Manual (POMs).

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What is NOT income? Medical and social services Personal service Income tax refund (resource after nine months) Loan Somebody pays a bill that is not food or shelter Clothing Others……….

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What is Income? Unearned income (SSDI check, Retirement

check, etc.) Earned income (earnings, self-employment) In-kind support and maintenance (food and

shelter provided by someone else) Other – Check POMs

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What is the Resource Limit? $2000 individual, $3000 couple Exclude:

Home the person resides in One automobile Retro SSA benefits for 9 months Certain trusts Burial fund up to $1500 PASS funds Income tax refund (up to 9 months) Others

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When does Earned Income Count? For SSI, earned income always counts in the

month that it is RECEIVED.

Therefore, paychecks every two weeks can come up with months where 2 pay checks are issued and months where 3 paychecks are issued!

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Supplemental Security Income and Employment SSI and earnings are calculated with a

formula. These deductions are subtracted from the gross income to determine countable income: General Income Exclusion $20.00 Earned Income Exclusion $65.00 Deductions/Exclusions

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Examples of Working @ $8.25/hr.Total Gross Earnings From WorkPart Time Full Time

$8.25 Hourly Wage $ 8.25

x 20 Hours/Week x 40

$165.00 $330.00

x 4.33 Avg Hours/Month x 4.33

$714.45 Gross Monthly Earnings/Employment $1,428.90

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Calculating Total Monthly Countable Income From EmploymentPart Time Full Time

$714.45 Monthly Income $1,428.90

-$20.00 General Income Exclusion - $20

$694.45 $1,408.90

-$65.00 Earned Income Exclusion - $65

$629.45 Gross Monthly Earnings/Employment $1,343.90 /2 Divide by 2 /2$314.73 Total Monthly Countable Income $671.95

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Calculating SSI payment Part Time Full Time

$ 674 2011 Federal Benefit Rate $ 674.00

- 314.73 Total Countable Income - 671.95

$ 359.27 Adjusted SSI Benefit Check $ 2.05

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Total Monthly IncomeAdjusted SSI Benefit + Monthly Income from Employment

Part Time Full Time

$ 714.45 Earnings from Employment $1,428.90

+ 359.27 Adjusted SSI Benefit Check + 2.05

$ 1073.72 Total Monthly Income $1430.95

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SSI Work Incentives Impairment Related Work Expense (IRWE) Blind Work Expense (BWE) Student Earned Income Exclusion (SEIE) Plan for Achieving Self-Support (PASS) 1619(b) – Medicaid ($32,991/year in SD for

2011)

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Impairment Related Work Expenses (IRWE) These are expenses one must pay for out-of-

pocket in order to work They must be related to the primary disability

or an established secondary disability The individual must have an IRWE approved

by SSA first and must show receipts

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Where Do IRWEs Fit In? IRWEs deducted from countable income

before dividing by 2 in the calculation Therefore, IRWE is not subtracted from

countable income dollar for dollar (like it is with SSDI)

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Sample IRWE CalculationMary pays $100 per month for specialized transportation to

and from work. She is paid $500 per month from her job.

$500 Earned Income- $20 General Income Exclusion

- $65 Earned Income Exclusion- $100 IRWE

=$315/2

= $157.50 Countable Income

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Blind Work Expenses A person whose primary disability is statutory

blindness can use BWEs to deduct the cost of a large list of items

Unlike IRWEs, BWEs are deducted AFTER dividing by 2 on the calculation sheet. The entire BWE is deducted from income dollar for dollar

Because of this, BWEs can be used to deduct so much from countable income that often times the SSI check is not reduced at all!

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Types of BWEs IRWEs State and federal taxes Union dues Mandatory pension Cost of uniforms Reader services, driver services, and cost of service animal’s

care Childcare Transportation Meals consumed at work Adaptive equipment

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Blind Work Expense ExampleMary earns $500 per month. She has $100 in

various BWEs (taxes, etc.)$500 Earned Income

-$20 General Income Exclusion-$65 Earned Income Exclusion

=$415/2=$207.5

-$100 BWE$107.5 Countable Income!

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Student Earned Income Exclusion (SEIE) Must be under the age of 22 and regularly

attending school

Exclude up to $1,640 (2011) of earned income per month when SSA figures the SSI monthly payment amount

The maximum yearly exclusion in 2011 is $6,600

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Student Earned Income Exclusion Examples Mary earns $500 a month. But, she is also

attending community college with enough hours to qualify for SEIE.

$500 earnings minus $500 SEIE (out of the possible $1,640 max per month)

NO SSI REDUCTION until she uses $6,600

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Plan for Achieving Self-Support PASS excludes other income which normally

would reduce Supplemental Security Income With the exclusion, SSA asks the recipients

to put this money into a PASS that is then spent on a vocational goal.

Most common income excluded is wages/SSDI/savings

PASS allows SSI eligibility or higher payments of SSI

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Allowable PASS ExpendituresA PASS can be used to save and pay for a

variety of expenses necessary to reach the work goal: Computers and assistive devices Transportation and modifications Education and vocational training Tools/other items needed to start a business

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Elements of a PASS Must be in writing using form SSA-545 State a job goal, self-employment goal, or

vocational rehabilitation evaluation Contain a reasonable start and end date List expenses that are necessary to achieve

the work goal Must be able to prove that costs of food and

shelter can still be met by setting money aside in PASS

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How Does a PASS Work? Once the PASS is approved by the SSA PASS

Cadre; Recipient opens a special bank account for

PASS funds Recipient keeps an accounting of all money

received and spent Recipient will be required to show this report

to the PASS Cadre, upon demand

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Medical Assistance for Workers with Disabilities (MAWD) Meet modified definition of disability that

allows for work income (SSDI beneficiaries do)

Working (paying FICA taxes) Unearned income limit less than $694

per month Income limit is 250% FPL ($2256

countable earnings per month for an individual)

Assets are $8,000

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How do people apply for MAWD? They simply complete an enrollment form. An interested person can contact:

Local Department of Social Services office Local Division of Rehabilitation Services office Local Service to the Blind and Visually Impaired

office Freedom to Work staff

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