BenefitsBenefits ConsultationConsultation

Julie Koehler, Program DirectorRon Swain, Senior Benefits Consultant

John Hartman, CWIC Benefits SpecialistStephanie Gibson, CWIC Benefits Specialist

Karie Urban, CWIC Benefits SpecialistMike Keffer, CWIC Benefits Specialist

Carrie Printz, CWIC Benefits SpecialistTanya Chiles, CWIC Benefits Specialist

The benefits of Benefits Analysis

To clarify existing benefits

To assist with system navigation

To present financial options

To outline an individualized plan

Benefits Process Referral

COVA Career Developers– Bureau of Vocational Rehabilitation– Community Mental Health Centers– Social Security Administration– County Boards of MRDD– Job and Family Services– Educational Programs/Schools– Family Support Groups– Community Advocacy Centers

Contact– by phone– written letter– e-mail

Benefits Process

Collection– Gather information in person, phone, e-mail, fax– Contact guardian, representative payee, community

advocate

Research– Release of Information signed– Contact Work Incentive Liaison/ Obtain a Benefits

Planning Query (BPQY) if necessary– Reconstruct Work History– Identify the source of Benefits

Benefits Process

Analysis– Current position– With Employment– Transitioning off Benefits

Report– Biographical Information– Current Benefits– Assets and Resources– Employment– Concerns– Options

Work Incentives Planning and Assistance Funded by the Social Security Administration as part of the

Ticket to Work/Work Incentives Improvement Act of 1999

Currently receiving a Social Security Administration disability benefit

Between the ages of 14 and 64

Living within the 50 counties of central and southeastern Ohio

Participating in vocational rehabilitation with the goal of self-sufficiency.

Benefits Consultation Fee for Service Work Incentives Benefits Summary

– Work Incentives Plan for Achieving Self-Support Social Security Benefits Eligibility

Assessment (private pay from individuals and families)– Application for SSDI, SSI, Medicaid

Benefits Consultation– Overpayment– Benefits Case Management

SSDI vs. SSI Title II Title II Gross monthly Gross monthly

wages from 1st to wages from 1st to 31st31st

Based on previous Based on previous work credits earnedwork credits earned

Title XVI Title XVI Based on the date Based on the date

the paycheck was the paycheck was receivedreceived

Needs based Needs based programprogram

Childhood Disability Benefit

child must be 18 years of agechild must be 18 years of age disability onset prior to age 22disability onset prior to age 22 insured parent is disabled, retired or insured parent is disabled, retired or

deceaseddeceased benefits end when child marries benefits end when child marries

unless to another CDB beneficiaryunless to another CDB beneficiary

Income

EARNED INCOME– wages– self-employment net

earnings– temporary disability

payments– royalties and

honoraria for services

UNEARNED INCOME– pensions and annuities– payments such as

SSDI, Railroad Pension, Veterans Administration

– workers compensation– unemployment– dividends and interest– alimony and support

In-Kind Support- SSI Basic living expenses (food, shelter,

and utilities) must be at least 18 years of age FULL - no contribution

– 1/3 reduction of $224 = FBR $448 (approximately)

PARTIAL - presumed maximum value– contribution no greater than $224– pay fair share within $5 to use full FBR

Resources- SSI$2,000 for individual $3,000 for couple

EXCLUDED– home lived in– car for work, medical

or modified – $4500 fair market

value of car– Property Essential to

Self Support

INCLUDED– cash– stocks and bonds– land– property– cash surrender value

of life insurance or burial plan

Federal Benefit Rate

$674 for an individual $1,011 for a couple adjusted annually affected by income,

living arrangement, and use of Work Incentives

Social Security Disability Insurance& Childhood Disability Benefits (DAC)

Title II

Work Incentives

•Trial Work Period

•Extended Period of Eligibility

•Grace Period

•Expedited Reinstatement

•Substantial Gainful Activity

•Impairment-Related Work Expense

•Subsidy

•Unsuccessful Work Attempt

•Extended Medicare

Trial Work Period

$530$560$570$580$590$620$640$670$700

$0

$100

$200

$300

$400

$500

$600

$700

2001 2003 2005 2007 2009

threshold

9 months within any 60 month time period when earnings exceed threshold

2001 = $530 2002 = $560 2003 = $570 2004 = $580 2005 = $590 2006 = $620 2007 = $640 2008 = $670 2009 = $700

Substantial Gainful Activity

Earnings less than SGA will continue payment of benefits

$980 current SGA (is adjusted based on Federal Work Index)

Countable Income (may use incentives to subtract from gross monthly income)

For statutory blindness = $1,640

Extended Period of Eligibility

36 consecutive months following the Trial Work Period

earnings below Substantial Gainful Activity will receive cash benefit; earnings above SGA result in suspension of benefit for that month

Grace Period is the first month earnings exceed SGA, cash benefit is issued that month and the next 2 months

Subsidy

Employer pays more than the value of the work performed (extra support, lower productivity, extra breaks, etc.)

Special Conditions are subsidies paid by an agency such as BVR, MR/DD

Work Activity Questionnaire to determine subsidy

used on SSI for eligibility purposes only

Impairment-Related Work Expenses

Must be directly related to impairment– personal care attendant

– special transportation

– medical equipment

– prosthesis

– medications

Must be an expense incurred for work– equipment such as

interpreters– training– job coaching

EXR

TWWIIA-established safety net Effective January 1, 2001 For individuals who have stopped receiving

benefits as a result of work and then at a later date find themselves unable to work because of their medical condition

Provides for up to six months of provisional benefits

Provides 5 years of coverage from month of benefit termination

Supplemental Security IncomeTitle XVI

Work Incentives

•General Income Exclusion

•Earned Income Exclusion

•Student Earned Income Exclusion

•Plan for Achieving Self-Support

•1619(a)

•1619(b)

•Blind Work Expense

•301 Ticket Protection

Income Exclusions

GENERAL INCOME EXCLUSION– $20 per month– excluded from unearned

income if possible

EARNED INCOME EXCLUSION– $65 per month

STUDENT EARNED INCOME EXCLUSION– $1,640 per month– $6,600 annual cap

Impairment-Related Work Expenses

Must be directly related to impairment– personal care attendant– special transportation– medical equipment– prosthesis– medications

Must be an expense incurred for work– equipment such as

interpreters– training– job coaching

SSI Disincentives

Resource limit– No more than $2,000 for an individual

Immediate reduction in cash benefits– After Exclusions, $1 reduction for every $2

in earnings Overpayment cycle

– Payment on 1st of month, corrections based on earnings during month

Plan for AchievingSelf-Support money to be set aside to obtain a self-

sufficiency goal established in a Plan money from unearned income or

earnings goals can include education, training,

transportation, etc. Plan must have specific goals and

milestones

1619(b)Enters 1619(b) status when income equals or exceeds the break even point- SSI is reduced to $0.

No cash benefits Retains SSI eligibility and Medicaid with

no Spenddown Annual threshold of $33,194

EXR

TWWIIA-established safety net Effective January 1, 2001 For individuals who have stopped receiving

benefits as a result of work and then at a later date find themselves unable to work because of their medical condition

Provides for up to six months of provisional benefits

Provides 5 years of coverage from month of benefit termination

How much can I make and still keep my benefits?

“It’s never that simple!”

Ron Swain

Medicare vs. Medicaid

Administrated by the Center for Medicare/Medicaid Services (formerly HCFA)

Administrated by the state Job and Family Services county departments

has different criterion based on state regulations

Medicare Eligibility based on aged, blind or

disabled status with SSA Coverage begins following 24 months

of Title II payments Part A includes hospitalization Part B includes other services such as

doctor, lab work or outpatient svcs. Part D includes prescription drug

coverage

Medicaid eligibility Aged

– 65 years or older

Blind– Visual acuity of 20/200 or – receiving SSI due to a visual impairment

Disabled– Impairment that will last at least 12 months or

result in death– receiving SSI, SSDI or County Medical Service

has determined disability

Medicaid eligibility

FINANCIAL– Income

• SSI is exempt

– Assets ($1,500 or less)• e.g. Cash, Savings,

Stocks, Bonds

NON-FINANCIAL– Citizenship– Residency– Social Security

Number– Limiting Physical

Factor (e.g. Disability)

Non-waiver Medicaid

2009 standards Income Needs

Standard is $589 & $1,011 for a couple

Asset Limit is $1500 $2250 for a couple

Income Disregards

Gross Income– SSI exempt– $20 General– $65 Earned Income– Impairment-Related Work Expenses– 1/2 of remaining income

Cannot receive both Impairment-Related and Work Expenses for the Blind deductions which are deducted after the 1/2 remaining income

SPENDDOWN Allows for the deduction of

certain medical expenses so that income will fall within eligibility guidelines

– Example: Medical insurance premiums, prescriptions, past medical expenses

Determined by the County Department of Job and Family Services

3 Types– Ongoing– Delayed– Pay-In

Spenddown Comparison

Ongoing Delayed Pay-inMedical Premium Prescriptions Pays spenddown

amount to CDJFS

Past MedicalExpenses

Doctor Visit

Eligible firstof the month

Eligible datespenddown

amount is met

Eligible firstof the month

What are Home and Community Based Services Waivers (HCBS)?

HCBS waivers are State selected options that allow individuals to remain in the community– Ohio Home Care– PASSPORT– Individual Options– MRDD waiver (Level 1,2 &3)

Patient Liability

Example: Childhood Disability Benefits $700 Total income (both earned and

unearned) up to $1,380 before Patient Liability is incurred.$1,380 - $700 = $680 (earnings potential

before patient liability is incurred)

Medicaid Buy-In for Workers with Disabilities

Provides health coverage for WORKING individuals with disabilities

Ages 16 to 64 Allows up to $10,000 in resources Allows income up to 250% of the FPL Income above 150% of FPL results in

monthly premium for Medicaid Premiums charged are 10% of difference

between total family income and 150% of FPL

Creating opportunities that work

Contact

Julie Koehler….………...(614) 294-7117

Program Director

jkoehler@cova.org

www.cova.org3770 N. High St., Columbus, OH 43214

QUESTIONS?