overview of the social security disability insurance (ssdi) program 2013 ticket/en series...
TRANSCRIPT
Overview of the Social Security Disability Insurance (SSDI) program
2013 Ticket/EN Series
Hosted/Facilitated by: Miranda Kennedy with the NDI Technical Assistance TeamPresented by: Kevin Nickerson and Mary Lynn ReVoir with the NDI Technical Assistance Team
U.S. Department of Labor
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Disability Employment Initiative Disability Employment Initiative (DEI)(DEI)
•DEI Projects at the state level and/or local level participating LWIBs are required to become Employment Networks under Social Security Administration’s Ticket to Work Program.
•Training and Technical Assistance to DEI Projects in attaining Employment Network status and implementing effective EN operations is provided under U.S. DOLETA contract with NDI Consulting, Inc. and the National Disability Institute (NDI).
•Evaluation of the impact of the DEI Projects implementation and outcomes as Employment Network will be provided under U.S. DOL ODEP contract with Social Dynamics.
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Learning ObjectivesLearning ObjectivesUpon completion of this training webinar, DEI grantees
and participants and partners from the public
workforce system will have the following:
• Examine the role of the DRC & Benefits Planning services
• Understand the basics of the Social Security Disability Insurance (SSDI) program
• Basic knowledge of key Work Incentives specific to the SSDI program
• Understand the value of Work Incentives, and how they can apply to the work of an EN
• Next Steps
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Ticket/EN Subject Matter ExpertTicket/EN Subject Matter Expert
Mary Lynn ReVoirP: (515) 975-2344
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AgendaAgenda• The role of the DRC & Benefits Planning
• Overview of SSA disability programs, and eligibility requirements
• Review of Work Incentives associated with the SSDI program
• Options for returning to disability benefits, ifneeded
• Time for Q & A
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Understanding the Role of the Understanding the Role of the DRC and Coordinating Benefits DRC and Coordinating Benefits
Planning ServicesPlanning Services
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Why Benefits Planning is Important Why Benefits Planning is Important to the Success of any ENto the Success of any EN
• SSA disability benefits & Work Incentives are complex, and are often misunderstood by beneficiaries
• In order to help Ticket holders move forward in achieving gainful employment once again, having someone that can help navigate the complex world of SSA disability benefits is critical
• When used wisely, Work Incentives can be a powerful tool in assisting Ticket holders in the return to work
• Every EN should have basic knowledge of how SSA disability benefits work, if these systems confuse us as professionals, its easy to imagine why Ticket holders are hesitant to try working again
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Resource Model – DRC with expertise in TtW Resource Model – DRC with expertise in TtW ONLYONLY & & Partnering with Benefits PlannerPartnering with Benefits Planner
DRCs have expertise in TtW program, but rely on other avenues to assist SSA beneficiaries in accessing benefits planning services, and information about Work Incentives
DRCs maximize existing remote opportunities to provide information to Ticket holders through Work Incentive Seminar Events (WISE), with assistance from the Beneficiary Access and Support Services (BASS) contractor
For more information about WISE webinars, see: https://www.chooseworkttw.net/wise/jsp/wise.jsp
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Resource Model – DRC with expertise in TtW Resource Model – DRC with expertise in TtW ONLYONLY & & Partnering with Benefits PlannerPartnering with Benefits Planner
Due to the flexible nature of TtW funds, it is possible to use these funds to purchase needed items, or, in this case, benefits planning services
Example: Develop contract with a private certified benefits planner, whereby payment is provided if and when the Ticket holder returns to work at a level which would qualify the EN for payment
The payment to the private provider could be a percentage of EN payment(s), or a set amount provided after the first payment is achieved by the EN, or fee for service
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Expert Model – DRC with expertise in Expert Model – DRC with expertise in BOTH BOTH TtW & TtW & Benefits PlanningBenefits Planning
DRC has understanding of how the TtW Program operates AND has training in SSA disability benefits (SSI/SSDI) and work incentives
Example: NY, Maine, and NJ have DRC’s that are trained in understanding SSA disability benefits
DRC’s will be involved in EN operations AND are required to utilize disability benefits training available through Cornell University or VCU
For more information about VCU Work Incentives Counseling Training, see: http://www.vcu-ntc.org/training/initial.cfm
For more information about Cornell Universities online benefits planning training series, see: https://www.ilr.cornell.edu/edi/edionline/ediONLINE_catalog.cfm
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Ticket/EN Subject Matter ExpertTicket/EN Subject Matter Expert
Kevin NickersonE: [email protected]
P: (607) 272-7570 Ext. 136
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Overview of SSA disability Overview of SSA disability programs, and eligibility programs, and eligibility
requirementsrequirements
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OverviewOverview• The Social Security Administration offers two programs that
support individuals with disabilities with an inability to work at a substantial level.– Social Security Disability Insurance (SSDI)
– Supplemental Security Income (SSI)
• Many people with disabilities who receive SSDI and/or SSI, want to work or return to work but are unsure what will happen to their benefits when they do
• SSA has special work incentives available that make it possible for individuals to test their ability to work and continue to receive some or all of their cash and health benefits
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SSA disability benefit eligibilitySSA disability benefit eligibility
Individuals must prove 2 things to be eligible for
SSDI or SSI:
1. Prove that they have a documented medical disability that has, or will last 12 months or longer or result in death
2. Meet SSA’s definition of disability:
The inability to engage in Substantial Gainful Activity (SGA, which is paid work) by reason of any documented medical impairment (physical or mental) that will lasts 12 months or longer and/or result in death
NOTE: Individuals who are blind do not have to prove that they are
unable to work. They only have to prove that they meet SSA’s level of blindness
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Substantial Gainful Activity Substantial Gainful Activity (SGA)(SGA)
SGA is a basic test used by SSA to establish disability status
SGA is the performance of significant mental and/or physical duties for profit
It is usually determined to be gross earnings (before taxes) of an amount of money that is set January 1 of each calendar year based on the National Average Wage Index
To meet this test a person must not be working, or if working, earning less than the SGA level amount:
2013 SGA for non-blind individuals = $1040/month
2013 SGA for blind individuals = $1740/month
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Review of Work Incentives Review of Work Incentives associated with the associated with the
SSDI programSSDI program
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Social Security Disability Social Security Disability Insurance (SSDI)Insurance (SSDI)
SSDI is a Title II Benefit
•SSDI benefits are based on a person’s work history looking at length of time and amount of money earned, based on F.I.C.A. contributions, which is why SSDI check amounts will vary from person to person
•Disabled Adult Children (DAC)• Disability Prior to Age 22 & Never Legally Married• Insufficient FICA or higher parent amount• Parent is deceased, disabled or retired• Possible continuation of Medicaid• Medical Insurance - MEDICARE
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Important Notes on SSDIImportant Notes on SSDI
• 5 Month Waiting Period for cash benefits
• 24 month waiting period for Medicare (beginning with the first month of eligibility for cash benefits)
• No Asset limit (not a needs based program)
• Individual must have 12 months consecutive-initial eligibility
• SSDI is obsessed with SGA – this remains important both before, and after eligibility, although Work Incentives help to overcome this rule in some cases
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SSDI Work Incentives & WagesSSDI Work Incentives & Wages
Work Incentives that apply to the
SSDI program:
Trial Work Period = $750/Month for 2013 Extended Period of Eligibility Extended Medicare Coverage Impairment Related Work Expenses Special Condition/Subsidies Expedited Reinstatement of benefits
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Trial Work Period (TWP)Trial Work Period (TWP)
• A 9-month period, within 60 months, in which a person on SSDI can work and earn any amount of money without earnings affecting their SSDI eligibility, or cash benefits
• Each month an SSDI recipient earns more than $750 counts as one month of the TWP (2013 amount)
• These months do NOT need to be consecutive
• For Ticket holders, this represents an opportunity to attempt working again, and evaluate their abilities
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Extended Period of Eligibility Extended Period of Eligibility (EPE)(EPE)
• A period of extended eligibility that starts the month after the TWP ends and continues for the next 36 months (whether working or not)
• For months that countable earned income is less than the SGA level, beneficiaries receive their full SSDI check
• For months that countable earned income is more than the SGA level, SSDI cash benefits may not be received
• When countable wages first exceed the SGA level (cessation month), Social Security will plan to stop the benefits - but will allow the person to receive a check for that month and for 2 more months as a “Grace Period” before cash benefits cease
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SSDI TimelineSSDI Timeline
9 Months of Trial Work available
TWP
36 Months for Extended Period of Eligibility
EPE
3 Month Grace Period – Can occur anytime AFTER the TWP
is completed
Count when earnings are over $750/month
[SSA looking at determining when “Countable Earnings” are over SGA, during this period of time]
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Impairment Related Work Impairment Related Work Expenses (IRWE)Expenses (IRWE)
An IRWE exists when:
The individual with a disability pays for the item or service
The item or service is related to the person’s condition
The person would not be able to work if s/he did not spend the money and receive the item or service
IRWE amount may be reduced from Gross wages, the remaining Countable Wages are evaluated based on the SGA test, to determine whether the beneficiary remains in pay that month
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SubsidiesSubsidies
A Subsidy Exists When the Employer:
Willingly pays more in wages than the value of services performed (Employer Subsidy); or
Receives full value (of services from employee) only because additional supports are provided to the employee (sometimes called Special Considerations)
For use with SSDI beneficiaries
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Subsidy: For Self-EmployedSubsidy: For Self-Employed
• Unpaid help – for example, a relative that helps you in your business but is not paid for these services
• Unincurred business expense – for example, vocational rehabilitation program (ACCES-VR) pays for a computer for your business operation
• In either case, subsidies assist a beneficiary by reducing the amount of Gross wages SSA examines when determining whether someone is “gainfully employed”
NOTE: Additional rules apply to Self-Employment, and how SSA counts wages
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Extended Medicare EligibilityExtended Medicare Eligibility(effective October 1, 2000)(effective October 1, 2000)
An SSDI beneficiary is entitled to continued Medicare coverage after the Trial Work Period and for at least an additional 93 months following the ninth trial work month.
During this entire period, hospital insurance (Part A) is automatic and cost-free. Part B (Medical Insurance) continues to be optional and subject to premium payment ($104.90/month in 2013 for all enrollees)
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Options for returning to Options for returning to disability benefits, if neededdisability benefits, if needed
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Options for Returning to Options for Returning to Disability BenefitsDisability Benefits
• Re-Application
• Expedited Reinstatement (EXR)
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Expedited Reinstatement of Benefits Expedited Reinstatement of Benefits (EXR)(EXR)
SSDI benefits shall be reinstated without a new application if the person:
– Was eligible for SSDI; and– Lost SSDI due to performance of SGA– Requests EXR within the consecutive 60-month period
beginning with the month of entitlement termination – Is disabled by the same as (or related to) the physical or
mental disability that was the basis for their original claim– Is under a disability based on the application of the medical
improvement review standards (MIRS)– Is unable to perform SGA due to his or her medical condition
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EXR (cont.)EXR (cont.)• SSDI dependent’s benefits may be reinstated if the
dependent satisfies all of the requirements for entitlement to the benefits
• Provisional benefits may be received up to 6 months pending the reinstatement application
• Once the individual receives EXR benefits for 24 months (called the Initial Reinstatement Period, or IRP), he or she will be eligible for a new Trial Work Period, Extended Period of Eligibility and Expedited Reinstatement period (This is a new period of disability), and also becomes Ticket eligible again
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SummarySummaryNext StepsNext Steps
Q&AQ&A
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SummarySummary
In today’s presentation we covered the following:
• Methods for DRC to coordinate, or provide, benefits planning services for Ticket holders
• Basics of SSDI benefits eligibility
• SSDI Work Incentives, and how they can assist beneficiaries in the return to work
• Options for returning to benefits rolls if needed
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Next StepsNext StepsRegister to Attend the next training in this series:Monday, February 11th (3:00pm – 4:00pm EST)
Part 4: Ticket to work and Benefits Planning, Overview of Supplemental Security Income (SSI)This webinar will:
• Increase your understanding of the basics of the Supplemental Security Income (SSI) program
• Provide basic knowledge of key Work Incentives specific to the SSI program
• Increase your understanding of the value of Work Incentives and how they can apply to the work of the Employment Network
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Questions/CommentsQuestions/CommentsIf you have a comment or question you can:
A: Submit it to the host in writing via the Chat or Q&A Box to the right, or…
B: Click on the “raise hand” icon to have your line un-muted and ask your question/make your comment.
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Contact InformationContact Information
Kevin NickersonNDI Technical Assistance Team
Phone: (607) 272-7570 Ext. 136
Mary Lynn ReVoirNDI Technical Assistance TeamP: (515) 975-2344E: [email protected]
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