Benefits Transition Overview of SSI vs SSDI Medicaid

Benefits & Transition Overview of SSI vs. SSDI & Medicaid vs. Medicare For transition aged beneficiaries

Title II n Few different types of Title II benefits n Focus on SSDI: Social Security Disability Insurance

SSDI n n Our focus will be Child Disability Benefit (CDB, formerly DAC) Based off work record that parent paid taxes on (fica taxes) Disability that occurred before age 22 Must be older than 18 to receive this

SSDI Work Incentives n Trial Work Period months (TWP) 9 months: do not have to be consecutive! n TWP counted when someone earns $720 (in 2012) or more n Still receive full cash benefit n Amount usually increases every year OR does not increase n

SSDI Work Incentives n Substantial Gainful Activity (SGA) $1010 (this amount can increase annually) n SSA uses this amount to determine eligibility for benefits n If person earns more than SGA: receives NO benefit and can be terminated n Does not come into affect until after Trial Work Period Months (TWP) are complete n

SSDI Work Incentive n Extended Period of Eligibility (EPE) 36 Consecutive months: happens regardless of earnings n Begins the month immediately following the TWP n If individual’s earnings are above SGA: no cash benefit; if below SGA: will receive cash benefit n

TWP Example n n Chris started to receive SSDI in January 2012 and March 1 st 2012 started working and is earning $800. 00 a month What will happen to his benefits (if he continues to earn this amount) June 30 th 2012? What will happen to his benefits (if he continues to earn this amount) December 1 st 2012? What if Chris stopped working August 30 th 2012 and restarted in April of 2017?

SSDI Work Incentives n Incentives that can be used-especially if beneficiary is hovering around SGA! Impairment Related Work Experience (IRWE) n Subsidy/Special condition n Averaging n

SSDI IRWE and SGA Example n n n Person is earning $9. 00/hour and is working $30 hours a week for total monthly earnings of $1080 Paying $160 a month in job coaching SSA would calculate SGA: $1080$160=$920 so this person would still receive full cash benefit.

Why Bore you with all of the work incentive information? n n When you hear people say they can’t work or they will lose their benefits you will be able to tell them it’s not true! Many “safety nets” in place for people to “try” working

Medicare n n Eligible for Medicare 24 months after eligibility for SSDI cash benefits Part A, Part B, Part D

Medicare n Extended Period of Medicare Coverage (EPMC) Up to 93 months of Medicare coverage after the completion of TWP n Healthcare coverage even if cash benefit gets reduced to $0! n

Supplemental Security Income (SSI) n n n Needs based Disability Determination from the Disability Determination Bureau (DDB) Current Federal Benefit Rate (FBR): $698. 00

SSI n n Income paid in 1 month affects the cash benefit 2 months later Full benefit rate: $698 1/3 reduction rate: $465. 33 States might have their own supplements

SSI Work Incentives n Student Earned Income Exclusion (SEIE) Exclusion of inform for individuals who are under the age of 22 and regularly attending school n SSA will not count up to $1, 700 monthly (max: $6, 840 per year) n This work incentive is applied first! n

SSI Work Incentives n General Income Exclusion (GIE) n n $20 disregard on unearned income; if not unearned income then applied to earned income Earned Income Exclusion (EIE) n $65 and ½ disregard on earned income

SSI Work Incentives n Impairment Related Work Expense (IRWE) Related to disability, paid for out of pocket and the beneficiary needs it in order to work n SSA will “repay” the individual $1 for every $2 spent out of pocket n Any examples? ? ? n

Plan for Achieving Self Support n n Set aside money (other than SSI) to meet vocational goal Money in the pass plan: does not count towards SSI eligibility

SSI benefit Example n n Individual is receiving full benefit rate and is earning $373. 00 a month Not a student No IRWE Setting $100 a month away in a PASS plan for a training program

SSI Benefit Example n n n n $373. 00 monthly earnings and subtract $100. 00 for the Pass Plan for a total of $273. 00 you would then apply the GIE: $273. 00 -$20. 00=$253. 00 you would then Apply the EIE: $253 -$65. 00=$188 and then… $188/2=$94 and the final step: $698 -$94=$604 will be monthly cash benefit 2 months later

SSI Benefit Example n n n Sarah earns $850. 00 in September 2012 Full time student; under the age 22 No IRWE Eligible for the SSI full cash benefit No unearned income What will her cash benefit be in November 2012?

Answer… n September earnings: $850. 00 -$1700 (Student Earned Income Exclusion)=$0 n Sarah’s benefit in November will be the full benefit because of the SEIE: $698. 00 n Sarah still has $5, 990. 00 of the SEIE for the remainder of the year n

Another One! n n n Ben earns $552 a month Not a student Eligible for the 1/3 reduction rate Pays $80 a month for a job coach and has an approved IRWE for this What will his benefit be?

Answer… n n n $552 Earnings-$20. 00 (General Income Exclusion)=$532. 00 -$65. 00 (Earned Income Exclusion)=$467. 00 -$40. 00 (Impairment Related Work Expense)=$427. 00/2 (Earned Income Exclusion continued)=$213. 50 $465. 33 (1/3 Reduction rate)-$213. 50=Benefit amount of: $251. 83

SSI/Medicaid States have different rules for Medicaid eligibility (i. e some states automatically approve SSI beneficiaries for Medicaid coverage, others have separate application n Coverage: n n n n n medically necessary doctor visits hospitalizations prescription drugs mental health services dental care vision care alcohol and drug treatment equipment and supplies and transportation to medical appointments

Medicaid “incentives” n 1619 b: Continued Medicaid coverage if cash benefit is $0 due to EARNED income n First 12 months of this: “Suspension Period”

Medicaid/Medicare n When someone receives both Medicaid and Medicare: Part B Premiums are covered n All deductibles and co-pays are between $0$6 n

Example: SSI/SSDI and earnings n Receiving $607 in SSDI and receives $111. 00 in SSI n Calculation for SSI payment: $607 -$20 (GIE)=$587. 00 n $698. 00 current FBR-$587. 00=$111. 00 n

Example SSI/SSDI and earnings n Receiving $607 in SSDI and receives $111. 00 in SSI and earning $199. 95 a month n n $199. 95 -$65 (EIE)=$134. 95 then divide by 2 (EIE continued)=$67. 48 (countable earned income) $587 (countable unearned income)+ $67. 48 (countable earned income)=$654. 48 $698 (current FBR) - $654. 48= $43. 52 SSI cash benefit Total monthly earnings with work: $607+199. 95+ $43. 52=$850. 47 (and any other state specific supplements)

Ticket to Work n n n All person receiving SSI or SSDI have a “ticket” Can assign to local Employment Network to receive assistance obtaining employment More information: http: //ssa. gov/work/aboutticket. html

Important Take Away Messages n n When beneficiaries work-they earn MORE money Big changes can occur n n n n With change in earnings and/or living situation when beneficiary turns 18 is no longer a student parent dies/retires or becomes disabled themselves or enough work credits are earned Refer ALL beneficiaries for Benefits Counseling prior to graduation There are ways to maintain health insurance!

Important Take Away Messages n n n Invite Benefits Counselors to meetings with families who have transition aged youth! Encourage families to inform SSA that the individual is paying their fair share of room and board Earnings can affect other benefits: Food Stamps, Housing