MYTH BUSTERS – HOW EMPLOYMENT IMPACTS BENEFITS

MYTH BUSTERS – HOW
EMPLOYMENT IMPACTS
BENEFITS

A CRASH COURSE IN SOCIAL
SECURITY WORK INCENTIVES

TOPICS TO BE COVERED
TODAY

 SSI (Supplemental Security Income)

 SSDI (Social Security Disability Insurance)

 MEDICAID
AND OTHER STATE MEDICAL PROGRAMS

 MEDICARE

 TICKET-TO-WORK

 BENEFITS COUNSELING PROJECT

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It is a common misperception that:
‘Once I apply for Social Security disability benefits, I
should not — no — cannot work.’

The fact is, there are 2 criteria for being
determined disabled by Social Security.

One is: Does the individual meet the required
disability criteria? And the second: Is the
individual capable of performing substantial
work?

The first is a given in your patient population, so
we will focus on the second criteria in this
segment.

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Let’s look at SSI first, as that’s the easier of the 2 social
security disability programs

SUPPLEMENTAL SECURITY INCOME (SSI)

 Needs-based program
— Maximum Benefit of $710/mo in 2013
— Any type of income reduces the Benefit
— Maximum Asset limit of $2,000

 Cash assistance can often continue with work until
earnings are ‘sufficient’ for self-support.

 Associated with Medicaid/Title XIX.

 Medicaid/Title XIX can continue even when earnings
exceed the SSI break-even point.

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SSI and Work

With $710 SSI, the first $85, then 50% of gross
earnings are disregarded. The balance is then
subtracted from the SSI benefit.

Break-even amount in 2013 is $1,505.

Example: Gina gets a full $710 SSI benefit each
month. She received her first paycheck in
December and took home gross wages of $885
that month. Social Security will ‘count’ (i.e.,
subtract) $400 of those earnings from her
February SSI check, leaving her $310 in SSI – plus
the $885 earnings from December.

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SOCIAL SECURITY DISABILITY
INSURANCE (SSDI)

 Amount is based on what the Beneficiary, or
sometimes parent(s), paid into Social Security.

 SSDI has work incentives allowing you to try
working while keeping SSDI support.

 SSDI recipients are given Medicare after the 24-
month qualifying period, EXCEPT with diagnoses
of ESRD or ALS, in which cases Medicare begins
sooner.

 Medicare usually continues for many years even if

the cash benefit stops and/or until the individual

ceases to meet the Social Security disability

standard. 6

SSDI and Work

Beneficiaries have 9 months (consecutive or not)
for the opportunity to test his/her ability to
work while maintaining a full benefit, no matter
how much the beneficiary earns. This is called
a 9-month Trial Work Period.

SSA sets a monthly dollar amount to determine
the use of Trial Work months. In 2013 that
amount is $750.00 gross a month and/or work
80 or more hours a month in self-employment.

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SSDI and Work (continued)

After the use of the 9-month Trial Work Period,
Social Security determines if the value of the
work activity exceeds a specific dollar figure,
known as the Substantial Gainful Activity
guideline. In 2013 that amount is $1,040 gross a
month ($1,740 for beneficiaries on SSDI for
blindness), which applies to both wage and self-
employment.

If the work activity is above SGA, the SSDI benefit
will most likely cease. However, there are several
other work incentives (i.e., ‘deductions’) that could
be applied to the individual’s earnings, very
dependent upon his/her circumstances and
disability.

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MEDICAID
AND OTHER STATE OF CONNECTICUT
MEDICAL PROGRAMS

There are over 50 Medicaid programs in
the State of CT. Eligibility is oftentimes
dependent on household composition.

For today’s purposes, the focus will be
primarily on Medicaid groups for
disabled individuals and will use
figures for single and/or married
individuals.

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S01, S02 & S03 Medicaid

 Who Qualifies — Those on SSI
(automatically qualify), small amount of
SSDI, and those determined disabled per
Social Security disability standards but not
on a federal benefit

 Income Limit of about $830 gross a month

 Asset Limit of $1,600 (single), $2,400 (married)

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S04 Medicaid

 Who Qualifies — Those currently (or
within the past year) on SSI or State
Supplement Cash Assistance (also known
as 1619b or 1905q status) AND WORKING

 Income limit of $6,000 gross a month

 Asset limit of $2,000 (single), $3,000 (married)

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S05 Medicaid/MED-Connect

 Who Qualifies — Those on SSI, SSDI, State

Supplement Cash Assistance, or determined

disabled per Social Security disability standards but
not on a federal benefit — AND WORKING.

 Income limit of $6,250 gross a month. Income more
than $1,916 ($2,586 married) is assessed a 10%
premium, minus other out-of-pocket medical
insurance premiums

 Asset limit of $10,000 (single), $15,000 (married),
excluding home, 1 vehicle, IRAs, 401Ks, medical
savings and/or special employment account

 Eligibility can continue up to a year after the
individual stops working.

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S05 Medicaid/MED-Connect
(continued)

 Another little-used qualifying category for this
Medicaid program is the Medically-Improved Group

 If the beneficiary loses Medicaid eligibility because of
medical improvement, but continues to have a severe
medically-determinable impairment, even though the
impairment doesn’t meet the criteria for regular
Medicaid, s/he continues to be eligible for MED-
Connect, as long as s/he is earning at least $290 a
month (in 2013).

 There is no extension of coverage under this group
once the individual loses employment.

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Medicare Savings Program —
3 Levels

QMB INCOME LIMITS

$2021.38 single Pays Medicare B premium
$2728.23 couple

Also pays annual hospital and physician deductible, as
well as 20% co-insurance for Medicare approved services.

SLMB $2212.98 single Pays Medicare B premium
$2986.83 couple

ALMB $2356.68 single Pays Medicare B premium
$3180.78 couple

Subject to available funding. Not available to those on
Medicaid (i.e., S05/MED-Connect reviewed above).

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Income Limits above refers to unearned income. Earned
income of the disabled individual gets reduced by more
than 50%

Extreme Example: Married couple, husband receives
$1,000 SSDI, wife has no earned/unearned income.
During his 9-month Trial Work Period, he can earn
well over $4,400 gross a month and be eligible for
the Medicare Savings Program
($4,425 - $65 = $4,360÷ 2 = $2,180 + $1,000 = $3,180)

Medicare Savings Program beneficiaries also
automatically become eligible for the Medicare
Low Income Subsidy category, which prevents the
individual from going into the ‘donut hole’ as well
as keeping formulary prescription co-pays low

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CONNECTICUT TRANSPLANT PROGRAM —
ConnTRANS — 2 programs with 2 criteria levels

1. Assistance paying initial medical expenses of
the transplant

Monthly Income Limits – 100% CT Median
$4,400+ (single), 5,800+ (married)

2. Assistance paying ongoing transplant-related
medical needs

Monthly Income Limits – 300% FPL
$2,800+ (single), $3,800+(married)
Income Limit — Gross income minus health insurance premiums
Asset Limit — $10,000

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For those who exceed these income or asset limits,
ConnTRANS may be able to assist, if money is available
in the fund.

Example 1: Income exceeds the limit by
$500, then $500 is subtracted from total
amount of transplant related expenses, and
ConnTRANS pays the difference.

Example 2: Assets exceed the limit by
$1,000, then $1,000 is subtracted from the
expenses owed, and ConnTRANS pays the
difference.

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MEDICARE

For those who continue to meet Social Security’s
disability standard, Medicare continues more than 7
years after the person works his/her way off SSDI.
Medicare coverage will stop if an individual ceases to
meet the Social Security disability standard.

End Stage Renal Disease Medicare is a special program
not tied to receipt of cash benefits, has less stringent
rules to get on & different rules for when coverage
begins & ends. Unless these individuals are also
entitled to cash benefits under the disability programs,
the Social Security disability work incentives covered
in slides 7 and 8 above do not apply to the individual.

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Highlights of the provisions under ESRD
Medicare

1) A person may receive ESRD Medicare on the work
record of himself, a spouse, or parent if the required
amount of time was worked.

2) Medicare usually begins the 3rd month after dialysis
begins.

3) Coverage can begin earlier if the person self-
administers dialysis, or is scheduled for a transplant.

4) Coverage ends either 12 months after dialysis stops,
or 36 months after a successful transplant, but

5) Can be extended if the person was previously
entitled to Medicare under the ESRD provisions.

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TICKET-TO-WORK

Social Security provides protections to people receiving SSI/DI
under the Ticket-to-Work.

Voluntary program that allows beneficiaries to use services
needed to become employed or get a better job using the
state vocational rehabilitation agencies (BRS, BESB) and/or
Employment Networks (ENs) who have a signed contract
with Social Security to provide these services.

Once there is a signed employment plan with any of these
programs, Social Security will not conduct a continuing
medical review as long as ‘timely progress’ is being made.
Timely progress is reviewed once a year by SSA. Specifics
on timely progress are in a handout in your packet, but for
example, the first year would be earnings of $750 or more a
month for 3 out of the first 12 months.

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Who can Help Beneficiaries
Understand all this information?

 Connect-to-Work Project has 6 Benefits Specialist and
a Project Director who cover the State of Connecticut

 Meet with beneficiaries one-on-one
 Provide individualized assessment and analysis of the

person’s current situation and impact of potential
earnings/ employment on federal and state benefits
 Asset building strategies and programs, as well as
other community assists are also recommended,
according to the individualized assessment

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We reviewed the basics of work incentives and medical
programs available to persons with disabilities in the
topics covered today.

Specifically addressed were the SSI, SSDI, Medicaid
and Other State Medical Programs, Medicare, Ticket-
to-Work and Benefits Counseling program to help
understand how these programs work together.

There are many nuances of the social Security work
incentives that couldn’t be addressed in this time
frame, as well as other work incentives that are
available, such as PASS, IRWE’s, Unsuccessful
Work Attempt, Special Conditions, Subsidies, to
name a few. There is more detailed information in
your packets, as well as the availability of Benefits
Specialists to answer specific questions.

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