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The Social Security Administration
(SSA) manages two programs that provide cash benefits to persons
with disabilities. The two programs are Social Security Disability
Insurance (SSDI) and Supplemental Security Income (SSI). For
many individuals who are HIV-positive, these programs provide
a much-needed source of income at a time when the individual’s
physical or mental condition makes it very difficult for him
or her to work. However, because the monthly benefit amounts
are often not high enough to live comfortably, many HIV-positive
individuals receiving these benefits are interested in obtaining
some sort of employment either to replace or supplement the
benefit check. Fortunately, SSA does provide incentives to
obtain or return to work, and has recently implemented several
new work incentives under the Ticket to Work and Work Incentives
Improvement Act of 1999.1
In order to take advantage
of these work incentives, a Social Security beneficiary must
first determine whether they are receiving SSI, SSDI, or both.
It is important to determine this because the two programs
have different work incentives and rules concerning employment.
The easiest way to make this determination is by looking at
the amount of a monthly check and the date upon which it is
received. SSI recipients always receive their checks on the
first of the month, and, in Illinois, the standard SSI payment
for a single person living alone in 2002 is $545(2).
However, the amount of an SSI check is dependent on several
variables, including, but not limited to, living arrangements,
earned income, unearned income and in-kind support. SSDI beneficiaries
receive their checks on the third of the month or a later
day in the month, depending on their birthdate. The amount
of an SSDI check will vary, depending on a person’s work history
and the amount that the person has contributed under the Federal
Insurance Contributions Act (FICA). Dual beneficiaries, persons
who receive both an SSI and SSDI check, will receive two separate
checks during the month, usually totaling $565 in 20023.
Dual beneficiaries can take advantage of the work incentives
under both programs.
Below is a brief description
of some of the SSA work incentives and employment rules. This
description is not exhaustive, and any beneficiary thinking
of returning to work should contact the Benefits Planning
Assistance and Outreach Project (BPA&O), discussed below.
It is important to understand that, in most circumstances,
a beneficiary can go back to work and may not lose all of
his or her benefits entirely or immediately. In addition,
a beneficiary may continue to qualify for some important benefits,
like Medicaid or Medicare, for several years even though he
or she is working.
Work Rules and Incentives
for the SSDI Beneficiary
When an SSDI beneficiary
starts working, SSA begins to keep track of the beneficiary’s
average monthly amount of earnings. Under the SSA rules, when
an SSDI recipient returns to work and earns at least $560(4)
per month, he or she enters what is referred to as the Trial
Work Period (TWP). Each month that a recipient earns at least
$560 per month is referred to as a service month. A person
is allowed to make any amount of money over $560 for nine
service months, which do not have to be consecutive, within
a sixty month rolling window. During this time, the individual
will still receive SSDI benefits in the full amount and there
is no limit on the amount of earnings that a person can make
during the TWP. This is a very complicated rule, and a person
must keep track of his or her earnings to determine exactly
when the Trial Work Period begins and ends. Basically, an
SSDI beneficiary who has not earned income while receiving
SSDI can return to work and earn any amount of money for nine
months and he or she will continue to receive a full SSDI
check as long as the disabling condition continues. Once a
SSDI beneficiary has accumulated nine months of earnings over
the allowed TWP amounts, the TWP ends.
After the TWP ends, a person
enters the 36-month Extended Period of Eligibility (EPE).
During this period, a beneficiary may or may not receive a
SSDI check, depending on their earnings. If, during the EPE,
a beneficiary’s earnings exceed what SSA calls substantial
gainful activity (SGA5), then
the individual will receive a SSDI check for that month and
the next two consecutive months. This is known as the Grace
Period. During the remainder of the EPE after the Grace Period,
a beneficiary will not receive a check in any month in which
his or her earnings exceed the SGA amount ($780 in 2002).
However, in the months in which their earnings are below SGA
($780 in 2002), the individual will receive a full SSDI check.
This Extended Period of Eligibility assures that a beneficiary
has income for a significant time after he or she returns
to work.
After the Extended Period
of Eligibility ends, a beneficiary earning over the substantial
gainful activity amount ($780 per month in 2002) who has exhausted
the Grace Period will not receive benefits even if he or she
earns under $780 per month in the future. However, if, within
the next five years, the beneficiary can no longer work because
of the original disabling condition, that beneficiary can
take advantage of the new Expedited Reinstatement of Benefits
(EXR). When a former SSDI recipient files under this SSA provision,
the former recipient will immediately receive benefits while
SSA determines if the person is still disabled. These provisional
payments will last for up to six months and if it is determined
that the person’s disability was not the cause for their reduction
or cessation of work, he or she will not have to pay these
benefits back, absent fraud.
Under the old SSA rules,
when a person completed his or her Trial Work Period, SSA
usually performed a medical Continuing Disability Review (CDR).
A medical CDR is a review of the disability and determination
of whether the beneficiary continues to meet the criteria
of an individual with a disability. Many SSDI beneficiaries
have been afraid to return to work for fear that if they were
successful, they would lose eligibility for benefits when
this CDR occurred. Beginning in 2002, there will be no more
medical CDR’s performed because a SSDI beneficiary is working
if that beneficiary has received benefits for at least 24
months. A beneficiary will still be subjected to their regularly
scheduled medical reviews, which could occur while he or she
is working, and a work review. However, working alone will
not trigger a “second look” at the disability.
Most SSDI beneficiaries are
eligible for and receive Medicare. The fear of losing health
insurance is usually the main reason why beneficiaries do
not consider returning to work. However, under SSA rules,
almost all SSDI beneficiaries continue to qualify for Medicare
for 93 months after their Trial Work Period ends. In addition,
after this time, if a person remains disabled, he or she is
given the opportunity to buy his or her Medicare coverage
for a reasonable price.
Work Rules and Incentives
for the SSI Beneficiary
Because SSI is considered
to be a means-based welfare program, the rules regarding earned
income are different than the rules for SSDI beneficiaries.
If a person receives SSI and returns to work, the check does
not necessarily stop immediately. Rather, SSA allows for certain
deductions from countable income and most SSI beneficiaries
who begin earning income do receive a reduced check.
The
SSI work formula works as follows. First, SSA disregards the
first $65 of earned income. Second, one-half of the remaining
earned income is excluded. In addition, there is a general
$20 income exclusion that is applied first to unearned income,
and then to earned income. These rules allow an SSI recipient
to exclude over half of his or her income when determining
the deduction from the SSI check.
Simply
put, after earning $65, a beneficiary will lose $1.00 of benefits
for every $2.00 earned.
An
example will make these rules clearer. Jim is an SSI recipient
and receives a SSI check in the amount of $545. He gets a
job earning $805 per month. SSA will compute his SSI payment
amount as follows. First, they will deduct the first $65 of
his income, leaving $740. Second, another $20 will be deducted
under the general income exclusion, leaving $720. SSA then
divides the $720 in half, leaving a countable income of $360.
The countable income of $360 is then deducted from his SSI
amount of $545. Jim will receive an SSI check of $185 to supplement
his earned income of $805. This will give him a total monthly
income of $990.
Like
SSDI beneficiaries, SSI beneficiaries are often afraid to
return to work because they do not want to lose their health
insurance. Most SSI beneficiaries rely on the Medicaid program
for their health benefits. Fortunately, many SSI beneficiaries
can return to work and still receive Medicaid without a spenddown.6
Under a rule called 1619(b), an Illinois SSI beneficiary will
continue to receive Medicaid without a spenddown until he
or she earns a countable income of $25,302.7
Under this rule, a person could no longer be receiving an
SSI check due to income but will still qualify for Medicaid.
Although there have been some problems in implementing this
rule in Illinois in the past, the Illinois Department of Human
Service is well aware of this rule now and should not cut
a person off of Medicaid simply because they return to work.
SSI
recipients can also request reinstatement of their benefits
under the provision for Expedited Reinstatement of Benefits
(EXR). If an SSI recipient’s benefits are terminated because
of work, that former recipient can reapply for benefits within
60 months of his or her last check without filling out a new
application if the former recipient can no longer work due
to the original disability. Under this provision, the SSI
beneficiary will receive up to six months of provisional benefits
while the reinstatement application is pending. If a determination
is made that the person’s reduction or cessation of work was
not caused by the original disability, the individual will
not have to pay these benefits back, absent fraud.
The New Ticket to Work
Program
In 1999, the Ticket
to Work and Work Incentives Improvement Act of 1999 became
law. In addition to the many new work incentives outlined
above, this legislation creates a new vocational rehabilitation
system for beneficiaries of Social Security. This new system
will begin in thirteen states in 2002, and be implemented
in all states over the next three years. Illinois is one of
the first thirteen states to implement the new program.
Beginning in February of
2002, most Social Security beneficiaries in the state of Illinois
will receive “Tickets” in the mail. These Tickets can be used
by Social Security beneficiaries to choose a pre-approved
agency, called an Employment Network, from which to obtain
vocational rehabilitation services and/or other employment
support services. These services could include, but are not
limited to, case management, work incentives planning, supported
employment, career planning, career plan development, vocational
assessment, job training, placement services, and follow-up
services. Currently, there are 35 Employment Networks in Illinois.
It is important to understand
that this new program is voluntary. A beneficiary can choose
whether or not to use the Ticket. This is not a program to
force beneficiaries to go to work. In addition, the Employment
Networks can accept or reject anyone asking for their services
with a Ticket.8 The new Employment
Networks may be listed in the letter sent with the Ticket
or can be found at www.yourtickettowork.com.
A beneficiary is well advised to shop around to find the Employment
Network that is best equipped to meet their individual needs
and is willing to take their Ticket.
Support Assistance for
SSA Recipients Wanting to Return to Work
Understanding the work
rules and incentives of SSA is very difficult. Fortunately,
SSA has funded a new nationwide project called Benefits Planning
Assistance and Outreach (BPA&O). The BPA&O staff is
available to assist Social Security beneficiaries in understanding
what will happen to their benefits if they work. A trained
Benefits Specialist will sit down with the beneficiary and
gather individual information. The Specialist will then do
an analysis for the beneficiary to assist him or her in understanding
what will happen to each of the beneficiary’s government benefits
if he or she begins working. It is so important that beneficiaries
utilize this service before returning to work. As outlined
above, the work incentives are confusing and difficult to
understand. By working with a trained Benefits Specialist,
a beneficiary can understand exactly how income will affect
each of his or her state and federal benefits. Armed with
this information, a Social Security beneficiary can make an
educated and informed decision about and/or plan for working.
The services of this program
are free. In Illinois, three different agencies run these
projects, the Mayor’s Office for People with Disabilities
(1-312-746-5743), the Illinois Department of Human Services-Office
of Mental Health (1-866-390-6771) and the Illinois Department
of Human Services-Office of Rehabilitation Services (1-800-807-6962).
The Mayor’s Office for People with Disabilities serves the
residents of Chicago, and the other two agencies serve other
parts of the State. Benefits planners outside of Illinois
are listed at www.ssa.gov/work/ServiceProviders/statebystate.html
or with the local Social Security office.
Once a Social Security beneficiary
decides to return to work, he or she may need assistance in
accessing needed services and supports or requesting a reasonable
accommodation for his or her disability. In addition, the
beneficiary may encounter other legal barriers to returning
to work. Under the Ticket to Work Act, a new project has been
developed to advocate on behalf of beneficiaries with their
return to work issues. In Illinois, this project is run by
Equip for Equality, Inc. and is called Protection and Advocacy
for Beneficiaries of Social Security (PABSS).
In Illinois, as in most other
states, the PABSS Project has two major components. First,
the project will serve as advocates for Social Security beneficiaries
with return to work issues. This will include addressing any
legal barriers that are preventing the individual from beginning
or maintaining employment and assisting beneficiaries with
difficulties arising from the use of their tickets or in receiving
proper and appropriate services from the Employment Networks.
Second, the project is available to conduct training seminars
on the employment rights of Social Security beneficiaries.
These seminars are open to persons with disabilities, their
family members, service providers and agencies, or employers.
The training provides an overview of the Social Security work
rules and incentives and the Americans with Disabilities Act
of 1990.
The services of this project
are free as well. To contact a PABSS advocate in Illinois,
call 1-800-537-2632. All PABSS Projects around the country
are listed at www.ssa.gov/work/ServiceProviders/PADirectory.html
or can be reached by contacting the local Social Security
office.
John Coburn is the PABSS
Project Manager and attorney at Equip for Equality, Inc. in
Illinois.
1
It is important to note
that many of the incentives and rules explained in this article
pertain to non-blind Social Security beneficiaries. For individuals
receiving Social Security because of blindness, the rules
and incentives differ. Those individuals should consult with
their local Benefits Planning Assistance and Outreach Project.
2
Some states provide a supplement to the standard amount of
$545. SSI beneficiaries in those states would receive more
than $545 per month.
3
Again, this is the standard amount, which is given to beneficiaries
in Illinois. Some states provide a supplement.
4
$560 per month is the amount for the year 2002. The amount
was $530 in 2001 and $200 prior to 2001.
5
The substantial gainful activity (SGA) amount for 2002 is
$780. The amount will change yearly, based upon the national
average wage.
6
Spenddown is the term used for the monthly amount of medical
expenses, billed or paid, that a person or family must accumulate
before qualifying for Medicaid during that month.
7
This amount varies from state to state.
8
The only exception to this rule is that state vocational
agencies that become Employment Networks, including the Illinois
Office of Rehabilitation Services, must accept or reject persons
seeking services under its previously established rules.
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