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www. njwins .org 1-866-946-7465 Greg Makely Project Director Definition of Disability

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slide1

www.njwins.org

1-866-946-7465

Greg Makely

Project Director

definition of disability
Definition of Disability
  • “the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
slide3

What is Supplemental Security Income?

  • Known as SSI
  • Based on disability and financial need
  • Requires no work history
  • Has a resource limit
  • Any income will affect your payment level
slide4

To receive a check, you must…

  • Have a disability, as defined by
  • SSA
  • Be 65 or older
  • Meet the income and resource
  • tests
slide5

Resources Defined

Resources are anything you own, such as a bank account, stocks, business assets, real property, or personal property that you can use for your support and maintenance.

slide6

Resource Limits and Outcome

  • Limits - $2,000 single / $3,000 couple
  • Limit cannot be exceeded at the beginning of each month
  • Being over limit will render individuals ineligible for entire SSI benefit for as long as they are retained by the beneficiary
  • After 12 consecutivemonths over resource limit, the beneficiary will have to reapply
slide7

Property Essential To Self-Support

All primary possessions, such as primary residence or primary vehicle.

slide8

Reporting to SSA

  • Always use copies of check stubs to report earnings and submit them in person at the SSA Office for your zip code area.
  • Always keep copies of everything you submit, and get a receipt from the Claims Rep before leaving the SSA Office.
slide9

Reporting to SSA (Con’t.)

  • If you can’t submit in person, send it certified mail, so you have proof SSA received it.
  • Proof can be used to file a waiver of overpayment, if you are unable to pay it back.
  • Never report earnings over the phone.
slide10

Law Provision 1619a

  • Allows SSI recipients to work and keep a portion of their cash benefit.
  • Runs all earned and unearned income through an income test formula to lessen the check amount due.
  • Means that check amounts can change as often as income changes.
slide11

An Income Test Formula is…

…a formula which combines earned and unearned income with work incentives and standard exclusions and compares them to the Federal Benefit Rate in order to come up with a monthly cash benefit payment amount.

slide16

Requirements for Student Earned Income Exclusions

  • Under age 22
  • Not married or head of your household
  • Regularly attending school
slide17

Student Earned Income Exclusions

  • $1,640 of earned income per month, in 2010, not counted.
  • $6,600 annually These amounts are for the year 2010; they are adjusted each year based on the cost-of-living.
an irwe is
An IRWE is...
  • Impairment Related Work Expense
  • Paid for by the beneficiary
  • A service or product the beneficiary needs in order to work.
examples of irwe s
Examples of IRWE’s
  • Attendant care services
  • Transportation Costs
  • Medical Devices
  • Work-related equipment
  • Prosthesis
more irwe s
More IRWE’s
  • Residential Modifications
  • Routine Drugs & Medical Services
  • Diagnostic Procedures
  • Non-Medical Appliances and Devices
  • Other Items and Services (Expendable Medical Supplies, Cost of helper animals)
examples of b lind w ork e xpenses bwe s
Examples of Blind Work Expenses (BWE’s)
  • Guide Dogs
  • Fees
  • Transportation to & from work
  • Vehicle Modifications
  • Training to use impairment-related items
more bwe s
More BWE’s
  • Taxes
  • Prosthesis
  • Meals consumed during work
  • Other work-related equipment
  • Non-medical equipment/services
still more bwe s
Still More BWE’s
  • Drugs
  • Physical therapy
  • Expendable Non-medical Supplies
  • Mandatory pension contributions
  • Non-medical equipment/services
definition of blindness
Definition of Blindness

20/200 or less in better eye with glasses or field of vision less than 20 degrees

p lan for a chieving s elf s upport pass plan
Plan for Achieving Self Support (PASS Plan)
  • A way to save for a big ticket item
  • Used to exclude income & resources
  • An alternate method of obtaining or retaining SSI
criteria for pass approval
Criteria for PASS Approval
  • Must be in writing
  • Must contain:
    • A feasible occupational goal
    • A savings and spending plan
    • A list of items and services needed andtheir cost
    • A timetable for achieving goal
  • Must be expected to increase person’s prospect for self-support
the feasible occupational goal must
The feasible occupational goal must…
  • Specify a job or profession
  • Have a reasonable chance of attaining goal

Supported employment can be a goal

slide28

Additional Income Exclusions

  • Parent’s income / resources once a child reached age 18, regardless of student status
  • Income set aside or being used to pursue a Plan for Achieving Self-Support by a disabled or blind individual
slide29

Additional Income Exclusions Continued

  • State or locally funded assistance based on need
  • Rent subsidies under HUD programs and the value of food stamps
  • Infrequent or irregularly received income($20 or less a month)
law provision 1619b
Law Provision 1619b
  • Allows for a beneficiary to continue to receive Medicaid coverage after he has reached the break even point and lost his monthly cash benefit.
  • Allows a beneficiary to remaineligible for resumption of cash benefits for 12 months.
  • Has an annual earnings threshold.
2010 nj 1619b medicaid earnings threshold
2010 NJ 1619b Medicaid Earnings Threshold
  • If earnings exceed $34,284 in 2010, SSI Medicaid will stop.
  • In NJ, beneficiaries who lose SSI Medicaid can regain Medicaid through the NJ WorkAbility (Medicaid Buy-In) Program.
nj work a bility is
NJWORKABILITY is…
  • The Medicaid Buy-in program in NJ.
  • Allows individuals who work to be eligible for Medicaid.
nj work a bility 2010 income allowances
NJWORKABILITY 2010 Income Allowances

Earned Income

  • 250% of Federal Poverty Level
  • Single:$ 54,948per year($4,579 per month)
  • Couples: $ 73,644 per year ($ 6,137 per month)

Unearned Income

  • 100% of Federal Poverty Level
  • $ 903 per month for singles
  • $ 1,215 per month for couples
nj work a bility disregarded income
NJWORKABILITY Disregarded Income
  • Social Security Disability Insurance from own account
  • Railroad Retirement Benefits from own account
nj work a bility countable assets
NJWORKABILITY Countable Assets
  • Individuals

Under $20,000

  • Couples

Under $30,000

nj workability coverage includes but is not limited to
NJ WorkAbility Coverageincludes, but is not limited to:
  • Doctor
  • Dentist
  • Hospital
  • Personal Care Assistant Services
  • Podiatry
  • Laboratory Services
  • Out Patient Psychology Service
  • Home Health Care
  • Medical Transportation
  • Surgery Medical Supplies
  • Nursing Facility
  • Occupational Therapy
  • Prescription Drugs
  • Psychiatry
  • Durable Medical Equipment
  • Eye Glasses
  • Hearing Aides
  • Dentures
  • Speech Therapy
nj work a bility allowable assets
NJWORKABILITY Allowable Assets
  • IRA/401K account funds
  • Value of home
  • Value of vehicle
nj work a bility premium
NJWORKABILITY Premium
  • Under 150% of federal poverty level

No premium is paid.

  • Over150% of the federal poverty level

Individuals:$25.00 mo

Couples: $50.00 mo

nj work a bility application process
NJWORKABILITY Application Process
  • County Boards of Social Service will process the applications and establish service.
  • Bring the following information to your appointment:

a. Birth Certificate

b. Proof of SSDI benefitor proof of the disability itself

c.Recent pay stubs or a letter from the employer detailing gross monthly wages

d.Recent bank statement

slide43

What is Social Security Disability Insurance

  • Known as SSDI
  • Work history determines the
  • amount of your benefit
  • Has no resource limit
  • Only Worker’s Compensation or
  • other Federal and State Disability
  • checks affect your benefit amount
ssdi is
SSDI is…
  • …not based on need
  • …based on work done by you
  • …the benefit which comes from your FICA deduction
  • …an all or nothing payment
slide45

Trial Work Period 2009

  • Unless medical recovery is an issue, beneficiaries are entitled to a Trial Work Period
  • TWP provides opportunities to test work skills while maintaining full benefit checks
  • Begins first month of entitlement to benefits
  • Trial Work Amount is annually indexed

All earnings

$720 80 hr.

60 mos. window

9 mo.

slide47

Extended Period of Eligibility (EPE)

  • Begins month following 9th TWP
  • 36 consecutive months
  • Eligible for check when earning below thecurrent Substantial Gainful Activityfigure
  • First time at or above SGA kick in a 3 month “Grace Period”
  • After “Grace Period”, ineligible for a check during months earnings are at or above SGA
subsidies
Subsidies

Goods or services received that a person or an entity other thanthe beneficiary pays for.

types of subsidies
Types of Subsidies
  • Employer Wage Subsidy
  • Employer Accommodation Subsidy
  • Agency Job Coach Subsidy
  • Agency Job Sampling Wage Subsidy
subsidies for the self employed
Subsidies for the Self Employed
  • Unpaid Help Subsidy
  • Unincurred Business Expense Subsidy
slide52

Expedited Reinstatement (EXR)

  • Eligible for EXR Up to 60 mo. after EPE
  • If a beneficiary is unable to work because of their medical condition
  • Upon application for reinstatement, provisional checks begin for up to six months while application is being reviewed
  • If not reinstated, keep provisional checks
  • If re-instated, starting with the first provisional check, beneficiary receives 24 more months of checks non-consecutively

Easy back on

after 24 months of exr a beneficiary is entitled to
After 24 months of EXR, a beneficiary is entitled to…
  • A new Trial Work Period
  • A new Extended Period of Eligibility
  • A new 60 month period of eligibility for Extended Medicare & Expedited Reinstatement of Benefits
slide54

Tracking Sheet for SSDI

  • Under TWP
  • TWP
  • EPE/
  • Check
  • Grace Period
  • EPE/

No Check

178

180

380

160

600

400

500

550

500

625

650

650

700

700

700

450

450

500

700

700

700

800

800

770

900

900

700

800

900

790

750

950

1000

980

780

790

800

785

800

850

900

1000

985

1000

1100

1150

1300

1300

1300

1350