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Benefits Consultation

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Benefits Consultation

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  1. BenefitsConsultation Julie Koehler, Program Director Ron Swain, Senior Benefits Consultant John Hartman, CWIC Benefits Specialist Stephanie Gibson, CWIC Benefits Specialist Karie Urban, CWIC Benefits Specialist Mike Keffer, CWIC Benefits Specialist Carrie Printz, CWIC Benefits Specialist Tanya Chiles, CWIC Benefits Specialist

  2. The benefits of Benefits Analysis • To clarify existing benefits • To assist with system navigation • To present financial options • To outline an individualized plan

  3. Referral COVA Career Developers Bureau of Vocational Rehabilitation Community Mental Health Centers Social Security Administration County Boards of MRDD Job and Family Services Educational Programs/Schools Family Support Groups Community Advocacy Centers Contact by phone written letter e-mail Benefits Process

  4. Collection Gather information in person, phone, e-mail, fax Contact guardian, representative payee, community advocate Research Release of Information signed Contact Work Incentive Liaison/ Obtain a Benefits Planning Query (BPQY) if necessary Reconstruct Work History Identify the source of Benefits Benefits Process

  5. Analysis Current position With Employment Transitioning off Benefits Report Biographical Information Current Benefits Assets and Resources Employment Concerns Options Benefits Process

  6. Work Incentives Planning and Assistance • Funded by the Social Security Administration as part of the Ticket to Work/Work Incentives Improvement Act of 1999 • Currently receiving a Social Security Administration disability benefit • Between the ages of 14 and 64 • Living within the 50 counties of central and southeastern Ohio • Participating in vocational rehabilitation with the goal of self-sufficiency.

  7. Benefits Consultation Fee for Service • Work Incentives Benefits Summary • Work Incentives • Plan for Achieving Self-Support • Social Security Benefits Eligibility Assessment (private pay from individuals and families) • Application for SSDI, SSI, Medicaid • Benefits Consultation • Overpayment • Benefits Case Management

  8. Title II Gross monthly wages from 1st to 31st Based on previous work credits earned Title XVI Based on the date the paycheck was received Needs based program SSDI vs. SSI

  9. Childhood Disability Benefit • child must be 18 years of age • disability onset prior to age 22 • insured parent is disabled, retired or deceased • benefits end when child marries unless to another CDB beneficiary

  10. EARNED INCOME wages self-employment net earnings temporary disability payments royalties and honoraria for services UNEARNED INCOME pensions and annuities payments such as SSDI, Railroad Pension, Veterans Administration workers compensation unemployment dividends and interest alimony and support Income

  11. In-Kind Support- SSI • Basic living expenses (food, shelter, and utilities) • must be at least 18 years of age • FULL - no contribution • 1/3 reduction of $224 = FBR $448 (approximately) • PARTIAL - presumed maximum value • contribution no greater than $224 • pay fair share within $5 to use full FBR

  12. EXCLUDED home lived in car for work, medical or modified $4500 fair market value of car Property Essential to Self Support INCLUDED cash stocks and bonds land property cash surrender value of life insurance or burial plan Resources- SSI$2,000 for individual $3,000 for couple

  13. Federal Benefit Rate • $674 for an individual • $1,011 for a couple • adjusted annually • affected by income, living arrangement, and use of Work Incentives

  14. Social Security Disability Insurance& Childhood Disability Benefits (DAC) • Trial Work Period • Extended Period of Eligibility • Grace Period • Expedited Reinstatement • Substantial Gainful Activity Title II Work Incentives • Impairment-Related Work Expense • Subsidy • Unsuccessful Work Attempt • Extended Medicare

  15. TrialWorkPeriod • 9 months within any 60 month time period when earnings exceed threshold • 2001 = $530 • 2002 = $560 • 2003 = $570 • 2004 = $580 • 2005 = $590 • 2006 = $620 • 2007 = $640 • 2008 = $670 • 2009 = $700

  16. SubstantialGainfulActivity • Earnings less than SGA will continue payment of benefits • $980 current SGA (is adjusted based on Federal Work Index) • Countable Income (may use incentives to subtract from gross monthly income) • For statutory blindness = $1,640

  17. ExtendedPeriodofEligibility • 36 consecutive months following the Trial Work Period • earnings below Substantial Gainful Activity will receive cash benefit; earnings above SGA result in suspension of benefit for that month • Grace Period is the first month earnings exceed SGA, cash benefit is issued that month and the next 2 months

  18. Subsidy • Employer pays more than the value of the work performed (extra support, lower productivity, extra breaks, etc.) • Special Conditions are subsidies paid by an agency such as BVR, MR/DD • Work Activity Questionnaire to determine subsidy • used on SSI for eligibility purposes only

  19. Must be directly related to impairment personal care attendant special transportation medical equipment prosthesis medications Must be an expense incurred for work equipment such as interpreters training job coaching Impairment-RelatedWorkExpenses

  20. EXR • TWWIIA-established safety net • Effective January 1, 2001 • For individuals who have stopped receiving benefits as a result of work and then at a later date find themselves unable to work because of their medical condition • Provides for up to six months of provisional benefits • Provides 5 years of coverage from month of benefit termination

  21. Supplemental Security Income Title XVI Work Incentives • General Income Exclusion • Earned Income Exclusion • Student Earned Income Exclusion • Plan for Achieving Self-Support • 1619(a) • 1619(b) • Blind Work Expense • 301 Ticket Protection

  22. GENERAL INCOME EXCLUSION $20 per month excluded from unearned income if possible EARNED INCOME EXCLUSION $65 per month STUDENT EARNED INCOME EXCLUSION $1,640 per month $6,600 annual cap IncomeExclusions

  23. Must be directly related to impairment personal care attendant special transportation medical equipment prosthesis medications Must be an expense incurred for work equipment such as interpreters training job coaching Impairment-RelatedWorkExpenses

  24. SSI Disincentives • Resource limit • No more than $2,000 for an individual • Immediate reduction in cash benefits • After Exclusions, $1 reduction for every $2 in earnings • Overpayment cycle • Payment on 1st of month, corrections based on earnings during month

  25. PlanforAchievingSelf-Support • money to be set aside to obtain a self-sufficiency goal established in a Plan • money from unearned income or earnings • goals can include education, training, transportation, etc. • Plan must have specific goals and milestones

  26. 1619(b)Enters 1619(b) status when income equals or exceeds the break even point- SSI is reduced to $0. • No cash benefits • Retains SSI eligibility and Medicaid with no Spenddown • Annual threshold of $33,194

  27. EXR • TWWIIA-established safety net • Effective January 1, 2001 • For individuals who have stopped receiving benefits as a result of work and then at a later date find themselves unable to work because of their medical condition • Provides for up to six months of provisional benefits • Provides 5 years of coverage from month of benefit termination

  28. How much can I make and still keep my benefits? “It’s never that simple!” Ron Swain

  29. Administrated by the Center for Medicare/Medicaid Services (formerly HCFA) Administrated by the state Job and Family Services county departments has different criterion based on state regulations Medicare vs. Medicaid

  30. Medicare • Eligibility based on aged, blind or disabled status with SSA • Coverage begins following 24 months of Title II payments • Part A includes hospitalization • Part B includes other services such as doctor, lab work or outpatient svcs. • Part D includes prescription drug coverage

  31. Medicaid eligibility • Aged • 65 years or older • Blind • Visual acuity of 20/200 or • receiving SSI due to a visual impairment • Disabled • Impairment that will last at least 12 months or result in death • receiving SSI, SSDI or County Medical Service has determined disability

  32. FINANCIAL Income SSI is exempt Assets ($1,500 or less) e.g. Cash, Savings, Stocks, Bonds NON-FINANCIAL Citizenship Residency Social Security Number Limiting Physical Factor (e.g. Disability) Medicaid eligibility

  33. Non-waiver Medicaid • 2009 standards • Income Needs Standard is $589 & $1,011 for a couple • Asset Limit is $1500 $2250 for a couple

  34. Gross Income SSI exempt $20 General $65 Earned Income Impairment-Related Work Expenses 1/2 of remaining income Cannot receive both Impairment-Related and Work Expenses for the Blind deductions which are deducted after the 1/2 remaining income Income Disregards

  35. SPENDDOWN • Allows for the deduction of certain medical expenses so that income will fall within eligibility guidelines • Example: Medical insurance premiums, prescriptions, past medical expenses • Determined by the County Department of Job and Family Services • 3 Types • Ongoing • Delayed • Pay-In

  36. Spenddown Comparison

  37. What are Home and Community Based Services Waivers (HCBS)? • HCBS waivers are State selected options that allow individuals to remain in the community • Ohio Home Care • PASSPORT • Individual Options • MRDD waiver (Level 1,2 &3)

  38. Patient Liability Example: • Childhood Disability Benefits $700 • Total income (both earned and unearned) up to $1,380 before Patient Liability is incurred. $1,380 - $700 = $680 (earnings potential before patient liability is incurred)

  39. Medicaid Buy-In for Workers with Disabilities • Provides health coverage for WORKING individuals with disabilities • Ages 16 to 64 • Allows up to $10,000 in resources • Allows income up to 250% of the FPL • Income above 150% of FPL results in monthly premium for Medicaid • Premiums charged are 10% of difference between total family income and 150% of FPL

  40. Creating opportunities that work Contact Julie Koehler….………...(614) 294-7117 Program Director jkoehler@cova.org www.cova.org 3770 N. High St., Columbus, OH 43214

  41. QUESTIONS?