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Benefits Consultation. 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 - PowerPoint PPT Presentation
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BenefitsBenefits ConsultationConsultation
Julie Koehler, Program DirectorRon Swain, Senior Benefits Consultant
John Hartman, CWIC Benefits SpecialistStephanie Gibson, CWIC Benefits Specialist
Karie Urban, CWIC Benefits SpecialistMike Keffer, CWIC Benefits Specialist
Carrie Printz, CWIC Benefits SpecialistTanya Chiles, CWIC Benefits Specialist
The benefits of Benefits Analysis
To clarify existing benefits
To assist with system navigation
To present financial options
To outline an individualized plan
Benefits Process 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
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
Analysis– Current position– With Employment– Transitioning off Benefits
Report– Biographical Information– Current Benefits– Assets and Resources– Employment– Concerns– Options
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.
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
SSDI vs. SSI Title II Title II Gross monthly Gross monthly
wages from 1st to wages from 1st to 31st31st
Based on previous Based on previous work credits earnedwork credits earned
Title XVI Title XVI Based on the date Based on the date
the paycheck was the paycheck was receivedreceived
Needs based Needs based programprogram
Childhood Disability Benefit
child must be 18 years of agechild must be 18 years of age disability onset prior to age 22disability onset prior to age 22 insured parent is disabled, retired or insured parent is disabled, retired or
deceaseddeceased benefits end when child marries benefits end when child marries
unless to another CDB beneficiaryunless to another CDB beneficiary
Income
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
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
Resources- SSI$2,000 for individual $3,000 for couple
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
Federal Benefit Rate
$674 for an individual $1,011 for a couple adjusted annually affected by income,
living arrangement, and use of Work Incentives
Social Security Disability Insurance& Childhood Disability Benefits (DAC)
Title II
Work Incentives
•Trial Work Period
•Extended Period of Eligibility
•Grace Period
•Expedited Reinstatement
•Substantial Gainful Activity
•Impairment-Related Work Expense
•Subsidy
•Unsuccessful Work Attempt
•Extended Medicare
Trial Work Period
$530$560$570$580$590$620$640$670$700
$0
$100
$200
$300
$400
$500
$600
$700
2001 2003 2005 2007 2009
threshold
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
Substantial Gainful Activity
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
Extended Period of Eligibility
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
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
Impairment-Related Work Expenses
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
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
Supplemental Security IncomeTitle 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
Income Exclusions
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
Impairment-Related Work Expenses
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
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
Plan for AchievingSelf-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
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
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
How much can I make and still keep my benefits?
“It’s never that simple!”
Ron Swain
Medicare vs. Medicaid
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 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
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
Medicaid eligibility
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)
Non-waiver Medicaid
2009 standards Income Needs
Standard is $589 & $1,011 for a couple
Asset Limit is $1500 $2250 for a couple
Income Disregards
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
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
Spenddown Comparison
Ongoing Delayed Pay-inMedical Premium Prescriptions Pays spenddown
amount to CDJFS
Past MedicalExpenses
Doctor Visit
Eligible firstof the month
Eligible datespenddown
amount is met
Eligible firstof the month
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)
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)
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
Creating opportunities that work
Contact
Julie Koehler….………...(614) 294-7117
Program Director
www.cova.org3770 N. High St., Columbus, OH 43214
QUESTIONS?