How do you feel?How do you feel?

When your client says “I need help with…” (Social Security, housing, Medicaid, Medicare, etc) which emoticon represents how you feel?

Maybe the emoticons don’t cut Maybe the emoticons don’t cut it!it!

Do you want to Do you want to pick up everything pick up everything on your desk and on your desk and run?run?

Or jump with Or jump with frustration and pull frustration and pull your hair out after your hair out after an hour on the an hour on the phone with phone with Medicare?Medicare?

End the frustration!End the frustration!

• Relax! Relax!

• Get ready for Get ready for “Benefits Made “Benefits Made Simple”!Simple”!

Who does what?Who does what?

There are 3 categories of benefits.There are 3 categories of benefits. FederalFederal StateState LocalLocal And it is important to remember that their And it is important to remember that their

computer systems DO NOT computer systems DO NOT communicate on a regular basis!communicate on a regular basis!

Federal BenefitsFederal Benefits

The federal government controls all Social The federal government controls all Social Security programs. The benefit Security programs. The benefit programs that fall into this category are:programs that fall into this category are:

1.1. Social Security Disability Insurance Social Security Disability Insurance (SSDI)(SSDI)

2.2. Supplemental Security Income (SSI)Supplemental Security Income (SSI)

3.3. Medicare (A,B,C, & D)Medicare (A,B,C, & D)

Federal Benefits Federal Benefits DissectedDissected

Social Security Disability Insurance Social Security Disability Insurance (SSDI)(SSDI)

This program provides a monthly This program provides a monthly disability benefit for anyone deemed disability benefit for anyone deemed disabled by the Social Security disabled by the Social Security Administration AND they meet the Administration AND they meet the following rules for being fully insured following rules for being fully insured under the SSDI program.under the SSDI program.

Insured for Disability Insured for Disability StatusStatus

To qualify for SSDI a person must have at To qualify for SSDI a person must have at least 6 Social Security credits but not least 6 Social Security credits but not more than 40 and they must have at least more than 40 and they must have at least 1 credit for each year after they turned 21.1 credit for each year after they turned 21.

A credit is earned for each $1050 in A credit is earned for each $1050 in reported income. The maximum credits reported income. The maximum credits that are given in one year, regardless of that are given in one year, regardless of income, is 4. income, is 4.

The next step…The next step…

If the person is determined to be fully If the person is determined to be fully insured they must then meet ONE of the insured they must then meet ONE of the following rules:following rules:

1.1. Have at least 20 credits from the Have at least 20 credits from the previous 10 years.previous 10 years.

2.2. Became disabled prior to age 31Became disabled prior to age 31

3.3. Had a period of disability prior to 31; orHad a period of disability prior to 31; or

4.4. Be statutorily blindBe statutorily blind

Medically DisabledMedically Disabled

If a person meets the previous requirements, If a person meets the previous requirements, they must now meet SSA criteria concerning they must now meet SSA criteria concerning medical impairments. medical impairments.

The listing of what SSA considers to be a The listing of what SSA considers to be a medical impairment is listed at:medical impairment is listed at:

http://www.ssa.gov/OP_Home/cfr20/404/404-ahttp://www.ssa.gov/OP_Home/cfr20/404/404-ap10.htmp10.htm

The person also must NOT be working or must The person also must NOT be working or must be earning less than $980 a month.be earning less than $980 a month.

Another way to qualifyAnother way to qualify

An individual over the age of 18 who has a An individual over the age of 18 who has a disability that began prior to age 22, is not disability that began prior to age 22, is not married, and is the dependant of a person married, and is the dependant of a person who meets the fully insured requirements, who meets the fully insured requirements, may be entitled to SSDI benefits based on may be entitled to SSDI benefits based on the Social Security record of the parent. the Social Security record of the parent. This only applies if the parent is disabled, This only applies if the parent is disabled, retired, or deceased.retired, or deceased.

Supplemental Security Supplemental Security IncomeIncome

Better known as SSI, this benefit is also Better known as SSI, this benefit is also administered by the Social Security administered by the Social Security Administration but is very different from SSDI. Administration but is very different from SSDI.

SSI is a federally administered income SSI is a federally administered income assistance program to provide payments to assistance program to provide payments to needy persons who are aged, disabled, or needy persons who are aged, disabled, or blind but do not have the work history to make blind but do not have the work history to make them eligible for SSDI.them eligible for SSDI.

Eligibility requirements Eligibility requirements for SSIfor SSI

A person must:A person must:1.1. Have little or no income: andHave little or no income: and2.2. Have resources of less than $2,000Have resources of less than $2,0003.3. Be disabled or blind, 65 years of age or Be disabled or blind, 65 years of age or

older; andolder; and4.4. Apply for any other benefit programs the Apply for any other benefit programs the

person may be eligible to receive; andperson may be eligible to receive; and5.5. Not be working or working but earning less Not be working or working but earning less

than $980 a month.than $980 a month.

What counts as What counts as resources?resources?

In determining initial and ongoing SSI eligibility In determining initial and ongoing SSI eligibility a person is not allowed to have more than a person is not allowed to have more than $2,000 in resources at any time. This includes:$2,000 in resources at any time. This includes:

Money in bank accountsMoney in bank accounts Stocks and other investmentsStocks and other investments Real Estate other than home of residenceReal Estate other than home of residence Expensive jewelry and other expensive Expensive jewelry and other expensive

propertyproperty

Resources that do NOT Resources that do NOT countcount

A house and the land that it is on if the person resides in itA house and the land that it is on if the person resides in it A car or truck of reasonable value and the vehicle is used for A car or truck of reasonable value and the vehicle is used for

transport to worktransport to work Combined life & burial insurance up to $1,500Combined life & burial insurance up to $1,500 A burial plot for the individual & immediate family membersA burial plot for the individual & immediate family members $2,000 worth of personal belongings$2,000 worth of personal belongings Retroactive SSI or SSDI benefit payments are not counted as a Retroactive SSI or SSDI benefit payments are not counted as a

resource for 9 months beginning the month the payment is resource for 9 months beginning the month the payment is received.received.

Now that wasn’t so bad…Now that wasn’t so bad…

So those are the two primary So those are the two primary Government run programs. In a Government run programs. In a nutshell…nutshell…

SSDI—For people with a significant SSDI—For people with a significant work history in the previous 10 work history in the previous 10 years.years.

SSI—For people who have little or SSI—For people who have little or no work history for previous 10 no work history for previous 10 years and are financially in need.years and are financially in need.

Now for the fun—Medicare!Now for the fun—Medicare!

Medicare is the federal insurance Medicare is the federal insurance program provided to everyone program provided to everyone receiving Social Security Benefits. receiving Social Security Benefits.

This does not include SSI. Only This does not include SSI. Only people receiving SSDI or Social people receiving SSDI or Social Security retirement benefits are Security retirement benefits are eligible for Medicare. eligible for Medicare.

A, B, C, D, ……???A, B, C, D, ……???

There are 4 Medicare programs. They There are 4 Medicare programs. They are:are:

A—Hospital and long term care A—Hospital and long term care benefitsbenefits

B—Physician and routine care benefitsB—Physician and routine care benefits C---Managed care covering all of the C---Managed care covering all of the

above AND prescription coverageabove AND prescription coverage D---Prescription coverageD---Prescription coverage

Who gets what for Who gets what for insurance?insurance?

SSDI recipients are eligible to receive SSDI recipients are eligible to receive Medicare after 24 months of SSDI Medicare after 24 months of SSDI eligibility. eligibility.

Part B will have a premium but many Part B will have a premium but many recipients are eligible for assistance recipients are eligible for assistance through other programs for this through other programs for this premium.premium.

SSI recipients are eligible for state SSI recipients are eligible for state funded Medicaid coverage.funded Medicaid coverage.

Recap of Federal BenefitsRecap of Federal Benefits

SSDI-Monthly Social Security Disability SSDI-Monthly Social Security Disability Insurance benefit for people with a disability Insurance benefit for people with a disability AND a recent work history of at least 5 years.AND a recent work history of at least 5 years.

SSI-Monthly Supplemental Security Income SSI-Monthly Supplemental Security Income benefit for people with a disability who are benefit for people with a disability who are financially needy.financially needy.

Medicare—Federal insurance program for Medicare—Federal insurance program for SSDI recipientsSSDI recipients

Confused yet? Wait, Confused yet? Wait, there’s more!there’s more!

Hopefully you now have a better Hopefully you now have a better understanding of benefits provided by the understanding of benefits provided by the federal government. federal government.

What questions do you have about What questions do you have about Federal benefits?Federal benefits?

State of Vermont BenefitsState of Vermont Benefits

Supplement to SSI benefitsSupplement to SSI benefits Medicaid insurance benefitMedicaid insurance benefit VPharmVPharm VHAPVHAP Food StampsFood Stamps Medicaid for the Working DisabledMedicaid for the Working Disabled Section 8 Housing AssistanceSection 8 Housing Assistance Fuel AssistanceFuel Assistance

VT benefits explainedVT benefits explained

Vermont is one of only a few states to Vermont is one of only a few states to supplement the federal SSI cash benefit. The supplement the federal SSI cash benefit. The amount is small, average is about $60 a month. amount is small, average is about $60 a month. Recipients do not receive a separate check, this Recipients do not receive a separate check, this supplement is included in the recipients benefit supplement is included in the recipients benefit check from the government.check from the government.

Green Mountain CareGreen Mountain Care

Vermont has several medical insurance Vermont has several medical insurance programs available to assist residents of programs available to assist residents of varying income levels. These include:varying income levels. These include:

MedicaidMedicaid VHAPVHAP VPharmVPharm Medicaid for the working disabledMedicaid for the working disabled Catamount Health PlansCatamount Health Plans

MedicaidMedicaid

Medicaid is a state funded medical insurance program Medicaid is a state funded medical insurance program for low income Vermonters. for low income Vermonters.

Anyone receiving SSI benefits as the only household Anyone receiving SSI benefits as the only household income is automatically eligible for Medicaid.income is automatically eligible for Medicaid.

Total household income must be less than $1,100 a Total household income must be less than $1,100 a month for one person to qualify. (exceptions for month for one person to qualify. (exceptions for working disabled)working disabled)

VHAPVHAP VHAP—Vermont Health Access ProgramVHAP—Vermont Health Access Program This is a comprehensive medical plan for individuals This is a comprehensive medical plan for individuals

with income under $1,306 per month and with a with income under $1,306 per month and with a disability or over the age of 65. disability or over the age of 65.

There is a premium for this program and it is income There is a premium for this program and it is income based. The premium runs between $7 and $49 each based. The premium runs between $7 and $49 each month. There may be some copays for month. There may be some copays for medical/prescription services.medical/prescription services.

VPharmVPharm

Vermont Pharmacy programVermont Pharmacy program This program requires that an individual’s This program requires that an individual’s

income is below $1800 per month and also income is below $1800 per month and also requires a premium. requires a premium.

This is a benefit that covers prescription This is a benefit that covers prescription medications onlymedications only

There is a premium for this benefit as well.There is a premium for this benefit as well.

Other Vermont benefitsOther Vermont benefits

Vermont also offers Catamount Health Vermont also offers Catamount Health Insurance, VScript, Pharmacy assistance Insurance, VScript, Pharmacy assistance programs, and a new program that can help programs, and a new program that can help individuals afford their employer’s health individuals afford their employer’s health insurance premiums. insurance premiums.

For more information about all the Vermont For more information about all the Vermont Health Programs please visit Health Programs please visit www.greenmountaincare.orgwww.greenmountaincare.org

Medicaid for the Working Medicaid for the Working DisabledDisabled

This is a very under utilized benefit for people with disabilities who want This is a very under utilized benefit for people with disabilities who want to work but fear losing their medical benefits. to work but fear losing their medical benefits.

Vermont has a special Medicaid program where someone receiving SSDI Vermont has a special Medicaid program where someone receiving SSDI benefits can work and still receive Medicaid benefits. benefits can work and still receive Medicaid benefits.

Household income for one person must be less than $2,100 with work and Household income for one person must be less than $2,100 with work and benefits combined.benefits combined.

This application MUST be mailed to Waterbury.This application MUST be mailed to Waterbury. Use the regular Medicaid application but write “Medicaid for the Working Use the regular Medicaid application but write “Medicaid for the Working

Disabled” across the top of the application AND on the envelope. Local Disabled” across the top of the application AND on the envelope. Local PATH offices are not equipped to process these applications.PATH offices are not equipped to process these applications.

Food StampsFood Stamps

Food stamp eligibility is based on many Food stamp eligibility is based on many factors. factors.

Income (Eligibility rises to 185% of poverty Income (Eligibility rises to 185% of poverty level as of January 1, 2009)level as of January 1, 2009)

Rent & Utility ExpensesRent & Utility Expenses Medical Expenses (including OTC)Medical Expenses (including OTC) Number of people in the householdNumber of people in the household More info and an “estimator” can be found at More info and an “estimator” can be found at

www.vermontfoodhelp.comwww.vermontfoodhelp.com

Housing SubsidyHousing Subsidy

The most common housing subsidy is the The most common housing subsidy is the Section 8 voucher program. Section 8 voucher program.

This program has a limited number of This program has a limited number of vouchers in several different programs.vouchers in several different programs.

Project based voucherProject based voucher Individual voucherIndividual voucher State voucherState voucher Local voucherLocal voucher

Voucher programsVoucher programs A project based voucher is when a client moves into a A project based voucher is when a client moves into a

designated low-income housing project where all rents are designated low-income housing project where all rents are based on household income. Rent does not exceed 30% of based on household income. Rent does not exceed 30% of household income with additional exclusions for specific household income with additional exclusions for specific utilities.utilities.

An individual voucher is when a client is able to select an An individual voucher is when a client is able to select an apartment of their choice as long as it meets the building code apartment of their choice as long as it meets the building code requirements of Vermont State Housing Authority AND the requirements of Vermont State Housing Authority AND the rent is within the allowable amount as designated by VSHA.rent is within the allowable amount as designated by VSHA.

Vouchers continuedVouchers continued

State Vouchers—These vouchers are issued by State Vouchers—These vouchers are issued by the state Housing Authority and are usually the state Housing Authority and are usually individual vouchers that “travel” with the individual vouchers that “travel” with the client. There is often a very long waiting list client. There is often a very long waiting list for any of the State Section 8 programs as for any of the State Section 8 programs as demand clearly outweighs supply.demand clearly outweighs supply.

Vouchers continuedVouchers continued

Local vouchers—These are administered by Local vouchers—These are administered by the local housing authority. These most often the local housing authority. These most often are project based vouchers but there are a are project based vouchers but there are a limited number of individual local vouchers as limited number of individual local vouchers as well. Again, the waiting list is very long but well. Again, the waiting list is very long but often it is faster to be accepted into a project often it is faster to be accepted into a project based program than to wait for an individual based program than to wait for an individual voucher.voucher.

Fuel AssistanceFuel Assistance

Fuel assistance is a Vermont benefit that has Fuel assistance is a Vermont benefit that has several components. It can be paid to renters, several components. It can be paid to renters, homeowners, and boarders. homeowners, and boarders.

Fuel assistance can be paid regardless of who Fuel assistance can be paid regardless of who is responsible for paying the heating bills in is responsible for paying the heating bills in the home.the home.

Fuel assistance can be used towards any type Fuel assistance can be used towards any type of fuel; oil, wood, pellets, electric, propane, of fuel; oil, wood, pellets, electric, propane, etc.etc.

Fuel Assistance eligibilityFuel Assistance eligibility

There are 3 levels of eligibility to qualify for fuel There are 3 levels of eligibility to qualify for fuel assistance. assistance.

Seasonal Fuel (125% of poverty level)Seasonal Fuel (125% of poverty level) Crisis Fuel (150% of poverty level)Crisis Fuel (150% of poverty level) Shareheat & Warmth (200% of poverty level)Shareheat & Warmth (200% of poverty level) Even if someone receives a housing subsidy, they Even if someone receives a housing subsidy, they

could qualify for a fuel benefit. could qualify for a fuel benefit. If a person receives food stamps, applying for fuel If a person receives food stamps, applying for fuel

assistance can increase their food stamp benefit.assistance can increase their food stamp benefit.

Other programsOther programs There are other programs available to help in specific instances. Some There are other programs available to help in specific instances. Some

include:include: Lion’s Club—Assistance with eye careLion’s Club—Assistance with eye care Springfield Public Funds—Assistance with past due rent and on occasion, Springfield Public Funds—Assistance with past due rent and on occasion,

security deposits for utilities and/or rent.security deposits for utilities and/or rent. SEVCA—Assistance with emergency fuel and assistance with past due SEVCA—Assistance with emergency fuel and assistance with past due

electric bills.electric bills. Modest Needs—An online organization that helps a maximum of twice in a Modest Needs—An online organization that helps a maximum of twice in a

lifetime. Any need under $1000 qualifies. (You can apply for higher lifetime. Any need under $1000 qualifies. (You can apply for higher amounts but it’s rare to be funded for those.)amounts but it’s rare to be funded for those.)

Precision Valley Free Clinic—free medical care and prescription vouchers. Precision Valley Free Clinic—free medical care and prescription vouchers. Also has limited funds to assist with dental care.Also has limited funds to assist with dental care.

Visiting Nurse—Provides in home medical and personal care services Visiting Nurse—Provides in home medical and personal care services depending on severity of disability.depending on severity of disability.

PCA program—A personal care assistant program based on severity of PCA program—A personal care assistant program based on severity of disability. Program is run by Department of Aging and Disabilities.disability. Program is run by Department of Aging and Disabilities.

Helpful websitesHelpful websites

www.ssa.govwww.ssa.govwww.vermontfoodhelp.comwww.vermontfoodhelp.comwww.modestneeds.orgwww.modestneeds.orgwww.vermont.govwww.vermont.govwww.greenmountaincare.comwww.greenmountaincare.comwww.dcf.vermont.gov/serviceswww.dcf.vermont.gov/serviceswww.medicare.govwww.medicare.gov

Had enough yet?Had enough yet?

As you can see, the world of benefits As you can see, the world of benefits can be very complex and can be very complex and challenging. However by challenging. However by understanding the basics, especially understanding the basics, especially who provides what service, who provides what service, navigating the benefits obstacle navigating the benefits obstacle course becomes a little easier. course becomes a little easier.

What questions do you have?What questions do you have?

Thanks!Thanks!

Thank you for your patience and Thank you for your patience and willingness to navigate the world of willingness to navigate the world of benefits. benefits.

As always, feel free to call or email As always, feel free to call or email me if you have questions.me if you have questions.

ecole@hcrs.orgecole@hcrs.org(802) 886-4567 ext. 2617(802) 886-4567 ext. 2617