NAVIGATING THE
SOCIAL SECURITY SYSTEM
I.
THE SOCIAL
SECURITY ADMINISTRATION (SSA)
Disability
Programs: SSI and SSDI
II. ELIGIBILITY
REQUIREMENTS
III. THE
APPLICATION PROCESS
IV.
THE APPEALS
PROCESS
V. THE
TICKET TO
SSA WORK INCENTIVB PROGRAMS
VI. Q & A
·
A needs-based program
·
Must be aged, disabled or blind
·
Must have limited income and limited resources
·
Subject to parent or spouse deeming
·
Subject to in-kind support and maintenance
·
Subject to living arrangements*
·
SSI-linked Medi-Cal coverage
·
Funded by general trust fund of Federal and
state government**
·
Federal Benefit Rate- FBR = $579.00(2005) $603.00(2006)
·
State Supplement Program – SSP
·
2005 - $233.00 Disabled $298.00
Blind
* Not applicable to all states
** Not all states supplement the
· Entitlement program
·
Established as an insurance program (not a
retirement program)
·
Must have paid into the system via FICA taxes
·
Have accumulated enough credits (usually 20 in
past 10 years)
·
Can receive benefits on someone else’s record
·
Medicare coverage after 24 months
· Benefit amount depends on how much you paid into system
· Funded from Social Security trust fund
Definition of Disability – The law defines
disability as the inability to do any 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
(20 CFR §404.1505).
Statutory Blindness – Defined in the law as
central visual acuity of 20/200 or less in the better eye with the use of
correcting lenses. An eye which has an
limitation in the field of vision so that the widest diameter of the visual
field subtends an angle no greater than 20 degrees is considered to have a
central visual acuity of 20/200 or less (20
Substantial Gainful Activity (
The
·
To establish your “protective filing date” call
SSA at
·
An appointment will be set up with the local SSA
field office for you to complete and file the Disability Report.
·
An appointment letter will be mailed to you
informing you of your appointment date and time as well as any other documents
you will need to bring to the interview.
·
You can request that the Disability Report be sent to you prior to your appointment and have
it filled out before you go to the SSA office.
Evaluation – The completed application is forwarded to
the
Disability Determining Service (DDS) which
uses SSA regulations to determine the applicants medical eligibility.
In
SSI cases, the DDS will also use the Sequential Evaluation Process to determine
disability. The Sequential Evaluation Process
is not used in determining SSDI eligibility.
·
Is the individual working at a substantial level?
·
Is the individual’s medically determinable or
combination of impairments “severe?”
·
If the impairment is determined to be severe,
does it meet or medically equal the severity of a listing in SSA’s Listing of Impairments?
·
If the impairment is severe, but does not meet
or equal the severity of the listings, does the individual retain the capacity
to do his/her past relevant work, considering his or her residual functional capacity?
·
If past relevant work is precluded, does the
individual retain the capacity to do any other kind of work (which exists in
significant numbers in the national economy) considering the individual’s
residual functional capacity and the vocational factors of age, education and
work
Experience?
§
Request for Reconsideration of Decision
§
Request for a Hearing before an Administrative
Law Judge (ALJ)
§
Request for an Appeals Council Review
§
The Ticket to Work Program
- The ticket to work (TTW) program is the cornerstone of the ticket to
work and work incentive improvement act of 1999. The goal of the TTW program is to expand the
universe of service providers available to individuals entitled to SSI and SSDI
in obtaining the services necessary to find, enter and maintain employment.
The legislation also removes barriers that previously
influenced people’s choices between healthcare coverage and work.
To be eligible for a “ticket” you must BE:
(1)
Age 18 and have not reached your 65th birthday
(2)
Currently receiving SSI, SSDI or concurrent (receiving SSI
& SSDI)
eligible
(3)
SSA records show that your case is not designated as a
“medical improvement expected” (MIE) diary review case
(4)
Your case is designated a “medical improvement
expected” (MIE) diary review case and SSA has conducted at least one continuing
disability review (CDR) and has determined that your disability continues
(5)
You will only be entitled to receive one ticket
while you are entitled to SSI or SSDI
(6)
If your SSI or SSDI is terminated and you are reinstated, you will be entitled to
another ticket
SSA has contracted with national, state and local service
providers, known as employment networks (EN), that work with beneficiaries to
provide support and employment-related assistance. Tickets can be used to obtain rehabilitation
or employment services or a job from any EN the beneficiary chooses.
The beneficiary and the En design and agree upon an employment plan outlining the services to be provided to assist the beneficiary in obtaining employment. The ticket is then considered “assigned” to the EN. When services are being provided and the beneficiary is working toward his/her work goal, the ticket is “in Use”.
·
The Ticket program is voluntary!!!
·
Beneficiaries receiving Tickets are not required
to participate in the program or go to work.
·
The Ticket program is for those who want to get
off of their SSI or SSDI benefits.
·
No continuing disability review (CDR) while Ticket
is in use.
·
Created new employment and support systems (EN, PABSS,
·
Rewards work outcomes.
SSA has work incentive programs which encourage SSI
and SSDI beneficiaries to enter, return to or advance in the work place. These work incentives can allow the
beneficiary to keep some or all of his/her cash benefits and medical coverage
while they work.
The goal of the SSA work incentive programs are to
“significantly reduce or eliminate” the individual’s dependency on public
benefits. The work incentive programs
under SSI and SSDI are different because each program has its own work rules.
SSDI Work Incentives:
Trial Work Period
As per the Social Security Act (The Act), when an
individual who receives SSDI works, she/he is entitled to a 9 month Trial Work
Period (TWP), unless medical recovery is an issue. The TWP is a 9 month period in which the
individual is allowed to test her/his ability to work. These 9 months do not have to be consecutive,
but must occur in a 60 month “rolling” period.
During the TWP, income does not count against the SSDI check (20 CFR §
404.1592)...
Trial Work Month)
In 2005, a trial work month (TWM) is any month the
individual receiving SSDI earns $590.00.
As of
Substantial Gainful Activity
Substantial Gainful Activity (SGA) is work that involves
doing significant mental or physical activity for pay or profit (20 CFR § 404.1572). As of
Extended Period of Eligibility
After the
Any month, during the EPE, gross earnings are at or below
Cessation Period
The first month, after the
Impairment Related Work Expense
The Impairment Related Work Expense (IRWE) is an expense
the worker incurs because of her/his disability for goods or services which
allow her/him to work. These expenses
must be paid for by the individual and can not be reimbursed by any one else (Redbook
on Employment Supports)
Subsidy
A subsidy is an expense, for goods or services, paid for
by the employer which allows the individual to work and/or perform her/his job
duties (Redbook on Employment Supports).
Special Condition
A special condition is an expense that goods or services,
paid for by a third party which allow the individual with a disability to work
and/or perform her/his job duties (Redbook on Employment Supports).
Unincurred Business Expense
An unincurred business expense is self-employed business
support given at no cost. The cost of
the support given to business owner is deducted to determine whether earnings
exceed
Unpaid Help
Unpaid help is assistance given at no cost to a business
owner receiving SSDI which any other business would be expected to purchase as
a business/labor expense. The fair labor
cost of the assistance given to the business owner is deducted from net
earnings to determine
Under Social Security regulations, the IRWE, subsidy and
special condition expense should be disregarded when calculating the
individual’s monthly gross countable income (CI). These expenses are disregarded from the net income to obtain the CI for
self-employment. The CI is then compared
to the
Continued Medicare Coverage
With passage of the Ticket to Work and Work Incentive
Improvement Act of 1999 (“Ticket”), Medicare coverage was extended from 39
months to 93 months. During this period,
the individual will continue to retain her/his Medicare Part A (hospitalization)
and Medicare Part B (office visit) coverage.
Medicare Part A will continue to be free to the individual. Medicare Part B, however, is optional and a
premium must be paid to retain it.
Medicaid Buy-in Program
The “Ticket” legislation also encouraged states to
establish “Medicaid Buy-in” programs for SSDI beneficiaries who worked. These “buy-in” programs allow SSDI
beneficiaries to purchase Medicaid coverage through the state.
Expedited Reinstatement
The expedited reinstatement or “easy back on” prevision,
of the “Ticket” makes it easier for an individual to get their benefits
reinstated. If earnings fall below SGA,
after completion of the EPE, the individual can have their benefits reinstated
without having to re-apply to the system.
The expedited reinstatement provision allows the
individual to notify the SSA that she/he is no longer working at
SSI Work Incentives:
When a Supplemental Security Income (SSI) recipient works,
SSI work incentives must be applied to monthly gross income to determine
countable income (CI). The countable
income is the portion of the earned income which will count against the SSI
cash payment (20
Social Security Law allow for certain exclusions and expenses to be deducted in the countable income calculation. These exclusions are presented below:
General Income Exclusion
The general income exclusion (GIE) is an exclusion of the first $20.00 of any income (earned or unearned), per month. SSA does not count the first $20.00 in the countable income calculation. SSA does not count the first $20.00 against the SSI check amount.
Earned Income Exclusion
The earned income exclusion (EIE) is an exclusion of the first $65.00 of income earned per month. SSA does not count the first $65.00 earned in the countable income calculation against the SSI check.
50% Earnings Exclusion
SSA allows for 50% of the remaining income, after the GIE and EIE have been subtracted, to be excluded in the countable income calculation. This amount is the final CI which reduces the SSI check amount.
Student Earned Income Exclusion
The student earned income exclusion (SDIE) is an exclusion
of earned income by an individual under age 22, not married or head of
household who regularly attends school. As
of
The maximum SEIE Social Security can exclude is $5670.00,
in calendar year 2005. Beginning
Property Essential for Self-Support
Property essential for self-support (PESS) is resource
exclusion for SSI recipients who are self employed. PESS allows the exclusion of resources such
as business equipment, property and unintended business cash resources, in a
small business account, that are used in a small business not to be counted in
the CI calculation.
SSI regulations also allow for some expenses the SSI
recipient incurs to be excluded in the calculation of his/her countable
income. These expenses include:
Impairment Related Work Expense
The Impairment Related Work Expense (IRWE) is an expense
the worker incurs because of her/his disability for goods or services which
allow her/him to work. These expenses
must be paid for by the individual and can not be reimbursed by any one else (Redbook
on Employment Supports)
Blind Work Expense
A Blind Work Expense (BWE) is an expense a blind person incurred that enable the person to work. A blind person is allowed to exclude these expenses from earned income when calculating CI and the SSI payment amount.
The SSI program also offers medical work incentives to
assist the SSI recipient in his/her work efforts. Medical work incentives include:
Section 1619B
Section 1619B of the Social Security Act (the Act) is a provision of the law which states that if an individual who receives SSI benefits looses their cash payments solely because of earnings, they are entitled to keep their Medi-Cal coverage up to a certain state “threshold” level.
The threshold level in
Medicaid Buy-in Program
With the passage of the Ticket to Work and Work Incentive
Improvement Act of 1999, states were encouraged to establish “Medicaid buy-in”
programs which provide a mechanism for a person who has lost their Medicaid
coverage because of their earnings to purchase Medicaid at a reduced rate.
The 250% California Working Disabled (250% CWD) program is
the Medicaid buy-in program for the state of
There are other work incentive programs, under the SSI
program, that can assist SSI recipients in their return to work efforts. These include:
Expedited Reinstatement
This provision of the Ticket to Work and Work Incentive
Improvement Act provides an easier way for a person who has loss his/her
benefits because of work to have their benefits reinstated if their earnings
fall below substantial gainful activity level (
The Plan for Achieving Self-Support (The PASS
plan)
The PASS plan is another SSI work incentive program which
allows an individual who is SSI eligible to set aside a portion of their income
into a separate bank account to achieve a specific vocational goal. Instead of the individual’s countable income
(CI) reducing his/her SSI check, upon approval of the PASS plan by SSA, the
individual will be allowed to set this money aside to reach their vocational
goal. You must have income other than
SSI to qualify for a PASS plan.
To learn more about the PASS plan you can contact your
local Protection & Advocacy for Beneficiaries of Social Security (PABSS) program,
the Benefits Planning Assistance and Outreach (
The purpose of the PABSS program is to provide SSI
and SSDI beneficiaries information and advice about obtaining vocational
rehabilitation and other employment services.
The PABSS program is also obligated to provide
advocacy and other services that a beneficiary needs to secure or regain
gainful employment.
1. Investigate
and review any complaint of improper or inadequate services provided to a
beneficiary with a disability by a service provider, employer or other entity
involved in the Beneficiary’s return to work effort.
2. Provide
information and referrals to Social Security beneficiaries with disabilities
about work incentives and employment, including information on the types of
services and assistance that may be available to assist them in securing or
regaining gainful employment, particularly services and assistance available
through employment networks (EN) under the Ticket to Work program.
3. Provide
information and technical assistance on work incentives to beneficiaries with
disabilities.
4. Provide
consultation to and Legal representation on behalf of beneficiaries with
disabilities when such services become necessary to protect the rights of such
beneficiaries.
5. Assist
beneficiaries with disabilities in disputes before SSA involving work-related
program decisions and benefits overpayments that are clearly a barrier to
employment.
6. Provide
information and technical assistance to governmental agencies, employment networks
(EN) and other service providers and advocacy organizations.
7. Advocate
to identify and correct deficiencies in entities providing vocational
rehabilitation service, employment services and other support services to
beneficiaries with disabilities.
To be PABSS eligible
you must be:
1. A current
recipient of Social Security (SI, SSDI
or concurrent) cash payments due to a disability.
2. Previously received Social Security (SSI, SSDI, or concurrent) cash payments due to a disability.
3. Now receives Medi-Cal under 1619(b) or Medicare Part D.
4. The issue
must be employment/work related.