2012 Red Book

An AWIC is an experienced employment support expert who:

• Coordinates and conducts public outreach on work incentives in his or her local area; and
• Provides, coordinates and oversees training on our employment support programs for all personnel at our local offices.

The BPQY is an important planning tool for disability beneficiaries or any person who may be developing customized services for a disability beneficiary who wants to start working or stay on the job. The BPQY provides current information about your disability cash benefits, health insurance, scheduled continuing disability reviews, representative payee, and work history, as stored in our electronic records.

If you are blind, we do not count any earned income that you use to meet expenses in earning that income when we decide your SSI eligibility and payment amount. Common examples of BWE include state and federal payroll taxes, and money spent for meals at work.

The dollar amount of total income that will (after applicable deductions are applied) reduce the SSI payment to zero in a given set of case facts. Your break-even point depends on your earned and unearned income, living arrangements, applicable income exclusions, and state supplement, if any.

Childhood Disability Benefits (CDB)

A person disabled before age 22 may be eligible for child’s benefits if a parent is deceased or starts receiving retirement or disability benefits.

The adult child—including an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild-must be unmarried, age 18 or older, and have a disability that started before age 22.

Continuation of Medicare
Coverage

If your benefits stop because you are working you can receive at least 93 consecutive months of Medicare coverage after your trial work period (TWP). This provision allows your health insurance to continue even after your benefits have stopped.

Our process of obtaining complete current information about your condition to decide if your SSDI or SSI benefits should continue.

The amount of money left after we have subtracted all available deductions from your total income. We use this amount to decide your SSI eligibility and payment amounts.

One of the tests we may use to evaluate self-employment income if you have received SSDI benefits for 24 months.

An EN is a qualified public or private organization under contract with us to coordinate and deliver employment services, vocational rehabilitation services, or other support services to beneficiaries who are participating in the Ticket to Work program.

A safety net if your cash benefits end because of your work. You may request reinstatement of your benefits within five years of when they ended if you stop working at the substantial gainful activity (SGA) level because of your impairment. You may get up to six months of provisional (temporary) benefits while we make a decision on your request.

A consecutive 36-month period that follows your TWP. During your EPE, you may still receive payments depending on how much you work and earn. We can pay you disability benefits during your EPE if:

• your condition is still disabling, and


• your work is not SGA.

The basic benefits standards used in computing the amount of your federal SSI payments. Benefit levels differ for individuals and couples living in households and for persons in Medicaid institutions. Federal benefit rates may be increased annually to reflect increases in the cost of living.

When we make a SGA decision, we can deduct the cost of items and services that you pay out of pocket and that you need to work because of your impairment. Some examples are: medicines, co-pays, service animals, counseling services, and attendant care services. It does not matter if you also need the items for normal daily activities. We can usually deduct the cost of these same items from earned income to figure your SSI payment.

Medicaid
(Medi-Cal in California,
AHCCS in Arizona)

Medical coverage provided to a person by the state title XIX program.

A state may provide Medicaid coverage for persons with disabilities who:

• have earnings that are too high to qualify for SSI under current rules; and


• are at least 16, but less than 65 years of age; and


• meet state resource and income limits.

Medical Improvement Expected

If we approve your claim for disability benefits, we may also decide that we expect your disabling impairment(s) to improve. If so, we will schedule your case for a future review in less than three years.

Health insurance program for eligible disabled persons and persons age 65 or older usually consisting of:

• Hospital Insurance under Medicare (Part A);
• Supplementary Medical Insurance under Medicare (Part B); and
• Voluntary prescription drug coverage with a Prescription Drug Provider (PDP) under Part D.

Low-income beneficiaries with Medicare can get Extra Help paying their prescription drug coverage premiums by filing an application with SSA. More information is available at: www.socialsecurity.gov/prescriptionhelp/.

Medicare for Persons With Disabilities Who Work

If you are disabled and you return to work, you can buy continued Medicare coverage when your premium-free Medicare ends due to work activity. States are required to help you pay the hospital insurance premiums if you have limited income and resources but are not eligible for Medicaid.

Under an approved PASS, you may set aside income and resources over a reasonable time that will enable you to reach a work goal to become financially self-supporting. You can use the income and resources that you set aside to obtain training or education, purchase equipment, establish a business, etc. We do not count the income and resources that you set aside under a PASS when we decide SSI eligibility and payment amount.

Property Essential to Self-Support (PESS)

We do not count some or all of certain property necessary for self-support when we apply the SSI resources test.

Resources

Resources are anything you own. For example, bank accounts, stocks, business assets, real estate property, or personal property that you can use for your support and maintenance are considered resources. We do not count all of your resources; i.e., life insurance policies, when we decide if you are eligible for SSI benefits.

Social Security Disability Insurance (SSDI)

SSDI provides benefits to disabled or blind persons who are insured by workers contributions to the Social Security trust fund. These contributions are based on your earnings (or those of your spouse or parents). Your dependents may also be eligible for benefits from your earnings record.

Student Earned Income Exclusion (SEIE)

If you are under age 22 and regularly attending school, the SEIE allows you to have some of your earnings excluded from your income. We usually adjust the amounts we can exclude each year based on the cost-of living.

Subsidies and Special Conditions

Supports you receive on the job that may result in more pay than the actual value of the work you perform. We use only the actual value of the work you perform when we make an SGA decision.

Substantial Gainful Activity (SGA)

We will evaluate your work activity if you are applying for or receiving disability benefits under SSDI, or if you are applying for benefits because of a disability (other than blindness) under SSI. Under both programs, we generally use earnings guidelines to evaluate your work activity to decide whether your work is substantial, and whether we may consider you disabled under the law.

Supplemental Security Income (SSI)

The SSI program makes cash assistance payments to aged, blind, and disabled persons (including children) who have limited income and resources.

SSI Income

SSI income is:

• Earned income – money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, royalties and payments for volunteer work speeches; and
• Unearned income – money received from all other sources; for example, gifts, interest, pensions, Social Security, and veteran’s benefits. Unearned income also includes “in-kind income” (food or shelter) and “deemed income” (some of the income of a spouse, parent, or sponsor of an alien).

The Three
Tests

We may use these tests to evaluate self-employment income when you initially apply for SSDI, and before you have received SSDI benefits for 24 months. We also use the three tests to determine if we can reinstate your benefits when we evaluate your work activity in the EPE.

The TTW Program is for SSI or SSDI beneficiaries who want to work and participate in planning their employment. Participation in the TTW program increases your available choices when obtaining employment services, vocational rehabilitation services, and other support services you may need to get or keep a job. It is a free and voluntary service. When you participate in the TTW program, you are using your ticket. You might not be subject to a continuing disability review while you are using your Ticket.

The TWP lets you test your ability to work or run a business for at least nine (9) months and receive full SSDI benefits if you report your work activity and your impairment does not improve.

Unincurred Business Expenses

Support contributed to your self-employment effort by someone else for example, free rent, donated supplies, or unpaid help from friends or family members. If you are self-employed, we deduct unincurred business expenses from earnings when we make an SGA decision.

Unsuccessful Work Attempt (UWA)

An UWA is an effort to do substantial work (in employment or self-employment) that you stopped or reduced to below the SGA level after a short time (six months or less) because of your impairment, or the removal of special conditions related to your impairment that were essential to your work. We do not count earnings during a UWA when we make an SGA decision.

Vocational Rehabilitation (VR)

The VR program is a public program administered by a State VR agency in each State or U.S. territory to help people with physical or mental disabilities become gainfully employed.

Work Incentives Planning and Assistance (WIPA)

We fund community organizations to provide Work Incentives Planning and Assistance (WIPA) services. Nationwide, 102 programs help beneficiaries with disabilities understand and use work incentives and employment supports. Community Work Incentives Coordinators (CWICS) are professionals who work for WIPAs, meet with beneficiaries, and provide important information about your benefits and how working would affect your SSA income and health care.

Work Incentives Seminars (WISE)

A free, internet-based seminar that gives Social Security disability beneficiaries information they need to make a decision about going back to work or working for the first time. WISE feature various employment support service providers, such as Vocational Rehabilitation, Protection and Advocacy Services and Employment Networks. Some WISE address a broad range of disabilities, while others target people in specific disability categories or age ranges. WISE information may be accessed 24-hours per day at your convenience.