Work Incentives and Work Supports:
The Ins And Outs Social Security,
Medicaid Buy-In's And Other
Community Supports
JOE ENTWISLE
NCHSD
NTW AgrAbility Conference
Grand Rapids, MI
OUTLINE
•SSI: Eligibility, Resources, Income, Work,
Medical Assistance, PASS
•SSDI: Eligibility, Work, Medicare
•Self Employment
•Work Incentive Planning and Assistance
•Ticket to Work
•Employed Individuals with Disabilities MBI
Social Security’s
Benefit Programs
RSDI/SSDI
Retirement,
Survivors,
Insurance)
Medicare
Concurrent
Disability
SSI- Supplemental
Security Income
Medicaid*
• Social Security Disability
Insurance(SSDI) provides
benefits to disabled or blind
people who are “insured” by
workers’ contributions to the
SSA trust fund.
• Supplemental Security Income
makes cash assistance
payments to the aged, blind and
disabled who have limited
income and assets.
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Social Security
Disability
Insurance (SSDI,
Title II)
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Supplemental
Security Income
(SSI, Title XVI)
KEY CONCEPTS
“SGA”
“COUNTABLE
INCOME”
Definition of Disability
for both SSDI and SSI
•“Assistance Program”
•Must have low income & resources
•“Countable Income” = Key Concept
= $674 or less
•Resources = less than $2,000
•Cash payment + Medical Assistance

The maximum dollar amount a person
can receive in federal SSI cash benefits
on a monthly basis

$674 month for eligible individual
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SSI pays the difference between the FBR
and countable income
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General Income Exclusion of $20
Deducted first from unearned income
Earned Income Exclusion
$65 per month plus
1/2 of the rest
o
These are expenses that one must pay for
out-of pocket in order to work.
o
They must be related to the primary disability
or an established secondary disability.
o
The individual must have an IRWE approved
by SSA first and must show receipts.
o
o
o
o
o
o
medical appointment payments
prescription co-payments
prosthetic devices
transportation costs for taxis
costs of adaptive devices for automobiles
special transportation used by persons who
cannot drive an unmodified automobile.
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IRWE’s deducted from countable income
before we divide by 2.
Therefore, IRWE is not subtracted from
countable income dollar for dollar (like it is
with SSDI).
Mary pays $100 per month for specialized
transportation to and from work. She is
paid $500 per month from her job.
500 Earned Income
- 20 General Disregard
- 65 Earned Income Disregard
- 100 IRWE
=315/2
=157.50 Countable Income
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:
A person whose primary disability is a visual
impairment can use BWE’s to deduct the cost of a
large list of items.
Unlike IRWES, BWEs are deducted AFTER we divide
by 2. The entire BWE is deducted from income
dollar for dollar.
Because of this, BWEs can be used to deduct so
much from countable income that often times the
SSI check is not reduced at all!
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IRWEs
State and Federal Taxes
Union Dues
Mandatory Pension
Cost of Uniforms
Reader Services, Driver Services, and Cost of
Service Animal’s Care
Childcare
Transportation
Meals Consumed at Work
Adaptive Equipment
Mary earns $500 per month. She has $100
in various BWEs (taxes, etc.)
$500 Earned Income
-20 General Disregard
-65 Earned Income Disregard
=415/2
=207.5
-100 BWE
$107.5 Countable Income!
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Must be under the age of 22 and regularly
attending school.
Exclude up to $1550 of earned income per
month when they figure the SSI monthly
payment amount.
The maximum yearly exclusion is $6,240.
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Mary earns $500 a month. But, she is also
attending community college with enough
hours to qualify for Student Earned Income
Exclusion.
$500 Earnings minus $500 SEIE (out of the
possible $1550 max per month)
NO SSI REDUCTION until she uses $6240!
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When work earnings reduce SSI payments
to zero, MA will continue if yearly wages
below “Threshold” amount
Individual Thresholds can be higher based
on an individual’s actual MA use
SSDI
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DAC
Entitlement programs
Disability
Medicare Coverage
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Paid from Social Security Disability
Insurance Trust Funds
Have worked in “covered” employment
May be eligible on parents record if
disability began before age 22
Gateway to Medicare
1. Gross average earnings minus any:
- impairment-related work expenses;&
- special conditions or subsidy
2. Consider the value of the work
3. Consider if work is an “unsuccessful work
attempt” ( lasted 6 mo or less)
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TWP -Trial Work Period
SGA - Substantial Gainful Activity
EPE - Extended Period of Eligibility
Expedited Reinstatement
IRWE/Subsidy
EPMC
Medicare for people with disabilities who
work
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9 months of $700 or more (no limit)
80 hours of self-employment activity per
month
Don’t need to be consecutive
Only one TWP per disability entitlement
Review by SSA when completed

Measure of ability to work
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$980 per month for 2009
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$1,640 per month for the blind SGA

If performing work that is “SGA” after the
TWP cash SSDI benefits stop
IRWE
Subsidy

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Expenses that are necessary to work,
related to the person’s disability and paid
for by the worker
May be considered to reduce countable
income below SGA
 Value
of additional support to perform a
job, or difference between actual wages
received and value of work performed
 May reduce income below SGA like IRWE
EXAMPLES: more frequent breaks, more
supervision/support, lower production
requirements
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Consecutive 36 month period after TWP
Cash benefits reinstated for months
under SGA ($980) without a new
application
If at SGA at end of EPE, no more SSDI
payments
When someone’s Social Security or SSI disability benefits have
ended due to earnings from work, he/she is able to request
reinstatement without filing a new application
Within 5 years of last benefits received
Beneficiaries must be unable to work due to their medical
condition
They may receive temporary benefits (as well as Medicare/
Medicaid) for up to 6 months while SSA evaluates their medical
condition
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Federal health insurance program
24-month waiting period after SSDI benefits
start
$96.40/month Part-B premium (2009); Part A
is free
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Continued Medicare coverage even if no
longer eligible to receive SSDI payment
because of work
At least 93 months of coverage after TWP
ends
Billed quarterly for months an SSDI
payment isn’t received
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After EPMC, Medicare can continue if
beneficiary pays the monthly premiums
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Must continue to have disabling condition
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State may pay Medicare premium through
the Medicare Buy-In program, if income
guidelines are met
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Programs designed to allow workers with
disabilities to buy into Medicaid at higher
income and asset levels
◦ First and only Medicaid work incentive
◦ Operating in 40 states
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Program features:
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Vary from state to state
Required to pay premiums
Eligible from 16-64 and above
Most offer ability to increase assets
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◦ Must have a disability to participate
◦ Must be working to participate
◦ Provides wrap around coverage for private
insurance
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More than 100,000 participants nationwide
Many offer participants the ability to retire
while maintaining eligibility
Utilize net income for eligibility on selfemployment
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o
o
o
7.8% of the general population is self
employed
12.2% of people with disabilities are self
employed
90% of businesses started by people with
disabilities are successful due to planning
and pre-determined supports
o
Provide greater flexibility and freedom to
the owner
o
Allow independence and autonomy
o
Provide greater income potential
o
Allow for building of assets
o
Accommodate some disabilities more
readily than wage employment
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Determine if it is self employment.
Determine Net Earnings from Self
Employment (NESE).
For SSDI, determine TWP
Determine countable earnings for SSDI and
SSI (NESE minus any applicable deductions).
Adjust checks accordingly.
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Is the beneficiary showing good faith
intention of making a profit or producing
income? AND
Is the beneficiary engaged in the activity
on a regular basis? AND
Is the beneficiary presenting him/herself
to others as ‘a business’?
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SSA will calculate the Net Earnings from Self
Employment (SSI and SSDI)
Utilize SSA deductions (IRWE, Unpaid help
etc..)
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Establish countable income
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Determine impact on benefit
o
Plan for Achieving Self Support
o
Individual Development Accounts
o
Vocational Rehabilitation Services
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SSI recipients submit their business plan to
SSA for approval as a PASS.
Expenses within the business plan may be
approvable for a PASS.
A SSI recipient must have NESE or assets in
order to fund the PASS!
May use SSDI as funds for PASS, making SSI
eligible
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Under the Rehab Act, VR agencies are allowed
to support self-employment as a goal and
can help to fund a business.
Rules vary from state to state and some
states have strict requirements.
VR agencies can work with other workforce
systems, such as the Small Business
Development Centers, to support individuals.
o
o
o
A matched savings account in cooperation with
a local bank; goal can be small business.
Individual Development Accounts may be used
on their own, or in conjunction with a PASS or
Family Self-Sufficiency Plan, to fund a business.
Federal IDA programs are exempt from most
public benefit programs like SSI. This means
that what the individual deposits, matching
deposits and interest earned will not count as a
resource.
Pizza Restaurant Owner:
o Developed PASS to fund rent for restaurant
($35,000).
o State VR funded a Business Enterprise Program
grant ($50,000).
o Individual Development Account containing wages
from previous employment ($15,000)
$100,000 for the Business!!
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www.start-up-usa.biz
http://www.worksupport.com/resources/listCont
ent.cfm/5/2/0
http://digitalcommons.ilr.cornell.edu/edicollect/
53/
www.griffinhammis.com
Self Employment For People with Disabilities
http://www.brookespublishing.com/store/books
/griffin-6520/index.htm
Work Incentive Planning and Assistance
◦ Information and Referral
◦ Benefit Problem Solving and
Advocacy
◦ Benefits Analysis and Advisement
◦ Benefit Support Planning
◦ Benefit Management
SSA’s Website
https://secure.ssa.gov/apps10/
oesp/providers.nsf/bystate
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Provides beneficiaries with more choices
for receiving employment services
Provides greater incentives for entities
providing employment services
•
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Employment Network (EN)
Any qualified State, local, or private
entity
Assumes responsibility for coordination
and delivery of employment services,
vocational rehabilitation services, or
other support services under the Ticket
to Work program
see www.yourtickettowork.com for list in
our area
 1-866-968-
7842(yourticket)
 TDD
1-866-833-2967
INFORMATION
WWW.SSA.GOV
Red Book on Work Incentives
SSA Employment Support Programs WWW.SSA.GOV/WORK
www.yourtickettowork.com
1-800-772-1213
Joe Entwisle
312.401.3909
www.nchsd.org
jentwisle@hdadvocates.org
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