OREGON’S
WORK INCENTIVES NETWORK
(WIN)
When you work, you WIN!
http://www.win-oregon.com
This presentation is sponsored by The Oregon Competitive Employment Project, which is part of the Oregon State Department of Human Services, Office of Vocational
Rehabilitation Services funded through a Medicaid Infrastructure Grant from the U.S. Centers for Medicare and Medicaid Services (CFDA #93.768).
Updated April 2010
SOME BASIC TERMS YOU MIGHT NOT KNOW
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SSA: Social Security Administration
SSI: Supplemental Security Income
SSDI: Social Security Disability Insurance
Office of Vocational Rehabilitation Services
Other Federal & State Benefits Training
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Temporary Assistance to Needy Families (TANF)
Supplemental Nutrition Assistance Program (SNAP)
Housing Assistance (HUD)
Unemployment Insurance
Medicare Savings Programs (QMB)
Low Income Subsidy (LIS)
Medicaid (OHP or OHP+)
Overview of Title II
To be eligible for a T2 benefit based on disability:
• Have insured status based on:
• Own work record (SSDI)
p. 19
• Parent’s work record (SSCDB)
• Deceased spouse’s work record (SSDWB)
• Meet SSA’s Definition of Disability:
• A person must be determined to be medically
disabled
• Not be working or earning less than SGA
THE BASICS:
SSDI PAYMENT AND HEALTH CARE SYSTEM

SSDI – Cash Benefit:
Be disabled by SSA definition: and
 Be “insured” or draw off “insured” worker who is
disabled, retired, deceased. Amount varies based on
work history. No asset test.
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SSDI – Health Care:
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Medicare (after 24 month waiting period).
Office of Vocational Rehabilitation Services
Social Security Disability Insurance (SSDI)
Reach Insured status based on your own work
record:
• 20 credits earned of all credits needed, at
p. 19
least in the 10 years prior to onset of
disability
• Those disabled prior to age 31 need less to
qualify
• Possible to earn up to four credits per year
• One credit = $1,120 for 2010
Childhood Disability Benefits
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To be eligible for Social Security as an adult
child with a disability individuals must be:
 18 years of age or older
p. 20
 Disabled by SSA’s definition before age 22;
and,
 Child of an insured worker who are either
disabled, retired or deceased.
 If child marries, benefits end unless marriage is
to another Title II beneficiary
Disabled Widow(er) Benefits

To qualify a widow(er) must be found disabled before
the end of a certain period:
 Month of a spouse’s death
p. 20 Last month of entitlement to mother’s benefits
21
 Last month of previous entitlement to DWB
 DWB are not payable prior to age 50
 Must meet specific disability criteria
 Waiting period of five consecutive calendar months
Title II Disability Check Amounts

Check amount is based, in general, on amount
paid in FICA taxes. Varies from person to person
 Total Family Benefit: Max amount all dependents
can draw, split between number of dependents
 CDB/DWB: check amount is a % of the insured
workers benefit. Varies as well.
 If Insured Worker is drawing a benefit check,
their amount is not reduced/changed if CDB is
being drawn.
THE BASICS: SSI PAYMENT
AND HEALTH CARE SYSTEM
SSI - Cash
 Disabled by SSA definition;
 Little to no assets; under $2,000 for an individual,
$3000 for a couple;
 Little to no income; and
 Benefit Amount for 2011 is $674, $1,011 for a couple,
reduced by other income.
 SSI – Health Care
 Medicaid.
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Office of Vocational Rehabilitation Services
The SSI Calculation
Step
Unearned Income
General Income Exclusion (GIE)
Countable Unearned Income
Gross Earned Income
Student Earned Income Exclusion
Remainder
GIE (if not used above)
Remainder
Earned Income Exclusion (EIE)
Remainder
Impairment Related Work Expense (IRWE)
Remainder
Divide by 2
Blind Work Expenses (BWE)
Total Countable Earned Income
Office of Vocational Rehabilitation Services
Calculations
=
-
Total Countable Unearned Income
Total Countable Earned Income
PASS Deduction
Total Countable Income
Base SSI Rate (check for VTR or PMV)
Total Countable Income
Adjusted SSI Payment
+
=
-
-
=
Total Income
Unearned Income
Adjusted SSI
Wages
TOTAL INCOME
=
Resource Test
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The SSI program has specific resource limitations set
by statute and include real or personal property
(including cash).
 Limits - $2,000 single / $3,000 couple
p. 3334  Not subject to regular COLAs
 Limit cannot be exceeded at the beginning of each month
 Resources in excess will render individuals ineligible for
SSI cash benefits
 Ineligibility will continue until resources fall below
allowable limits
 Eligibility will cease if excess continues for 12
consecutive months
Countable and Excluded Resources
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Countable: most assets are counted, such as
 Bank accounts, stocks/bonds, property you don’t live
on
 Excluded Assets: there are a few assets that don’t count,
such as
 The house you live in, a car you use for medical/work,
special needs trust, Property Essential to Self Support
(work incentive)
 Key: does person have access to it to pay for food and
shelter
SSI is the “2 to 1” Benefit
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Every $2 earned causes a $1 cash reduction
SSDI is about phases and SSI is about a calculation
SGA is not a consideration with SSI benefits
Work Incentives keep more cash in a beneficiary’s
pocket
Many ways to stay connected to SSI and Medicaid if
working
Office of Vocational Rehabilitation Services
Living Arrangements

Must first determine household or non-household
 Primary household living arrangements:
◦ Non-institutional care
◦ Home ownership
p. 29◦ Rental liability
31 ◦ Public assistance households
◦ Separate consumption
◦ Separate purchase of food for oneself
◦ Sharing
◦ Earmarked sharing
 Determinations are subject to SSA appeals process
Medicare Coverage
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Five month waiting period from month of onset of disability
for cash benefit
Additional 24 month qualifying period for Medicare
coverage
Months needn’t be accumulated consecutively
Months accumulated can be applied to subsequent case
should entitlement cease due to SGA and entitlement be
re-established
If 24 months completed prior to losing entitlement and reestablished within 5 years (7 for CDB), 24 add. months not
required
Four Part Medicare
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Hospital Insurance / Part A
 financed through FICA
 pays for inpatient hospital care and certain follow-up
p. 57
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Medical Insurance / Part B
 pays for doctor’s services and variety of other medical
services not covered under Part A
 voluntary and financed through monthly premiums paid
by beneficiaries opting for coverage ($96.40)
Four Part Medicare
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Managed Care / Part C
 Generally administered by HMO type health care
agencies.
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Prescription Drug Coverage / Part D
 Provides prescription drug coverage for Medicare
covered participants.
Extended Medicare Coverage
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Extended coverage (Part A free) - a minimum of
93 months following the conclusion of the TWP
Beneficiaries can buy into the Medicare program
p. 59
once the extended Medicare coverage is
exhausted. Medicaid may help pay Part A
premium if under income threshold
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They must no longer be entitled to benefits
because of having earnings above SGA and must
have extended period of Medicare eligibility.
Keeping Access to Medical Assistance
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A person with a disability who works in Oregon will
very likely have access to medical benefits.
 Medicaid Continuation (1619b)
 Employed Persons with Disabilities
 Medicare Continuation
 Medicare for Persons with Disabilities Who Work
Office of Vocational Rehabilitation Services
Oregon’s Work Incentive Network (WIN)
WIN is a benefits and work incentives planning service that
helps people with disabilities:
1.
2.
3.
MAKE INFORMED DECISIONS about work and
their benefits;
USE WORK INCENTIVES to achieve their
employment goals; and
NAVIGATE THE BENEFITS SYSTEMS when they
begin working.
Office of Vocational Rehabilitation Services
Other Federal & State Benefits Training
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TANF
SNAP
Housing Assistance
Unemployment Insurance
Veteran’s Benefits
Medicare Savings Programs
Low Income Subsidy
Medicaid
Temporary Assistance to Needy Families
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Program Intent
 Provide
cash assistance to needy families
 Case management
 Promote personal responsibility and accountability
 Reduce families living in poverty by promoting self
sufficiency, employment & community resources
PRE-TANF
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Program Intent
 Provide
screenings, case management & cash
assistance to needy families
 Holistic assessment; including the whole family,
strengths, needs, goals
 Focus on family stability, employment and self
sufficiency
TANF Grant Amounts
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Typical grant amounts:
2 person = $448, income limit = $499
 3 person = $528, income limit = $616
 4 person = $647, income limit = $795
 5 person = $747, income limit = $932
Examples above are maximum benefits
based on 0 income.
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TANF and Employment
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Example:
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Family of 3, TANF countable income $616. They were
receiving a full TANF grant of $528 based on 0 income. New
job with earnings of $600 per month. Family is still below
countable income of $616.
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When looking at income computer will calculate:
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Earned income at 50% reduction
Grant of $528 - $300 = $228 new grant amount
Supplemental Nutrition Assistance Program
Basic Eligibility and Program
Requirements
SNAP
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The intent of the SNAP Program is to improve
the health and well-being of eligible individuals
by providing a means to meet the nutritional
needs.
Basic requirements
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Must have a valid Social Security Number
Must be a US citizen or meet certain alien
status requirements
Must participate in the OFSET program
Students must meet certain criteria
Financial Eligibility
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Categorical eligibility
185% of the Federal Poverty Level
Deductions
Clients are responsible for:
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Reapplying for benefits and responding to
Interim Change Reports
Responding to requests for additional
information from their worker
Knowing their reporting requirements and
reporting when required
Housing Choice Vouchers (HCV):
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Provides tenant-based rental assistance in
privately-owned units
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Tenants pay rent based on income
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Rental subsidy is paid by Housing Authority
(HA) to landlord
32
Public Housing:
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Project-based rental assistance in housing units
owned and managed by HA
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Tenants pay income-based or flat rent
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Housing authority performs repairs, annual
inspections, collects rent, etc.
33
Public Housing vs. Vouchers
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Public Housing is owned
and managed by the local
public housing authority
(PHA or HA).
 Housing Authority
serves as the landlord.
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Subsidized housing or Housing Choice Vouchers (a.k.a.
Section 8) is owned and operated by private owners, individuals, or
landlords.
 Housing Authority is not the landlord
 HA provides rental subsidies to private owners/landlords
 Subsidy follows the tenant, not the property
34
Rental Developments
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Multifamily Housing (HUD) is where the
subsidy is given to the owner, who provides
affordable housing to low-income families. The
housing subsidy stays with the property.
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Rural Development (USDA), similar to
Multifamily Housing, subsidized rental
assistance to low-income individuals and
families in non-metropolitan settings
35
Participant Eligibility
Must be a U.S citizen,
national or non-citizen
with eligible immigration
status.
Must meet the low-income
guidelines as published by
HUD.
36
Income Limits
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Income Limits:
http://www.huduser.org/DATASETS/il.html
 30%
of the Median
 Very Low Income
 Low-Income
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30% of the Median:
 40%
of all public housing admissions
 75% of all housing choice voucher admissions
37
The Application Process
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Pre-application completed – income is
calculated and eligibility determined
Applicant is placed on waiting list
Some HAs have wait list preferences, i.e.,
 Homeless
 Current
county/city resident
 Terminally ill
 Young and disabled (for Mainstream only)
38
The Application Process
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Initial Screening and background check—must
deny applicants for certain crimes
HAs may deny for other reasons
 Owing
a HA money
 Committed fraud
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Income, assets, and deductions are verified by
third party source
39
The Application Process
Applicant reaches top of waiting list
 Applicant attends briefing/orientation
 Applicant receives a ‘voucher’, and
housing search begins
 Applicant finds unit, landlord completes
Request for Tenancy Approval form.
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40
Unemployment Insurance Program
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Program Intent
 “Pay
benefits promptly to claimants who are out
of work through no fault of their own.”
Office of Vocational Rehabilitation Services
Eligibility for Unemployment Insurance
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There are three tests an individual must meet to
qualify for unemployment insurance:
 Be
unemployed as defined in state law,
 Qualify as a worker based on prior employment,
and
 Be out of work through no fault of his/her own.
Office of Vocational Rehabilitation Services
Ways to Qualify for Unemployment Insurance
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There are two ways to qualify:
 Be
paid at least $1,000 in wages from employment
subject to UI law AND have total base year wages
equal to or exceeding one and a half times the
wages paid in the highest quarter of the base year,
or
 Have some wages paid in the base year and
perform at least 500 hours of work during the base
year at employment subject to UI law.
Office of Vocational Rehabilitation Services
How Benefit Amounts are Determined
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The weekly benefit amount (WBA) is 1.25 percent of the wages
paid during the base year from subject employment, within
minimum and maximum amounts set by law.
The minimum weekly benefit is $115 and the maximum weekly
benefit is $492 for new claims filed effective June 28, 2009.
Beginning with claims filed effective July 4, 2010 the minimum
WBA will be $116 and the maximum $496. Benefit amounts for
claims effective before July 4, 2010 will not change.
Office of Vocational Rehabilitation Services
Maximum Benefit Amount for UI

The maximum benefit amount (MBA) is the total
regular benefits a person can draw during the
lifetime of the claim. For most people, the MBA
is 26 times the weekly benefit amount.
However, people who have very low base year
wages qualify for the lesser of 26 times the
weekly benefit amount or 1/3 of the total base
year wages.
Office of Vocational Rehabilitation Services
Qualified Medicare Beneficiaries
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QMB provides additional medical coverage for
Medicare recipients. When used alone, QMB
refers to all QMB programs.
Sometimes these programs are referred to as
“Medicare Savings Programs”, or MSPs.
The QMB programs are:
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QMB-BAS: Qualified Medicare Beneficiaries - Basic.
The basic QMB program.
QMB-SMB: Qualified Medicare Beneficiaries Special Medicare Beneficiary.
QMB-SMF: SMB, Full federal reimbursement.
SBI: State Buy-In. For Medicare Part A beneficiaries
with countable incomes above 135% of the Federal
Poverty Level. SBI is a case descriptor, not a
program. More on this later.
QMB benefits
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QMB-BAS: payment of Medicare Part A and
Medicare Part B premiums, co-pays and
deductibles. QMB-BAS is considered a
medical benefit and recipients receive a
medical card.
QMB-SMB/SMF and SBI: payment of Medicare
Part B premiums only. SMB, SMF, and SBI are
not medical benefits.
QMB Non-financial Eligibility Requirements
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To receive QMB or any of its subprograms, an
individual must be receiving Medicare Part A.
(OAR 461-135-0730)
A person does not have to receive Medicare
Part B benefits to be eligible for QMB benefits.
Medicare Part D
Prescription Drug Program
and Low Income Subsidy
(Extra Help)
Prescription Drug Plan
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Beneficiaries enroll themselves through
participating drug plan (PDP)…
SSA does not process Part D enrollments
Beneficiaries enroll during an enrollment period
Participants must meet deductible, premium and
copayment responsibilitioes
Premium amount will vary from plan to plan
Part D
Participation voluntary
 CMS can assist a beneficiary in enrolling in a
plan through its website
http://www.medicare.gov
 Refer all questions regarding Part D coverage to
1-800-Medicare
 Beneficiaries can also get assistance selecting a
plan through their State Health Insurance
Counseling and Assistance Program (SHIP)
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Medicaid (OHP+) Eligibility for People with
Disabilities
Doors on the House of Medicaid
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Specifically for People with Disabilities
1.
2.
3.
4.
5.
6.
7.
8.
SSI
Former SSI Recipients:1619(b)
Former SSI Recipients: DAC/CDBs
Former SSI Recipients: Pickle
Former SSI Recipients: DWB
300%
Mental Health Non-Waivered
Employed Persons with Disabilities
Order of Use

If eligible for SSI, 1619b, or any of the Former
SSI Protected groups, those should be used
first.
 There
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is no monthly premium/fee/liability
If not eligible for those doors, determine most
cost effective door to use
 300%
or EPD
 MH Non-Waivered or EPD
Your Role
1.
2.
Is NOT to determined eligibility
Is to verify eligibility
During comp intake ask a few questions
about the person’s situation to be sure it
matches the Medicaid group they are
going under
 When verification comes back, check to
make sure everything matches.
 If you find someone could be better off
under a different group; contact case
worker, pull in Medicaid Policy Analyst
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IT TAKES A TEAM TO REMOVE THIS BARRIER
You can’t do your job AND be a Work Incentive Expert..…..
BUT YOU CAN:
1.
Let people know there are WORK INCENTIVES
that support their employment efforts;
2.
Recognize MYTHS and communicate FACTS; and
3.
Encourage people to connect to WIN for more
individualized analysis.
Office of Vocational Rehabilitation Services
QUESTIONS?
CALL THE WIN STAFF IN YOUR AREA!
Or for more information about WIN:
http://www.win-oregon.com
Office of Vocational Rehabilitation Services