Benefits Training and Consulting

December Newsletter

December 5, 2012 

 Contents of this Newsletter

1.  Questions and Answers

2.  New Social Security Ruling

3.  Pre-Publication Sale

4.  Do You Know What Is Expected?

5.  Scheduled Workshops

Questions and Answers

The purpose of this section of the newsletter is to continue expanding your knowledge of Social Security benefit programs and other benefits received by individuals with disabilities.  Here is a sample of the questions I have recently received.  If you have a question about a benefits please send it to me.

Question:

Thank you for your help.  I contacted you several weeks ago about an individual that went into 1/3 reduction "in-kind" status.  I took your suggestion and had their payee ask for the BPQY form sent from SSA.  Due to this henow has a full SSI check and SSA is taking away his overpayment.

I have a new question for you.  I have an individual that has both SSI and SSDI.  He would only get $100 a month if he did not work due to his SSDI check being $598 a month he receives on the 3rd (of the month).  This individual is thinking about working more hours at the sheltered workshop.  I know that after $285 a month in gross wages he would not be eligible to receive a SSI check that month.  He has been working a schedule so that he does receive at least $5 a month of SSI so it is not at risk of being lost.  The question I have is there a limit that he can work up to SGA $1,020, as this would loose his SSDI as he earned his trial work periods and (is) past the 5-year extended eligibility period.  This happened years ago before I started working with him.  Cessation of benefits would occur right away.  He is worried that not getting at least $5 a month in SSI will have him lose his Medicaid card right away and SSI eligibility if he were unable to work in the future.  I am thinking he would still continue to have Medicaid and be SSI eligible whether he gets a check on the 1st (of the month) or not due to hvaing a disability but not sure how long this can go on before Medicaid would stop or if it is based on wages earned.  His vocational services are funded by Medicaid to attend the workshop.  Also not sure if there is a time limit to loose SSI eligibility either if he goes without a check for an extended time period based on wages.

Answer:

If his new wage (more than $325) brings his SSI payment to $0, he would move into Section 1619(b) of the SSI program - he would remain eligible for SSI but not receive a SSI payment, thus he mains eligible for Medicaid.  As long as he keeps his resources below $2,000 and continues to work, he will remain in Sction 1619(b) and his Medicaid is protected.  Section 1619(b) must be renewed annually.

You indicated he has completed his Trail Work Period and has been in his Extended Period of Eligibility for five years.  You are correct - if he performs Substantial Gainful Activity (SGA - $1,010 in 2012) Cessation of Disability will occur immediately unless he has Impairment-related Work Expenses and/or Special Work Conditions that would bring his countable earned income below SGA. 

If his countable earned income remains below $1,040 (in 2013) he will continue to remain in the Extended Period of Eligibility and receive his SSDI cash benefit.  Countable earned income below $1,040 would keep him in Section 1619(b) status of the SSI program and protect his Medicaid eligibility.

Question:

I know that Medicare has a 24-month waiting period.  If someone works during the 24 months after their disability begins and earns over SGA does that reset the waiting period?  If they stay below SGA are they ok?

Answer:

Working and the amount of wage does not affect the waiting period for Medicare, as long as the person remains entitled to SSDI.  If the person perform SGA during the first 24 months after entitlement to the benefit, Social Security may determine the person no longer disabled due to the amount a wage.

Question:

If someone is receiving SSI, and their family assists them with paying their rent, would that be looked at as a gift that could effect their social security.

Answer:

If an SSI recipient recieves money to assist him/her in paying rent, the amount received would be treated as unearned income and the SSI payment will be adjusted (reduced) by Social Security.  If the family pays the landlord a portion of the rent, the SSI recipient has "in-kind support" and the SSI payment can be reduced by up to 1/3.

Question:

I work for a non-profit agency that provides in-home support to disabled adults.  One of the individuals that I support receives $443 for SSI and $431 for SSA per month [person lives inCalifornia].  We have just received a letter from an unclaimed asset recovery consultant declaring that he is eligible to receive a life insurance death benefit from his deceased wife.  The letter states that she has one account for $3,193 and a second for $833.  If we file the paperwork for him to claim this money, how will it affect his Social Security check(s)?

Answer:

The insurance death benefits will not affect his title II benefit (SSDI) or Medicare.

The insurance death benefits will affect his SSI and MediCal.  The month he receives the money it will be counted as unearned income, the SSI payment received that month will owed back to Social Security.  What amount remains in his possession at the beginning of the next month becomes a resource.  IF this amount brings his total resources over $2,000 his SSI cash benefit will be suspended until he brings his resources under $2,000.  He would also be over the resource limit for MediCal.

Question:

I am currently working with an individual on my caseload whi is 19 years old and her SSI benefits stopped.  By OPWDD standards [New York] she is considered developmentally disabled and qualifies for OPWDD services, however, after she turned 18 last year, she was required to go through mandated evaluations by the Social Security Administration and I was asked to rpovde them a copy of a recent psychological exam.  [This is called an "age 18 redetermination"]  This was all done and the end result was that she is no longer eligible to receive the SSI benefits, even though she remains a high school student and is not able to have gainful employment at this time.

Answer:

A child can qualify for SSI using the children's medical criteria that essential evaluates the child by comparing the child's basic daily functioning to an age-appropriate "norm."  When the person turns 18 years of age, the individual must re-qualify using the adult medical criteria that primarily measures whether the adult has the ability to generate $1,040 (in 2013) of countable earned income per month with the impairment.  Also, if the measured IQ is more than 55 the person probably will not qualify unless there are other significant impairments.

If her high school education program includes an Individualized Educational Plan (IEP), Social Security should place her into "Section 301 Special Payment" status.  Under this provision her SSI payment and Medicaid will continue as long as she has an IEP.  technically, she was found to have medically improved and is not eligible for SSI as an adult, but Social Security will continue the cash benefit under this status to enable her to be more employable at the completion of the high school program. 

 Social Security Issues Ruling

Note:  Social Security Rulings (SSRs) are precedential decissons relating to the Federal old-age, survivors, disability (title II), supplemental security income, special veterans benefits, and black lung benefits programs.  Social Security bases SSRs on determinations or decision made at all level of administrative adjudication, Federal court decisions, Commissioner's decisions, opinions of the Office of the General Clounsel, or other interpretations of the law and regulations.  Although SSRs do not have the same force and effect as statues or regulation, they are binding until Social Security rescinds or modifies the ruling.

Social Security (SSA) recently issued Social Security Ruling 12-1p for evaluating whther work performed by self-employed persons who are blind is substantial gainful activity (SGA) under the title II disability program.  In addition, this ruling clarifies what income does not count from the Randolp-Sheppard Act, and similar program operated by states, as earnings when determining whther blind person are engaging in SGA.

Evaluation of work performed by self-employed persons who are blind.

SSA will evaluate self-employment work activity based on whether the blind person has received a substantial income from the business and rendered signficant services to the business.

   Substantial Income  -  To determine if the person has achived substantial income, SSA will use the Internal Revenue Service rules to determine gross income, deductions, and net income from self-employment.  Next, SSA will deduct 1) the reasonable value of any significant amount of unpaid help furnished by the person's spouse, children, or others; 2) impairment-related work expenses (if they are not deducted as business expenses); and 3) un-incurred business expenses.  The income remaining after all applicable deductions represent the acutal value of work performed and is the amount SSA will use to determine whether the person has enggaged in SGA.  If the countable income is above SGA ($1,740 in 2013), SSA will then evaluate whether the person rendered significant services to the work activity.

   Significant Services  -  If the blind person operates a business alone, SSA considers any services rendered to be significant to the business.  If the business invloves the servuces of more than one person, SSA will evaluate the acutal services rendered by the blind person to determine whether the services are significant.  SSA will consider services significant of the blind person provides more than half the total time needed to manage the business, or more than 45 hours per month, regardless of the toal management time the business required.

Income derived from the Randolph-Sheppard Act and similar programs.

This portion of the ruling applies to vending services under the Randolph-Spehhard Act.  The Randolp-Sheppard Act established a set-aside contract program for person who are blind to provide services as a business on Federal property.  The most commonly known businesses are concession stands, restuarant facilities, and vending machine services.

SSA has ruled the income the blind vendor recieves from the operation of the vending business is self-employment income.  In addition, under the Randolp-Sheppard Act, a blind vendor who operates a vending business on Federal property may also receive income from other vending machine that are located on the same property, even though the blind vendor does not service, operate, or maintain these vending machines.  SSA has determined the income received from vending machines not services by the blind vendor will not be counted in determining SGA.  This decision also applies to self-employed blind benficiaries operating vending services in states which offer similar set-aside contracts in state facilities.

Pre-Publication Sale

Limited Time - Save 40% or more

Each year, at this time, I offer a Pre-publication Sale of the upcoming edition of "THE GUIDE: Social Security Benefits and Work Incentives." 

The 2013 version will be the 21st Edition of this popular refernce manual.  "THE GUIDE" clearly explains how wage and other income affects entitlement to title II benefits (SSDI and Childhood Disability Benefits) and how income affect eligibility for SSI and Medicaid.  "THE GUIDE" contains numerous examples and tables.  Over the years, customer have used the publication as a desktop refernce when counseling beneficiaries. It has helped many people avoid overpayments.

The two handbooks on how to manage benefits and income are also on sale.  "Managing Your Title II Benefit and Income Handbook" and "Managing Your SSI Benefit and Income Handbook" shows people how to properly reprt income to Social Security and maintain records.  Individuals, families, representative payees, and support staff have used these techniques for years to maintain records and facilitate budgeting of all income.

The Pre-publication Sale will last until December 31st.  Orders placed now will be shipped beginning December 26h.  During this sale the normal publication rpices are reduced 40% and greater if multiple copies are ordered.

For more information and to order [Click here]

Do You Know What Is Expected?

During the workshops I coducted this year, I noted a large number of participants have little knowledge of the Ticket to Work Program.  Maybe, this is because many of the attende new to the field of serviing individuals with disabilities.  So I went back (again) to Social Security's resources on the Ticket to Work program to see what has been added, and I discovered something very important is not available to beneficiaries who are considering their involvement in the program (at least I couldn't find it).

Background:  Under federal law, Social Security (SSA) has the responsibility of assisting title II beneficiaries and SSI recipients (herein called "beneficiaries) to return to work or attain employment.  Prior to 1999, SSA met this responsibility by entering into contract with all state vcational rehabilitation agencies (state VR agencies) to provide services to Social Security beneficiaries and if the beneficiary achieved specific wage standards for a period of time, the state VR agency could seek reimbursement of their costs and adminsistrative overhead in serving the individual from SSA.   This is know as a cost-reimbursement contract and it continues to be in polace between SSA and state VR agencies.

The Ticket to Work program became law in 1999 as part of the Ticket to Work and Work Incentives Improvement Act of 1999 (the Act).  The Act gre out of Congress's concerne (at the time) of the rapid increase in enrollment in the benefit programs and the low number of beneficiaries leaving the benefit roles as self-sufficient employed individuals.  Congress took the position that more beneficiaries would go to work if they had a choice of wo they receieved employment services and support services from.  Thus the Ticket to Work program ebalbed a wide variety of qualified individuals, companies, organizations, and public agencies to enter into contract with Social Security to serve beneficiaries, as Employment Networks (ENs).  The program enabled beneficiaries to "assign their ticket" to an EN of their choice.  In other words, the beneficiary and the EN had developed a plan of service and the plan was approved by Social Security's program manager of the Ticket program.

State VR agencies continued to be available to beneficiaries for vocational rehabilitation services and employment services.  State VR agencies were given the opportunity to choose to serve the beneficiary under the cost-reminbursement contract or as an EN.  Today, state VR agencies continue to provide services to the majority of beneficiaries seekin employment.

In addition, the Act addressed a commonly held concern (in 1999) that Social Security would determine a person had medically improved of s/he worked.  Under the provisions of the Act, Social Security is prohibited from initiating a medical review of the beneficiary has "assigned" the ticket or was being served by a state VR agency under the cost-reimbursement contract.  SSA is permitted to conduct a medical review that was intiated prior to the assignment of the ticket or prior to the agreement of Individualized Plan of Employment (IPE) with a state VR agency.  Thus, the Ticket to Work program significantly reduced the possibility of Social Security determining a beneficiary medically improved simply because s/he is working.

But what does it take to keep the ticket "assgned" and continue to avoid medical reviews?

I discovered this information is not readily available to beneficiaries and, as a result, beneficiaries could be misled in their decision to participate in the program.  Beneficiaries have the right to know what is expected of them if they chose to participate in the "Ticket to Work" program.

The regulations governing the Ticket to Work program require SSA to periodically measure a participant's progress in achieving self-sufficiency.  If a beneficiary is unable to achieve a specific measurment of progress the "ticket" is no longer assigned and SSA is permitted to conduct medical reviews while the "ticket" is not assigned.

For example, if the beneficiary is not participating in a post-secondary education program and assigns her/his ticket, here is the progress Social Security expects:

1.  In the first twelve months following assignment of the ticket, the beneficiary must work for three months (out of twelve) with gross earnings over $750 (in 2013) per month.

2.  In the second twelve month period, the beneficiary must work for six months (out of 12) with gross earnings over $750 (in 2013) per month.

3.  In the third twelve month period, the beneficiary must work for nine months (out of 12) with gross earnings over the SGA amount ($1,040 in 2013) per month.

4.  In the fourth twelve month period, the beneficiary must work for nine months (out of 12) with gross earnings overs the SGA amount ($1,040 in 2013) per month.

5.  In the fifth twelve month period, the beneficiary must work for six months out of twelve with earnings high enough to stop the title II cash benefit (SSDI, CDB, DWB) or the SSI cash benefit.

6.  In the sixth twleve month period, the benefiary must work for six month out of twelve with earnings high enough to stop the title II cash benefit or the SSI cash benefit.
7.  In all subsequent twelve-month periods, the beneficiary must repeat step #6.

(There are other progress standards for beneficiaries engaged in post-secondary education prior to employment.)

In the beneficiary does not meet the progress expected in any twelve-month period above, the "ticket" is no longer assinged and Social Security is then permitted to conduct a medical review when a Continuing Disability Review is next intitiated.  The beneficiary can re-assign the "ticket" at a later time.

Upcoming Workshops

The following "Benefit and Emplyment in 2013" workshops are scheduled.

      January   7, 2013   Lafayette, LA

      January   8, 2013   Baton Rouge/ Port Allen, LA

      January   9, 2013   Mobile, AL

      January 10, 2013   Pensacola, FL

      January 11, 2013   Tallahassee, FL

[Click Here for More Information]

I am currently planning to conduct workshop in:

    Northern California   late January

    Florida                         February

    Southern California   February

    Oregon                        March

    Washington                 March

I'll annouce the specific dates and locations when scheduling is completed.

 Are You Interesting in Hosting a Workshop?

I am looking for agencies and organization interested in hosting a live presentation of "Benefits and Employment in 2013."

By serving as the host for a workshop, the organization will have ten free seats.  This certainly reduces staff training costs, particiularly when your program is on a tight budget. 

I ask the host organization to provide meeting space, for approximately 35-40 people in a classroom setting. The host organization is responsible for providning light refreshment (coffee, soda, snack food).  I can reimburse the organization up to $100 toward this expense.  I also ask the host organzation to distribute an advertisment of the workshop to local contacts, as they have a better distribution list of contacts in the local area.  I'll supply the advertisment.

Benefit Training and Consulting will provide the training materials and audio-visual equipment.  In addition, I take care of all rgistrations matters and the confirmation of registration.

Host organizations have used a variety of free local meeting space when their facility was inadequate to accomodate the workshop.  The meeting space must be accessible to individuals with disability.  Over the past 20 years, I have done workshops in a wide variety of settings.

Let me know if you are interested [Click Here to Send Email]

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HAVE A GREAT HOLIDAY SEASON.

Please remember to help people

 not as fortunate as you. 

Sincerely,
Mike Walling

Benefits Training and Consulting | | wallinginc@aol.com | PO Box 1483
Chadds Ford, PA 19317