Slide 1: Our logo became effective 3/31/95 when SSA became an Independent Agency. The following proposed talking points are provided for your review. You may find them useful as a resource for you or for your fellow employees. In no way are they intended to be all inclusive. Virtually all of the information contained within the talking points was derived directly from our Intranet Website. We hope they will be useful in supplementing your presentation. HELPFUL HINT: To view talkers in PowerPoint, go to “View” on toolbar and select “Note Pages.” To print talkers, go to “File”, then “Print” and under “Print What”, select “Note Pages.” Slide 2: 24-hour Telephone Service: 1-800-772-1213 Slide 3: Social Security Website: www.ssa.gov.work 1. Publications: HANDOUT! •Disability (5/96) •Project ABLE: able beneficiaries' link To employers (12/97) •Reviewing your disability (6/97 •Social security: benefits for children with disabilities (04/96 •Social security: if you are blind how we can help (6/96 •Social security: what you need To know when you get disability benefits (6/98) •Social security benefits for people living with HIV/AIDS (05/95) •Social security disability programs can help (9/95) •A guide to social security and SSI disability benefits for people with HIV infection (5/97) •Disability based On drug addiction Or alcoholism (5/96) •How we decide if you are still disabled (4/96) •How social security can help with vocational rehabilitation (6/970) •Receiving your benefits By direct deposit (8/96) •Working while disabled...How we can help (1/97) •Work incentives For people with disabilities (redbook) 2. Legislative Highlights 3. Press Releases 4. Law and Regulations and much more! Slide 4: The Social Security Administration administers two programs that provide benefits based on disability: Social Security Disability Insurance (SSDI) (Title II SSAct-- To individuals "insured" by their contributions to the Trust Fund through the SS tax on their earnings, or to their spouses/children. Supplemental Security Income Program (SSI) (Title XVI SSAct)--individuals (including children under age 18 ) who have limited income/resources. These programs are similar in many respects but also have Important differences. Here's where we run into trouble. I always tell people that the two programs are more different than alike. Slide 5: SSDI Paid from Social Security disability insurance trust funds Average benefit--$789/mo. for a disabled worker. Slide 6: SSDI- Eligibility Requirements The worker must : Have worked and paid SS taxes (FICA) - Be “DIB insured”, or - Be Currently “insured” - Special “Statutory Blindness” insured The claimant must be: - The worker or worker’s dependent - Medically disabled - Not working or earning less than SGA As You Work and Pay Taxes, You Earn Credits That Count Toward Eligibility for Future Social Security Benefits. You Can Earn a Maximum of Four Credits Each Year. Most People Need 40 Credits (10 Years of Work) to Qualify for Benefits. Younger People Need 20 Credits out of the last 40 quarters to Qualify for Disability or Survivors Benefits. $700 per quarter for 1998. $740 per quarter for 1999. Slide 7: SSDI-How We Figure Payment Amounts - Benefits are based on worker’s lifetime average earnings covered by Social Security - Reduced by workers comp, black lung, and other public disability benefits Figuring Social Security Benefits Your Social Security benefit is a percentage of your earnings averaged over most of your working lifetime. Social Security was never intended to be your only source of income when you retire or become disabled, or your family's only income if you die. It is intended to supplement other income you have through pension plans, savings, investments, etc. Low income workers receive a higher rate of return than those in the upper income brackets, but a worker with average earnings can expect a retirement or disability benefit that represents about 42 percent of his or her average lifetime earnings. To get a free estimate of the retirement, disability and survivors benefits that would be payable to you and your family, call Social Security at 1-800-772-1213. Slide 8: SSDI-Waiting Period A worker who becomes disabled must wait 5 full calendar months after the onset of the disability before receiving SSDI benefits. No new waiting period is required, if a worker returns to the disability rolls within 5 years of leaving the rolls. NOTE: Children, widows, and widowers are subject to different rules. Slide 9: SSDI-Medicare SSDI recipients get medical coverage via Medicare AFTER 24 months on the rolls (Medicare Qualifying period). The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. During this qualifying period for Medicare, an SSDI beneficiary may be eligible for health insurance through a former employer or through SSI eligibility. The beneficiary should contact the employer for information about health insurance coverage. One month is counted for each month of disability benefit entitlement. Slide 10: ... inability to engage in any substantial gainful activity by reason of any medically determinable...impairment which can be expected to result in death or which has lasted or can be expected to last for…not less than 12 months. SSDI-Definition of Disability: Return to work within 12 months can lead to reopening and disallowance based on a finding that the individual did NOT meet the definition of disability when he/she applied. Medical evidence of MEDICAL recovery can be considered at any time. Slide 11: SSDI-Substantial Gainful Activity: The performance of (work) activity for pay or profit.. Earnings over $500 per month for the non-blind--since 1990. Effective July 1, 1999-earnings over $700 per month. Earnings over $1170 per month for the blind for 2000, $1240 per month in 2001. Applies to initial eligibility . Applies to continuing eligibility After the TWP. Describes a level of work activity that is both substantial and gainful. Performance of significant physical or mental duties, or a combination of both, which are productive in nature. Gainful work activity is: Work performed for remuneration or profit; or Work of a nature generally performed for remuneration or profit; or Work intended for profit, whether or not a profit is realized. Need not necessarily be performed on a full-time basis; work activity performed on a part-time basis may also be substantial. In short, when an individual generates earnings from work during a period of alleged disability, those earnings are generally used to measure the individual's ability to engage in SGA. However, low or no earnings during a period of work activity do not establish inability to engage in substantial gainful activity. The circumstances under which work is performed must be considered. If work is performed under special conditions (e.g., in a sheltered workshop) only the earnings attributable to the individuals' own efforts are considered. In the SSDI program, SGA is an eligibility factor for both initial claims and for continuing eligibility (after the trial work period). For people who are non-blind persons, earnings after 1989 averaging over $500 a month will generally demonstrate that the individual engaged in SGA Slide 12: New Regulation Changes SGA amounts are now indexed and increased to earnings over $740 effective 01/01/01. Slide 13: SSI Program Based on Financial Need; amount of income, resources, & living arrangements affect monthly payment amount. - Paid from General Tax Revenues. Slide 14: SSI-Eligibility requirements: Age 65, or blind, or disabled Limited Income Limited Resources Citizenship/Legal Residence Slide 15: SSI Federal Benefit Rates (FBR) Individual---$531 per month for 2001 Couple--$796 per month for 2001 Michigan supplements the monthly amount $14.00 Michigan provides Medicaid to SSI eligibles. Slide 16: How we compute SSI payment amounts: Federal Benefit Rate + State Supplement amount - countable income = $$I payment amount Slide 17: No waiting period. No benefits for dependents. Slide 18: ... inability to engage in any substantial gainful activity by reason of any medically determinable...impairment which can be expected to result in death or which has lasted or can be expected to last for…not less than 12 months. (the same as SSDI) SSI-Definition of Disability: Slide 19: What are SSA’s work incentives? They are SSA’s rules that help disability beneficiaries go to work and continue to receive benefits as they test their ability to become more independent. The SSDI and SSI programs should not be viewed as exclusive and permanent sources of income to the person with disabilities. They should, in every case possible, be used as stepping-stones to improving a person's economic condition. Work incentives are intended to give beneficiaries the support they need to move from benefit dependency to self-sufficiency. The work incentives are designed to help people with disabilities enter or reenter the workforce by protecting their entitlement to cash payments and/or Medicaid or Medicare protection, until they can support themselves. Most people with disabilities want to work. It is important for disability beneficiaries to understand that they can still receive benefits while they try to work. Anyone who represents or deals with working SSDI or SSI beneficiaries should encourage them to contact the Social Security Administration and ask work incentives and how they can affect their benefits. Work incentives provide support over a period of years to allow the disability beneficiary to test the ability to work and gradually become self-supporting and independent. In general, a person has at least 4 years to test the ability to work, including full cash payments during the first 12 months and a period in which cash benefits can be started again without a new application. The person continues to have Medicare coverage during this time. Slide 20: SSDI-Work Incentives -- Trial work period -- Impairment-related work expenses -- Subsidy -- Unsuccessful work attempt -- Unincurred Business expenses -- Extended period of eligibility -- Continuation of Medicare coverage --Continued payments under a vocational rehabilitation program Slide 21: SSDI-Trial Work Period (TWP) In General, 9 months (not necessarily consecutive) within a rolling 60 month period during which an SSDI beneficiary may test his/her ability to work and continue to receive benefits. A TRIAL WORK PERIOD is provided as an incentive for personal rehabilitation efforts for disabled workers, disabled widow(er)s and childhood disability beneficiaries who are still disabled but who return to work, whether or not under State plans of rehabilitation. It allows them to perform services in as many as 9 months (within a rolling 60-consecutive-month without losing benefits during the trial work period (if their impairment does not improve). (Since benefits will continue for the month the disability is determined to have ceased and the 2 months after that, benefits may be paid for at least 12 months during which the individual works.) Any work and earnings during these 9 months is disregarded in determining whether disability ceased during the trial work period. However, work done in or after the trial work period is considered in determining whether the disability ceased after the end of the trial work period. Moreover, the trial work period does not prevent the consideration of any medical evidence that may demonstrate recovery before the ninth month of trial work. Thus, it is possible for benefits to terminate before the ninth month of trial work. Only one trial work period is allowed in any one period of disability. Entitlement to a trial work period begins with: The month in which the worker with a disability becomes entitled to disbility benefits, Or the month in which the application is filed, whichever is later. A person is not entitled to a trial work period if he or she is not entitled to disability benefits. Slide 22: SSDI-“Services” for TWP Purposes: “Services” are earnings of more than $200 for work performed (or work over 40 hrs. per month in own business). Effective 01/01/01 these amounts increases to $530 and 80 hours. This amount will be indexed in future years. What is counted as a trial work period month Each month in which earnings are more than $200 (or over $200 in net earnings or more than 40 hours of work in a month for the self-employed) is counted as a month of the trial work period. A person will get a new trial work period every time he/she becomes re-entitled to a new period of disability based on a new application. After the trial work period, the Social Security Administration reviews the work. SGA earnings during or after the trial work period normally indicate that the beneficiary is able to work in spite of a disabling impairment): If the work is not SGA, SSDI benefits continue; or If the work is SGA, the disability ceases, cash benefits continue for the month of cessation plus two more months (this is known as the grace period"), then the payments stop. Slide 23: SSDI -Impairment-Related Work Expenses (IRWE) IRWE are items or services which you pay for. These items or services help you work or get to work. IRWE are deducted from earnings in making SGA decisions. They must be incurred because of a physical or mental impairment. Impairment-related work expenses may reduce earnings below the SGA level. The Social Security Administration field office determines whether expenses may be deducted from earnings. o The person, because of a severe physical or mental impairment, needs the item or service for which the expense is incurred in order to work even if these items and services are also needed for non-work activities. o The cost is paid by the person with a disability and is not reimbursed by another source (e.g., Medicare, Medicaid, private insurance); o The expense is "reasonable"--that is, it represents the standard charge for the item or service in the person's community; Slide 24: SSDI-Subsidy from Employer The services you provide to your employer are worth substantially less than the pay you receive, e.g., your employer pays for your job coach. Subsidies are deducted from earnings in making SGA decisions. A subsidy is support a person receives on the job which could result in more pay than the actual value of the services the person performs. We deduct the value of subsidies when we determine SGA. Subsidies do not reduce countable income for SSI. Some workers with disabilities are not yet able to do a job as well as non-impaired workers without receiving some form of subsidy or work support. Examples of subsidies are: - Giving the worker with a disability more supervision than other workers doing the same or a similar job for the same pay; and/or - Giving the worker with a disability fewer or simpler tasks to complete than other workers doing the same job for the same pay. Only earnings that represent the real value of the work performed are used to determine if work is at the SGA level. If an employer has difficulty setting the real value of the work and/or the amount of the subsidy, the Social Security Administration will make a determination of the value of the work. Slide 25: SSDI-Unsuccessful Work Attempt (UWA) The impairment(s) or removal of special conditions, which allowed you to work, forced you to stop work or reduce earnings to below SGA level within 6 months. UWA earning are not counted in SGA decisions. Work during the TWP can not be considered a UWA. UWA does not apply in EPE after a SGA cessation. Slide 26: SSDI-Unincurred Work Expenses For Self-Employed Only. - Business expenses paid by a third party are not counted for SGA decisions. They can be deducted from net earnings. Slide 27: SSDI-Extended Period of Eligibility (EPE) - Consecutive 36 month period after the end of the TWP. - Cash benefits will be reinstated in any month earnings are under SGA level without a new application. The EPE confuses many people. Simple provision with a BAD NAME. What it is--A Window of Opportunity for reinstatement The extended period of eligibility is a consecutive 36-month period during which cash benefits will be reinstated for any month the person does not work at the SGA level. Benefit checks can be started again without a new application, disability determination or waiting period. This reinstatement of benefits saves critical time for the beneficiary and replaces the loss of earnings. NOTE: Benefits can be reinstated within the 36-month period. However, benefits may be paid for an even longer period of time if a person is unable to perform SGA--until first post EPE month of SGA. When it begins--The extended period of eligibility begins the month following the end of the trial work period. Slide 28: SSDI-Continuation of Medicare - If: SSDI payments cease due to SGA (work), - Then: Medicare will continue for at least 39 consecutive months, after the month the TWP ends. (Old Law) Under TWWIIA Add another 54 months to Equal 93 months of Medicare What it does--PREMIUM FREE SSDI beneficiaries can receive at least 39 months of hospital and medical insurance after the trial work period. This provision allows health insurance to continue when a person goes to work and is engaging in SGA. How it helps people Although cash benefits may cease due to work, the beneficiary has the assurance of continued health insurance. If the beneficiary is entitled to extended Medicare after a work cessation in October 2000, then the beneficiary qualifies under this provision if they continue to have a disabling impairment(s). Slide 29: Continued Payments Under a Vocational Rehabilitation (VR) Program(a.k.a. section 301)--SSDI & SSI IF: - medical condition improves - SSA decides disability ceased - you are participating in an SSA approved active VR program THEN: - payments and/or health insurance continue until the VR program ends. It applies to persons who are receiving SSDI or SSI benefits who improve medically and, therefore, are no longer considered disabled by the Social Security Administration. SSDI and SSI benefits will continue if, at the time disability medically ceases: o The person is actively participating in an approved state or (effective November 1, 1991) an approved non-state public or private vocational rehabilitation program; and o Completion or continuation of the program is likely to enable the person to work permanently. "Approved non-state public VR programs" include demonstration and research projects administered by SSA and other Federal agencies. Cash payments and health insurance continue until the rehabilitation services are completed or until the person ceases to participate in the program. The Social Security Administration, with the aid of vocational rehabilitation information, determines eligibility for continued payments, based on the criterion that the person's participation in the vocational rehabilitation program will increase the likelihood of permanent self-sufficiency and independence from the disability rolls. Slide 30: The SSI Work Incentives are: Impairment Related Work Expenses General and Earned income exclusions Student Earned Income exclusion Blind Work Expenses Plans for Achieving Self-Support Property Essential for Self-Support SSI Payments for People Who Work Extended Medicaid for People Who Work Extended Eligibility for VR participants who medically recover Reinstatement of SSI Slide 31: SSI-Impairment-Related Work Expenses (IRWE) IRWE are expenses that you pay for items or services that help you work or get to work. They are incurred by you because of a physical or mental impairment. Slide 32: SSI-Impairment-Related Work Expenses (IRWE) 1. IRWE are deducted from earnings in making initial eligibility SGA decisions. 2. IRWE are deducted from earned income received when computing SSI payment amounts (initial and continuing eligibility). Slide 33: SSI-General and Earned Income Exclusions General Income Exclusion: First $20 of any income per month. Earned Income Exclusion: Next $65 earned income per month. 1/2 of remaining earnings. Slide 34: SSI-Earned Income Exclusion: Example: $815 gross monthly wages - 85 general & earned exclusions $730 / 2 = $365 countable earnings $531 - $365 = $166 SSI Payment $166 + $815 = $981 net income Slide 35: SSI-Student Earned Income Exclusion - Under age 22. - Neither married, nor head of household. - Regularly attending school. - Can Exclude up to $1290 per month with an annual maximum exclusion of $5200 eff 01/01/01. - Still gets benefit of other income exclusions. Slide 36: Blind Work Expenses - Earned income that is used to pay for work-related items or services is not counted in deciding SSI eligibility or payment amount. - The items do not have to be related to blindness. Slide 37: Examples of BWE: - Dog guide expenses - Transportation to and from work - Federal, state and local income taxes - Social Security taxes - Visual and sensory aids - Union dues Slide 38: Plan for Achieving Self Support (PASS) A written plan. A specific work goal. The plan approved by SSA. Income or resources needed to attain the work goal are excluded. PASS can help establish or maintain SSI eligibility. It can increase the SSI payment amount. Slide 39: SSI-Property Essential for Self Support Excluded from Resources: Property of any value used in a trade or business. Up to $6000 equity in essential activity property, e.g., livestock. Up to $6000 equity in income production property yielding at least 6% return. Slide 40: SSI Payments for People Who Work a.k.a. Section 1619(a) No SGA for people who are on the SSI rolls. Earnings are NOT used to determine continuing disability. No TWP. No EPE. No UWA. Payment amount computation still applies. Slide 41: SSI--Extended Medicaid for People Who work - a.k.a. Section 1619(b) When work/earnings reduce SSI payments to zero, Medicaid will continue until State’s Charted Threshold amount is reached. Individual Thresholds can be higher based on actual and projected Medicaid use and other needs. POMS SI 02302.200 Threshold calculation: Breakeven point (EI only) + per capita Medicaid expenditures. Deductions for customized threshold calculations: IRWE BWE PASS publicly funded personal/attendant care NOT funded by Medicaid medical expenses in excess of State per capita amount Slide 42: Continued Eligibility Under a Vocational Rehabilitation (VR) Program - a.k.a. section 301 -- SSDI & SSI IF: medical condition improves SSA decides disability ceased you are participating in an SSA approved active VR program THEN: payments and/or health insurance continue until the VR program ends. It applies to persons who are receiving SSDI or SSI benefits who improve medically and, therefore, are no longer considered disabled by the Social Security Administration. SSDI and SSI benefits will continue if, at the time disability medically ceases: - The person is actively participating in an approved state or (effective November 1, 1991) an approved non-state public or private vocational rehabilitation program; and - Completion or continuation of the program is likely to enable the person to work permanently. "Approved non-state public VR programs" include demonstration and research projects administered by SSA and other Federal agencies. Cash payments and health insurance continue until the rehabilitation services are completed or until the person ceases to participate in the program. The Social Security Administration, with the aid of vocational rehabilitation information, determines eligibility for continued payments, based on the criterion that the person's participation in the vocational rehabilitation program will increase the likelihood of permanent self-sufficiency and independence from the disability rolls. Slide 43: Reinstating SSI Without A New Application When cash benefits and/or Medicaid eligibility under SSI rules end for any reason other than medical recovery, benefits may be reinstated WITHOUT A NEW APPLICATION if the individual again meets SSI eligibility criteria within 12 months. Slide 44: The Ticket to Work and Work Incentives Improvement Act of 1999 Slide 45: OESP - (Office of Employment Support Programs) Internet: www. ssa.gov/work Slide 46: Goals of Ticket Law - Increase beneficiary choice for employment services, VR services, and other support services - Allow people with disabilities to retain health coverage while working - Give more Americans with disabilities the opportunity to work and become independent President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999 on Dec. 17, 1999. This new law: increases beneficiary choice in obtaining employment services, vocational rehabilitation services and other support services; removes barriers that require people with disabilities to choose between health care coverage and work; and assures that more Americans with disabilities have the opportunity to participate in the workforce and lessen their dependence on public benefits. One major provision of the law establishes the Ticket to Work and Self-Sufficiency Program, or Ticket Program.The Ticket Program provides that eligible Social Security and Supplemental security Income (SSI) beneficiaries with disabilities will receive a Ticket they can use to obtain employment services, vocational rehabilitation services or other support services from an approved provider of their choice. Slide 47: Ticket to Work Legislation - Creates Employment Support Representative (ESR) Position (a corps of work incentives specialists) - Work incentive enhancements - New work incentive service structure - Health insurance improvements - Work incentive demonstration authority Slide 48: Ticket Major Features - Ticket to Work and Self-Sufficiency - Work incentive enhancements - New work incentive service structure - Health insurance improvements - Work incentive demonstration authority Slide 49: Ticket to Work - SSDI and SSI beneficiaries get Tickets - New contract with providers of services--Employment Networks (EN) - Contract with Program Manager(s) (PM) - New payment system for ENs - Outcome payments (over 60 months) - Outcome-Milestone payments Amounts below are for 2000 payment, current payment would be higher. These were shown in proposed regulations. Title II Outcome - $277 x 60 = $16,620 Title XVI Outcome $176 X 60 = $10, 560 Milestones The maximum payable under the Outcome-Milestone system is approximately 85% of the maximum payable under the Outcome payment system. Slide 50: When does Ticket Program Start? The Ticket Program is being phased-in nationally over a three-year period beginning in 2001. SSA plans to mail tickets to eligible beneficiaries in 13 States after the regulations are finalized in late summer. The Ticket Program is being phased-in nationally over a three-year period beginning in 2001. In 2001, we will mail tickets to eligible beneficiaries in these 13 states: Arizona Colorado Delaware Florida Illinois Iowa Massachusetts New York Oklahoma Oregon South Carolina Vermont Slide 51: 13 States Participating in the Rollout of the Ticket Program Arizona Colorado Delaware Florida Illinois Iowa Massachusetts New York Oklahoma Oregon South Carolina Vermont Slide 52: Notice of Proposed Rulemaking Published December 28, 2000 Public comment period ended February 26, 2001 Final Regulations Published in ??? Slide 53: Important Ticket Points 1. Program Manager helps SSA administer 2. Information with Ticket tells beneficiary to contact MAXIMUS for information 3. Ticket program is voluntary 4. Beneficiaries cannot be charged for services 5. Ticket program expands available services - does NOT guarantee job. Slide 54: MAXIMUS’ Toll-Free Numbers 1-866-968-7842 or 1-866-YOURTICKET TTY 1-866-833-2967 or 1-866-TDD 2 WORK Slide 55: Who provides the services? - Employment Networks provide: - Employment services - VR services - Other support services Who Provides the Services to the Beneficiaries? Beneficiaries participating in the Ticket Program will receive employment services, vocational rehabilitation services or other support services from organizations called Employment Networks. Employment Networks can be: - any qualified State, local or private organization, including the State vocational rehabilitation services agency - One-stop delivery systems - Public or Private schools that provide vocational rehabilitation or employment services - Employers - Beneficiaries will "assign" their ticket to an Employment Network when they agree to work together. These employment networks are under contract to Social Security, which will pay them for helping beneficiaries work. Employment networks cannot charge beneficiaries for the services they provide. Slide 56: Who can be an Employment Network? - any qualified State, local or private organization, including the State vocational rehabilitation services agency - One-stop delivery systems - Public or Private schools that provide vocational rehabilitation or employment services - Employers Employment Networks can be: - any qualified State, local or private organization, including the State vocational rehabilitation services agency - One-stop delivery systems - Public or Private schools that provide vocational rehabilitation or employment services - Employers Slide 57: Ticket Points No time limit for using Remains valid even if cash benefits terminate for work or earnings Still valid if moves to non-ticket state. Slide 58: Beneficiaries SELECTED can participate even if ticket not yet mailed. Slide 59: Ticket Users - All beneficiaries and recipients ages 18-64 - Residing in a Ticket Pilot State Except for: - Not receiving a federal benefit - Medically expected to improve and not had first medical review - SSI recipients with disability not based on adult standard Most Social Security and SSI beneficiaries with disabilities will receive a ticket. In the Notice of Proposed Rulemaking published in the Federal Register on December 28, 2000, we propose that all disability-based beneficiaries who are age 18 or older and are not yet age 65 will be eligible for a ticket except those who: (1) are not receiving a Federal benefit (2) are medically expected to improve and have NOT had their first continuing disability review (CDR), (3) are SSI recipients and are not receiving benefits based on the adult standard. In addition, beneficiaries must reside in one of the "ticket" states shown above. We will publish final rules later in 2001. These final rules will consider public comments we received on the Notice of Proposed Rulemaking, and may be different from the rules we published on December 28, 2000. Slide 60: How do I get a ticket? - Tickets will be sent to eligible beneficiaries and recipients in the mail along with information about the Ticket program - The ticket will be a personal document with the individuals name and social security number on it How Will Beneficiaries Receive the Ticket? Eligible beneficiaries automatically will receive a Ticket in the mail. The ticket is a personal document that has the beneficiary's name and social security number on it. Along with the ticket, each beneficiary will receive a notice explaining the important points about the program, as well as a booklet with more detailed information Slide 61: How Will Beneficiaries Receive Ticket? Will receive Ticket in mail with: - “Good News” letter from Commissioner - Booklet with more detailed information Slide 62: Photograph of the Ticket Slide 63: Ticket Use - Consumer selects an Employment Network (EN) - Ticket assigned to EN after agreement - SSA will pay EN for successful outcomes - Employment Networks cannot charge beneficiaries for services Beneficiaries will "assign" their ticket to an Employment Network when they agree to work together. These employment networks are under contract to Social Security, which will pay them for helping beneficiaries work. Employment networks cannot charge beneficiaries for the services they provide. Slide 64: Medical Reviews After Ticket Used For beneficiaries who choose to participate in the Ticket Program, we will not conduct medical reviews of their cases as long as they meet certain requirements. Beneficiaries must assign their ticket to an employment network and meet other requirements to qualify How Does Participating in the Ticket Program Affect Medical Reviews of a Beneficiary's Disability? We ordinarily review a beneficiary's medical case from time to time to see if he or she still is disabled under our rules. If we find that the beneficiary is no longer disabled, we may stop benefits. For beneficiaries who choose to participate in the Ticket Program, we will not conduct medical reviews of their cases as long as they meet certain requirements. Beneficiaries must assign their ticket to an employment network and meet other requirements. SSA will send beneficiaries more information about these requirements after they assign their ticket. Slide 65: Ticket to Work and Self-Sufficiency, continued - Illinois and Wisconsin Selected for initial rollout of Ticket in Chicago Region - Proposed Ticket Regulations closed for comment on 02/26/01 - Request for Employment Networks released in mid-April. It is estimated that 310,000 tickets will be released in Illinois over a four month period. Slide 66: SSA’s Employment Support Representative (ESR) The ESR specializes in giving full, accurate and timely information to about SSA’s employment supports to beneficiaries with disabilities who want to work - ESRs are experts on SSA’s work incentives, VR & other employment support provisions and programs - ESRs collaborate with community-based organizations that assist people with disabilities Slide 67: CDR Process - Beneficiaries using Ticket will not be scheduled for medical CDRs - SSDI beneficiaries for 24 months--no work-triggered medical CDRs; scheduled medical CDRs will still be conducted Slide 68: CDR Process, cont’d Effective when: January 1, 2001--beneficiaries using Tickets January 1, 2002--SSDI beneficiaries for 24 months SSA Role--Publish regulations and make systems and operational changes Slide 69: Work Incentives Advisory Panel 12 members appointed by the President and Congress To provide advice to the Commissioner of Social Security, Congress, and other agencies on work incentives and the Ticket program Have been meeting since July 24, 2000 Slide 70: New Work Incentives Service Structures --Benefits Planning, Assistance and Outreach Programs (BPAOs) - Benefits planning grants, contracts or cooperative agreements - Effective -- on enactment (12/17/1999) - We have awarded BPAO grants to qualified applicants. We will be issuing another request for applications for those geographic areas where we did not receive awardable applications under the previous announcement. Slide 71: New Work Incentive Structures--Protection and Advocacy (PA) - TWWIIA provides that SSA make grants to protection and advocacy systems in all states to provide services to beneficiaries with disabilities - Effective -- on enactment (12/17/1999) Slide 72: Demonstration Projects - Effective -- on enactment (12/17/1999) - SSA Role: Develop $1 for $2 demonstration project Develop other experiments and demonstration projects as appropriate Slide 73: Medicare Changes for Beneficiaries Who Work Effective 10/1/2000 Medicare for an additional 4 1/2 years beyond current limit Entitlement to at least 93 months of Medicare after TWP ends. Slide 74: Extended Medicare Applies If: - Entitled to a TWP, and - Still have disabling condition and - Starting to work for first time after DIB benefits began or - Currently in TWP, or Slide 75: Extended Medicare Applies If: - In 36-month EPE which began after June 1997, or - Medicare coverage not due to end prior to October 1, 2000 or - EPE began prior to June 1997, depending on their SGA activity Slide 76: Medicaid Changes for Disabled Beneficiaries Who Work Effective 10/01/2000: - State options expand for Medicaid coverage for individuals ages 16-64 - Liberalize limits on resources and income - Provide opportunity for Medicaid buy-in - HHS grants to States - HHS demo for buy-in Slide 77: Expedited Reinstatement of Benefits - When does Expedited Reinstatement (ER) Apply? - ER applies after disability benefits end based on work - SSDI--after extended period of eligibility - SSI--after 1 year suspension - 60-month period to request reinstatement after disability benefits end based on work - Up to 6-months of provisional benefits payable while SSA is deciding on reinstatement request. - ER is Effective January 1, 2001 Slide 78: Expedited Reinstatement - Effective 1/1/01 - Reinstate without new application if: - Unable to work,because of medical impairments - Medical condition same or related, and - File request within 60 months of date last entitled Slide 79: New Regulation Changes SGA amounts are now indexed and increase to earnings over $740 effective 01/01/01. Slide 80: SSDI-“Services” for TWP Purposes: “Services” are earnings of more than $200 for work performed (or work over 40 hrs. per month in own business). Effective 01/01/01 these amounts increases to $530 and 80 hours. This amount will be indexed in future years. What is counted as a trial work period month Each month in which earnings are more than $200 (or over $200 in net earnings or more than 40 hours of work in a month for the self-employed) is counted as a month of the trial work period. A person will get a new trial work period every time he/she becomes re-entitled to a new period of disability based on a new application. After the trial work period, the Social Security Administration reviews the work. SGA earnings during or after the trial work period normally indicate that the beneficiary is able to work in spite of a disabling impairment): - If the work is not SGA, SSDI benefits continue; or - If the work is SGA, the disability ceases, cash benefits continue for the month of cessation plus two more months (this is known as the grace period"), then the payments stop. Slide 81: SSI-Student Earned Income Exclusion: - Student under age 22. - Regularly attending school. - Prior to 01/01/01 could exclude up to $400 per month with an annual maximum exclusion of $1,620 - Effective 01/01/01 can exclude up to $1290 per month with an annual maximum exclusion of $5200 - Still gets benefit of other income exclusions.