Where to Turn... Your Guide to Federal Disability Policies and Programs Authors Patrice Drew, Esq. Cathy Ficker Terrill Anne C. Parrette, Esq. Project Coordinator Janna Starr Editors Larry H. Hoffer Lisa Ward Monique Marino Brain Injury Association US Department of Health and Human Services HRSA Health Resources and Services Administration Maternal and Child Health Bureau Disclaimer The Brain Injury Association shall not be held liable for content changes made by unauthorized parties, including but not limited to: alterations of text, images or other information within Where to Turn: Your Guide to Federal Disability Policies and Programs (the Guide.) The Guide contains general information. It is not an authoritative legal document, nor shall it be construed as legal advice. The Guide shall not be relied upon as a legal authority for acting or refusing to act. The information contained in the Guide may change as Federal polices and programs are amended periodically. The Brain Injury Association is not responsible for notifying the Public of these changes. Employment I have a disability and am looking for employment. What laws will protect me from discrimination and assist me in finding employment? There are several laws that deal with employment for individuals with disabilities, including the American with Disabilities Act, the Rehabilitation Act of 1973 and the Social Security Act. For an in-depth look at how each law contributes to the complex mosaic created to protect individuals with disabilities, please refer to Chapter 2 (ADA), Chapter 3 (Rehab. Act) and Chapter 4 (Social Security). What are the work disincentives under the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs? Many people with disabilities want to work. However, due to the stringent rules promulgated by the Social Security Administration (SSA) regarding employment, many people fear loss of cash benefits, loss of health insurance coverage and-should a work attempt fail-the time-consuming reapplication process. The general rule is that average earnings of $700 per month or more amount to substantial gainful activity (SGA). Absent the application of one of the rules discussed below, a person earning an average of $700 per month would be denied benefits as an applicant for SSDI or SSI, or be terminated from the SSDI program if receiving benefits already. Under these rules, average earnings of less than $300 per month will not amount to SGA and will not affect entitlement. If earnings are between $300 and $700 per month, SSA is required to individually evaluate the person's work to see if it indicates that he or she is performing SGA. Typically, SSA does not terminate benefits under the SGA rule unless earnings are more than $700 per month. For the SSDI applicant or recipient who is legally blind, $1,170 in monthly earnings is considered to be SGA in 2000. That amount increases each year, as the SGA test for persons who are blind is adjusted annually. There is no SGA rule in the SSI program for persons who are blind. The United States Court of Appeals for the 10th Circuit has held that Social Security's statutes and regulations allowing persons who are blind a higher SGA threshold than those allowed for persons with other disabilities does not violate the U.S. Constitution's equal protection clause. People with disabilities and those who have worked as disability advocates know how harsh the $700 rule can be. Monthly earnings in the $700 to $1000 range will seldom, if ever, duplicate the combination of cash and medical benefits of a mere subsistence existence. When one factors in the difficulties in finding permanent gainful employment, many individuals with disabilities have chosen not to seek competitive employment. The Continuing Disability Review (CDR) can be another major disincentive to work. Many justifiably fear that work activity in one's record increases the likelihood that a CDR will result in a termination of benefits. Indeed, many advocates have discouraged work activity for this very reason. Advocates should not discourage work activity. Instead, the advocate's role is to ensure that the person with a disability understands the potential impact of work on benefits so that he or she can make informed choices about work and use of the work incentives. The Ticket to Work Act will eliminate CDRs in some circumstances. There are three categories of SSDI or SSI beneficiaries for CDR purposes. Individuals in each category will have SSA review their cases more or less frequently, depending upon where they fit. These are referred to as "diaried" CDRs and will occur whether or not the individual is working. The three categories are: Medical Improvement Not Expected: Reviewed every five to seven years Medical Improvement Possible: Reviewed once every three years Medical Improvement Expected: Reviewed six to 18 months after initial entitlement Under current law, when can my disability benefits be terminated if I have a medical improvement? Generally, disability benefits will be terminated only if there is medical improvement that enables the person to engage in substantial gainful activity. There are several exceptions to the medical improvement standard, allowing for termination of benefits when there has been no medical improvement. Three of these exceptions are noteworthy: Where there is no real medical improvement, but the person is now able to engage in SGA because he or she is a beneficiary of advances in medical or vocational therapy or technology Where new or improved diagnostic techniques or evaluations show that the person's impairment or combination of impairments is not as disabling as it was considered to be when the person's case was reviewed most recently Where substantial evidence shows that a prior determination was in error When any of the listed criteria are determined to be present, a person can be terminated from SSDI or SSI, despite the absence of medical improvement. I am a recipient of SSDI or SSI and I work, how can I avoid the implication of medical improvement? The only "safe" cases, where it is clear that a disability has not improved, are those in which a person's disability continues to meet the criteria of a "listing." The Listing of Impairments contains 14 different categories of disability and specific criteria under each category that will support a finding of disability without further analysis of the person's ability to perform work activity. Primary candidates for the listings include persons with mental retardation, legal blindness, deafness or severe physical disabilities, particularly those that render a person quadriplegic. Since meeting a listing results in an automatic finding of disability, a medical improvement termination could not occur. More problematic cases are those involving mental illness or pain as the primary disability. Since mental illness and pain symptoms cannot be objectified or quantified as easily, the work activity might be viewed as evidence of improvement. Are there any work incentives? SSDI Work Incentives provide support over several years to allow you to test your ability to work and gradually become self-supporting and independent. In general, you have at least four years to test your ability to work. This includes full cash payments during the first 12 months and a 36-month period in which SSA can start your cash benefits again without a new application. You will continue to have Medicare coverage during this time. The SSDI work incentives are: Impairment-Related Work Expenses Subsidies and Special Conditions Unincurred Business Expenses (Self- Employed Only) Unsuccessful work attempts Trial Work Period Extended Period of Eligibility Continuation of Medicare coverage Medicare for People With Disabilities Who Work Continued payment under a Vocational Rehabilitation program The SSI work incentives are: Impairment-Related Work Expenses Earned Income Exclusion Student Earned Income Exclusion Blind Work Expenses Plan for Achieving Self-Support (PASS) Property Essential to Self-Support Special SSI Payments for People Who Work -- section 1619(a) Reinstating eligibility without a new application Continued payment under a Vocational Rehabilitation Program Special Benefits for People Eligible Under Section 1619 (a) or (b) who enter a Medical Treatment Facility SSDI and SSI Work Incentives Impairment-Related Work Expenses (IRWE) How can IRWE help? SSA considers the cost of certain impairment-related items and services that you need to work as a deduction from your gross earnings when it decides if your "countable earnings" demonstrate performance of SGA. It does not matter if you also use these items and services for non-work activities. IRWE also is excluded from your earned income when SSA figures your monthly SSI payment amount. IRWE are deductible for SGA purposes when: The item or service enables you to work You need the item or service because of your disability You pay the cost yourself and are not reimbursed by another source (e.g., Medicare, Medicaid, private insurance) The expense is "reasonable"-that is, it represents the standard charge for the item or service in your community You paid the expense in a month in which you are or were working (occasionally, an impairment-related work expense may be used before the first or after the last month of work activity) Examples of expenses likely and not likely to be deductible Deductible Medical devices such as wheelchairs, hemodialysis equipment,pacemakers, respirators, tractionequipment and braces (arm, leg, neck,back, etc.) Attendant Care Services Performed in the work setting The cost of structural or operational modifications to your vehicle that you need in order to travel to work, even if you also use the vehicle for non-work purposes Artificial hip or artificial replacement of an arm, leg or other parts of the body Not Deductible Any medical device you do not use for a medical purpose Attendant Care Services performed on non-workdays or helping you with shopping or general homemaking (e.g., cleaning, laundry) The cost of modification to your vehicle not related directly to your impairment or critical to your operation of the vehicle (e.g., paint or décor preferences) Any prosthetic device that is primarily for cosmetic purposes Subsidies and Special Conditions "Subsidies" and "special conditions" are names for support you receive on the job that could result in your receiving more pay than the actual value of the services you perform. "Subsidies" are items provided by your employer. "Special conditions" are items provided by someone other than your employer (e.g., a vocational rehabilitation agency). SSA deducts the value of subsidies and special conditions from your earnings when it makes an SGA decision. SSA does not deduct subsidies or special conditions when it figures your SSI payment amount. Examples of subsidies and special conditions are: You receive more supervision than other workers doing the same or similar job for the same pay You have fewer or simpler tasks to complete than other workers doing the same job for the same pay You have a job coach or mentor who helps you perform some of your work SSA only uses earnings that represent the real value of the work you perform to decide if your work is at the SGA level. If your employer and/or other involved parties have difficulty setting the real value of your work or the amount of the subsidy or special conditions, SSA will decide the value of your work. Unincurred Business Expenses (Self-Employed Only) "Unincurred business expenses" is SSA's name for self-employment business support that someone else gives to you without cost. Because someone gives you these items or services, the Internal Revenue Service (IRS) does not allow you to deduct their cost for income tax purposes. Examples include the State Vocational Rehabilitation agency giving you a computer for your business or a friend working for your business as unpaid help. If you are self-employed, SSA generally follows the IRS rules to figure your net earnings from self-employment. However, when it makes an SGA decision it also deducts unincurred business expenses from your net earnings to gain a more accurate measure of the value of your work. SSA does not deduct unincurred business expenses from earnings when it figures your SSI payment amount. For an item or service to qualify as an unincurred business expense: It must be an item or service that the IRS would allow as a legitimate business expense if you had paid for it, and Someone other than you must have paid for it. Unsuccessful Work Attempts An unsuccessful work attempt is an effort to do substantial work (in employment or self-employment) that you stopped or reduced to below the SGA level after a short time (six months or less) because of your impairment or the removal of special conditions which are related to your impairment and essential to the further performance of your work. SSA does not count earnings during an unsuccessful work attempt when SSA makes an SGA decision for initial eligibility (for SSDI or SSI); or, when it decides (for SSDI only) if disability continues or ceases because of work. SSA does not take into account unsuccessful work attempts when it figures your SSI payment amount. Continued Payment Under a Vocational Rehabilitation Program If SSA finds you no longer have a disabling impairment due to medical improvement, your benefit payments usually stop. If you participate in a vocational rehabilitation program, however, your benefits may continue until the vocational rehabilitation program ends. To qualify: You must have started the vocational rehabilitation program before your disability ceased; and SSA must review the situation and decide that your continued participation in the vocational rehabilitation program would increase the likelihood of your permanent removal from the disability benefit rolls. Trial Work Period (TWP) How does the TWP help people? The TWP allows you to test your ability to work for at least nine months. During your TWP, you will receive full SSDI benefits, regardless of how high your earnings might be so long as you have a disabling impairment. When does the TWP start? Your TWP starts with the first month you are eligible for SSDI benefits and are working. How long does the TWP last? The TWP continues until you accumulate nine months (not necessarily consecutive) of "services" that you performed within a 60-consecutive-month period. SSA uses this "services" rule only to control when the TWP stops. "Services" means any activity you do in employment or self-employment for pay or profit, or of the kind normally done for pay or profit (whether or not it is SGA). SSA currently considers your work to be services if you earn more than $200 a month (or work more than 40 self-employed hours in a month). What else do I need to know about the TWP? You are not eligible for disability benefits or a TWP if you work at SGA level within 12 months of the onset of your impairment(s) or before SSA approves your claim for disability benefits. This is because your impairment does not meet SSA's definition of disability. SSA can consider medical evidence that might demonstrate your medical recovery at any time. It is possible, therefore, for your benefits to stop because of your medical recovery before the end of your TWP. SSA allows only one TWP in any one period of disability. Note: Unsuccessful work attempts do not apply to the TWP. What happens when I complete my TWP? SSA considers your work and earnings after the end of the trial work period to decide if you can work at SGA level. It also considers whether any of the work incentive provisions may affect your situation. If SSA decides that you cannot work at the SGA level, your SSDI benefits continue. If SSA decides that you can work at the SGA level: It pays your SSDI benefits for the month your disability ceased (either resulting from medical improvement or your work at GA level) plus the next two months (this is called the "grace period"). If your benefits stopped because you worked at SGA level, you are now in the extended period of eligibility (see next section). Extended Period of Eligibility (EPE) How does the EPE help me? If SSA ceased your disability benefits because you worked at SGA level, it can automatically reinstate your benefit payments automatically. No new application and/or disability determination is required. When can SSA reinstate my benefits? The earliest it can reinstate your benefits is the first month following the end of the trial work period. (Note that the extended period of eligibility and the grace period may overlap.) The latest SSA can reinstate your benefits is the 36th consecutive month following the end of the trial work period. (If your earnings change significantly from month-to-month, it is possible that SSA could reinstate your benefits up to 18 times during this period.) How do I qualify for reinstatement of my benefits? You qualify for any month in the period described above in which: You continue to have a disabling impairment, and Your earnings in that month fall below SGA level. Can I receive reinstated benefits after the 36th month? Yes. If you are eligible for a reinstated benefit payment for the 36th month, you will continue to be eligible for benefits until you: Work a month at SGA level, or Medically recover. Note: Unsuccessful work attempts do not apply to people who receive reinstated benefits under the EPE because SSA already has made the decision that their disability ceased. Continuation of Medicare Coverage How does this rule help me? Although cash benefits may cease as a result of work, you have the assurance of continued health insurance. You can receive up to 39 consecutive months of Medicare hospital and medical insurance after the trial work period. This provision allows your health insurance to continue when you go to work and are engaging in SGA. You pay no premium. Medicare for People with Disabilities who work Is there any way I can buy Medicare coverage? Yes. After premium-free Medicare coverage ends because of work, some people who have returned to work may buy continued Medicare coverage, as long as they remain medically disabled. (Some people with low incomes and limited resources may be eligible for state assistance with these expenses.) Who is eligible to buy Medicare Coverage? You are eligible to buy Medicare coverage if you: Are not yet age 65 Have a disabling impairment, and Your Medicare coverage stopped because of work What kind of Medicare coverage can I buy if I'm eligible? You can buy Premium Hospital Insurance (HI Part A) at the same monthly cost which uninsured eligible retired beneficiaries pay ($309 per month for 1999), and You can buy Premium Supplemental Medical Insurance (SMI Part B) at the same monthly cost which uninsured eligible retired beneficiaries pay ($45.50 per month for 1999), or You can buy Hospital Insurance separately without Supplemental Medical Insurance. Note: You can buy Supplemental Medical Insurance only if you also buy Hospital Insurance. If I'm eligible, when can I enroll? You may enroll: During your initial enrollment period (the month you are notified about the end of your premium-free health insurance and for the following seven months) During the annual general enrollment period (January 1 through March 31 of each year) During a special enrollment period if you are covered under an employer group health plan Does the state ever pay Medicare premiums for people? States are required to pay Hospital Insurance premiums for some working individuals with disabilities. You qualify if you: Are eligible to enroll in premium Hospital Insurance for people with disabilities who work Meet certain income and resource standards, and Are not eligible for Medicare on any other basis Earned Income Exclusion How can the Earned Income Exclusion help me? SSA does not count all of your earned income when it figures your SSI payment amount. In fact, SSA counts less than one-half of your earnings when figuring your SSI payment amount. The first $65 of your earnings in any given month, plus one-half of the remainder, are not counted. This is in addition to the $20 general income exclusion that is applied to any unearned income that you may receive. Student Earned Income Exclusion Who does the Student Earned Income Exclusion help? If you are under age 22, not married or the head of your household and regularly attending school, SSA does not count up to $400 of earned income per month when figuring your SSI payment amount. The most they will exclude in a single year is $1,620. What is SSA's definition of "regularly attending school"? "Regularly attending school" means that you take one or more courses of study and attend classes: In a college or university for at least eight hours a week In grades 7-12 for at least 12 hours a week In a training course to prepare for employment for at least 12 hours a week (15 hours a week if the course involves shop practice), or For less time than indicated above for reasons beyond the student's control, (e.g., illness). If you are home taught because of a disability, you may be considered "regularly attending school" by: Studying a course or courses given by a school (grades 7-12), college, university or government agency, and Having a home visitor or tutor who directs the study. SSA applies the student earned income exclusion before the general income exclusion or the earned income exclusion. Plan for Achieving Self-Support (PASS) How could a PASS help me? A plan for achieving self-support (PASS) allows you to set aside income and/or resources for a specified time for a work goal. For example, you could set aside money for education, vocational training or starting a business. SSA does not count the income that you set aside under your PASS when it figures your SSI payment amount. SSA does not count the resources that you set aside under your PASS when it determines your initial and continuing eligibility for SSI. A PASS can help you establish or maintain SSI eligibility and increase your SSI payment amount. A PASS does not affect any SGA determination for your initial eligibility decision. Requirements for a PASS Your plan must: Be designed especially for you Be in writing (SSA prefers that you use their form, the SSA-545-BK) Have a specific work goal that you are capable of performing Have a specific timeframe for reaching your goal Show what money (other than your SSI payments) and other resources you have or receive that you will use to reach your goal Show how your money and resources will be used to reach your work goal Show how the money you set aside will be kept identifiable from other funds Be approved by SSA Be reviewed by SSA periodically to ensure your plan is actually helping you achieve progress Who can have a PASS? If you receive or could qualify for SSI, you can have a PASS. You may not need a PASS now, but you may need one next month or next year to remain eligible or increase your SSI payment amount. Who can help you set up a PASS? Anyone may help you with your PASS, including vocational counselors, social workers or employers. SSA evaluates the plan and decides if it is acceptable. SSA also helps people put their plans in writing. How does a PASS affect SSI? SSA does not count resources set aside under a PASS toward the resource limit when it figures your SSI payment amount. It applies this exclusion to your countable income after it applies all other applicable exclusions. How can I get more information about PASS? You can get a PASS Specialist's toll-free telephone number from your local SSA office, you can call SSA's national toll-free at 800-772-1213 or you can visit the Internet web site, www.ssa.gov/work/workincentives.htm. You can get copies of the form, SSA-545-BK from your local SSA office, any PASS Specialist or the web site. Property Essential to Self Support How can this provision help me? SSA does not count some resources that are essential to your means of self-support when it decides your initial and continuing eligibility for SSI. What is not counted? SSA does not count property that you use in a trade or business (e.g., inventory) or use for work as an employee (e.g., tools or equipment). Other use of the items does not matter. SSA does not count up to $6,000 of equity value of non-business property that you use to produce goods or services essential to daily activities (e.g., land used to produce vegetables or livestock solely for consumption by your household). SSA does not count up to $6,000 of equity value of non-business, income-producing property if the property yields an annual rate of return of at least 6 percent (e.g., rental property). It does not consider liquid resources (e.g., stock, bonds, notes) as property essential to self-support unless you use them as part of a trade or business. Special SSI Payments for People Who Work - Section 1619(a) How can Section 1619(a) help me? You can receive SSI cash payments even when your earned income (gross wages and/or net earnings from self-employment) is at the SGA level. This eliminates the need for the trial work period or extended period of eligibility under SSI. NOTE: If you are blind, this does not apply to you, because the SGA requirement never applied to you under SSI. Who qualifies? To qualify, you must: Have been eligible for an SSI payment for at least one month before you begin working at the SGA level Still be disabled, and Meet all other eligibility rules, including the income and resource tests. How does it work? Your eligibility for SSI will continue for as long as you meet the basic eligibility requirements and the income and resources tests. SSA will continue to figure your SSI payment amount in the same way as before. If your state provides Medicaid to people on SSI, you will continue to be eligible for Medicaid. Do I need to apply? You do not need to file a special application, just keep SSA up to date on your work activity. Continued Medicaid Eligibility - Section 1619(b) How can Section 1619(b) help me? Your Medicaid coverage can continue even if your income becomes too high for a SSI cash payment. Who qualifies? To qualify you must: Have been eligible for an SSI cash payment for at least one month Still be disabled Still meet all other eligibility rules, including the resources test Need Medicaid in order to work, and Have gross earned income that is insufficient to replace SSI, Medicaid and any publicly funded attendant care (see "threshold amount" section following). What is the "threshold amount"? The "threshold amount" is what SSA calls the measure that it uses to decide whether your earnings are high enough to replace your SSI and Medicaid benefits. Your threshold amount is based on: The amount of earnings that would cause your SSI cash payments to stop in your state, and The annual per capita Medicaid expenditure for your state If your gross earnings are higher than the threshold amount for your state, SSA can figure an individual threshold if you have: Impairment-related work expenses Blind work expenses A plan to achieve self-support Publicly funded attendant or personal care Medical expenses above the state per capita amount Continued Medicaid Eligibility in Certain States The following states use their own eligibility rules for Medicaid that are different from federal SSI eligibility rules: Connecticut Indiana New Hampshire Hawaii Minnesota North Dakota Virginia Oklahoma Ohio Illinois Missouri If you live in one of these states, you will continue to be eligible for Medicaid under the Section 1619(a) and (b) if you were eligible for Medicaid in the month before you became eligible for Section 1619. Special Benefits for People Eligible Under Section 1619 (a) or (b) Who Enter a Medical Treatment Facility Are there provisions for people who go into a treatment facility? If you are eligible under Section 1619, you can receive a SSI cash benefit for up to two months while in a Medicaid facility or a public medical or psychiatric facility. Usually, if you enter a Medicaid facility (i.e., a facility where Medicaid pays more than 50 percent of the cost of care), your SSI payment is limited to $30 per month minus any countable income. If you are eligible under Section 1619, however, your benefit will be figured using the full Federal Benefit Rate for up to two months. If you are in a public medical or psychiatric facility, you are not eligible to receive a SSI payment. If you enter a public medical or psychiatric facility while you are eligible under Section 1619, however, your SSI cash benefits can continue for up to two months. For this provision to apply, the facility must enter an agreement with SSA that will allow you to keep all of the SSI payment. Reinstating Eligibility Without a New Application Do people always have to fill out a new application to become eligible again? If you have been ineligible for SSI benefits for 12 months or less, you do not have to file a new application to restart your SSI cash payment and/or Medicaid coverage. When your situation changes, contact SSA and ask about how you can restart your SSI benefits or Medicaid. Examples: Example 1 - If: You are eligible for continued Medicaid coverage under Section 1619(b), and your countable income drops enough to allow a payment Then: SSA can start your SSI cash payments again. Example 2 - If: You become ineligible for SSI because your earnings exceed the threshold amount, and Your countable income drops enough to allow payment within 12 months Then: SSA can start your SSI cash payments again and notify your state to start your Medicaid coverage again. Example 3 - If: You become ineligible for continued Medicaid coverage under Section 1619 (b) because your earnings exceed the threshold amount, and Your earnings drop below the threshold amount within 12 months Then: SSA can notify your state to start your Medicaid coverage again. Special rules for people who are blind What are special rules for people who are blind? Work incentives, in general, are special rules that help you return to work or work for the first time. Some of the rules apply only to people who are blind. Congress designed these rules specifically to make it easier for people who are blind to go to work. How does SSA define blindness? Blindness is central visual acuity of 20/200 or less in the better eye with best correction, or a limitation in the field of vision in the better eye so that the widest diameter of the visual field subtends an angle of 20 degrees or less (tunnel vision). Under SSDI, this condition has to have lasted or is expected to last at least 12 months. There is no duration requirement for blindness under SSI. How SGA is applied under SSDI to persons who are blind? Every year, SSA changes the SGA level for beneficiaries who are blind every year to reflect changes in general wage levels. For 2000, if you are blind, average monthly earnings over $1170 will ordinarily demonstrate that you are performing SGA. This is higher than the current guideline for non-blind, workers with disabilities. REMINDER: If you are blind, you may use any or all of the deductions from earnings that apply to SGA decisions. SSA can deduct each item only once. How is SGA applied to self-employed SSDI beneficiaries who are blind? SSA can decide the SGA of self-employed persons who are blind solely on their earnings. SSA does not look at time spent in the business or services rendered as it does for non-blind self-employed persons. How is SGA applied to SSDI beneficiaries who are blind and age 55 or older? After your 55th birthday, if your earnings demonstrate SGA but your work requires a lower level of skill and ability than the work you did before age 55, benefits are only suspended, not terminated. Your eligibility for SSDI benefits continues indefinitely, and SSA pays your benefits for any month earnings fall below SGA. Is SGA applied under SSI to people who are blind? If you meet the medical definition of blindness, SGA is not a factor for your SSI eligibility. Your SSI eligibility continues until you medically recover or SSA ends your eligibility because of a non-disability-related reason. Blind Work Expenses (BWE) under SSI How does BWE help? If you are blind, SSA does not count any earned income that you use to meet expenses needed to earn that income in deciding your SSI eligibility and your payment amount. To qualify you must be: Under age 65, or Age 65 or older and have received SSI payments because of blindness. The BWE items do not have to be related to your blindness. When SSA figures your SSI payment amount, SSA treats items as BWE instead of impairment-related work expenses. Examples of BWE items: Guide dog expenses Transportation to and from work Federal, state and local income taxes Social Security taxes Attendant care services Visual and sensory aids Translation of materials into Braille Professional association fees Union dues The Ticket to Work and Work Incentive Improvement Act of 1999 How does the "Ticket to Work and Work Incentive Improvement Act of 1999" affect SSA work-related programs? The Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) created a program called the Ticket to Work and Self-Sufficiency Program. This program supplements previously-existing programs and makes some fundamental changes to the way the issue of work for individuals with disabilities is handled by the SSA. The program establishes entitlement to a "ticket to work and self-sufficiency" for every individual who meets eligibility criteria established by the SSA. The Ticket may be used to obtain vocational rehabilitation, employment services and other support services. The beneficiary holding a ticket may take the Ticket to any employment network (i.e., a service provider) of his or her choice that is willing to accept the assignment. Note: Some beneficiaries will begin to receive Tickets early in 2001. During the first year of operation, beginning January 2001, the program will be available only in certain states. In the following years, SSA will expand the program to other parts of the country. The program will be operating in the entire country by January 1, 2004. Changes to the SSA programs by TWWIIA: A beneficiary who fails to accept rehabilitation services can no longer have his or her SSI or SSDI benefits reduced or terminated. The provision requiring prompt referral of specified individuals with disabilities under the SSDI and SSI programs to state VR agencies is repealed. What will a Ticket look like? The ticket will be a paper document that will have some personal information and some general information about the Ticket Program. How will I get my Ticket? SSA will be working with an organization the law calls a Program Manager. The Program Manager will help SSA manage the Ticket program and send the Tickets in the mail with letters explaining the program. Where would I take my Ticket to get services? You will take your Ticket to what the law calls an Employment Network. The Employment Networks will be private organizations or public agencies that have agreed to work with Social Security to provide services under this program. How will I find out about the Employment Networks? You will receive a list of the approved Employment Networks in your area when SSA sends you your Ticket. Some Employment Networks may contact you to offer their services. This information also will be available on SSA's web site and in other places. How will I choose an Employment Network? You can contact any Employment Network in your area to see if it is the right one for you. You and the Employment Network have to agree to work together. Can I change Employment Networks? Yes. You can stop working with one Employment Network and begin working with another. Before you make this decision, however, you should make sure you fully understand how the Employment Network plans to help you to work. How can I get more information about the Ticket program? Contact Social Security: You can call the toll-free number at 1-800-772-1213. Pamphlets and other written material available are at local Social Security offices. Information about the Ticket program also is available from many other private and government organizations that assist people with disabilities. If you have access to the Internet, you can get information from SSA's special web site, www.ssa.gov/work. Note: Effective January 2001, you can contact the Program Manager. SSA will announce their toll-free telephone number and the date they are available to answer questions. If I get a Ticket, do I have to use it? No. The Ticket Program is voluntary. If I go back to work, will I automatically lose my disability benefits? No, the new law has not changed SSA's work incentive rules. For more information about Social Security's work incentives you should: Call SSA's toll-free number at 1-800-772-1213; Contact your local Social Security office; or Visit SSA's special web site at www.ssa.gov/work If my disability benefits stop because I go back to work, will I have to file a new application if I can't work anymore? Effective January 1, 2001, if your benefits have ended because of work, you can request that SSA start your benefits again without a new application. There are some important conditions: You have to be unable to work because of your medical condition. The medical condition must be the same as or related to the condition you had when SSA first decided that you should receive disability benefits. You have to file your request to start your benefits again within 60 months of the date you were last entitled to benefits. Will I have to wait for SSA to make a new medical decision before I can receive benefits? No. SSA will make a new medical decision, but while it is making the decision, you can receive up to six months of temporary benefits If SSA decides that it is unable to start my benefits again, will I have to pay back the temporary benefits? No. Will SSA still review my medical condition? Effective January 1, 2001, SSA does not review the medical condition of a person receiving disability benefits if that person is using a Ticket. Effective January 1, 2002, under certain conditions, SSA does not review the medical condition of beneficiaries who have received Social Security Disability Insurance benefits for at least 24 months. Does the new law include changes in health care coverage? Yes. TWWIIA extends premium-free Medicare Part A (Hospital Insurance) coverage for an additional 41/2 years beyond the current limit. This new law is for people who want to receive Social Security disability benefits and go to work. How long is Medicare extended? Medicare (Part A) coverage is extended for 41/2 years. General Rule: You will get the extended Medicare coverage for the additional 41/2 years if: You still have a disabling condition, and sign up for Premium Hospital Insurance (Part A) You are starting to work for the first time after your disability benefits began You are in a trial work period (TWP) You are in your 36-month extended period of eligibility (EWE) which began after June 1997 Your Medicare coverage under the current law didn't end before September 30, 2000 Under this law, how long will I get to keep Medicare if I return to work? As long as your disabling condition still meets SSA rules, you can keep your Medicare coverage for at least 81/2 years. (The 81/2 years includes your nine month trial work period.) After my TWP, under this law, how long will I have Medicare coverage? You will get at least seven years and nine months of continued Medicare coverage, as long as your disabling condition still meets SSA rules. I completed my TWP. I am now in my 36-month Extended Period of Eligibility. Will this law apply to me? If you are in an EPE that began after June 1997, the law will apply to you. This means you will get the additional Medicare coverage of 41/2 years. If your EPE began before July 1997, SSA must consider the following factors before it can decide if the new law applies to you: Are you still disabled? When did your trial work period end? Are you working at substantial gainful activity (SGA)? What was the first month you worked SGA after your TWP? I have Medicare hospital insurance (Part A) and medical insurance (Part B) coverage. Will I get to keep both parts under this law? Yes. As long as your disabling condition still meets SSA rules. Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage also will continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop because of your work, you or a third party (if applicable) will be billed every three months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check. I have Medicare (Part A) but I did not take Part B coverage when it was first offered to me. Can I get Part B when the new law changes? Yes. The law did not change the enrollment periods. However, you do not get a new enrollment period. If you did not sign up for Part B when you first could, you only can sign up for it during a general enrollment period (January through March of each year) or during a special enrollment period. The special enrollment period is a period of time during which you may enroll if: You did not enroll during your initial enrollment period because you are covered under a group health plan based on your own current employment or the current employment of any family member, or You enrolled (or were deemed to be enrolled) in your initial enrollment period (and any subsequent special enrollment periods), and have been covered under a group health plan based on your own current employment or the current employment of any family member. The special enrollment period may occur during any month you are covered under a group health plan based on current employment, or during the eight-month period that begins the first full month after employment or group health plan coverage ends, whichever comes first. When I return to work and get medical coverage through my employer, does this change my Medicare? Do I need to notify anyone? Medicare often is the "secondary payer" when you have health care coverage through your work. Notify your Medicare contractor right away. Prompt reporting may prevent an error in payment for your health care services. Under the new law will I still be able to purchase Medicare after my premium-free Medicare (hospital insurance) ends? Yes. The new law did not change this. The same rules apply. As long as you still have a disabling condition, you can purchase Medicare (hospital insurance, Part A). If you purchase Part A, you may purchase medical insurance (Part B). You cannot purchase Part B unless you purchase Part A. Do I need to apply for this premium Medicare (hospital insurance, Part A)? If so, when? Once your Medicare ends, you will get a notice that will tell you when you can file an application to purchase Medicare coverage. Note: There is a program that may help you with your Medicare Part A premiums if you decide to purchase Part A after your extended coverage terminates. To be eligible for this help, you must: Be under age 65 Continue to have a disabling impairment Sign up for Premium Hospital Insurance (Part A) Have limited income Have resources worth less than $4,000 for an individual and $6,000 for a couple, not counting the home where you live, usually one car and ertain insurance Not be eligible for Medicaid already To find out more about this program, contact your county, local or state Social Services or medical assistance office. Ask about the Medicare buy-in program for Qualified Disabled and Working Individuals. See Chapter 5 on Medicare for more information on this program. Endnotes Job Accommodation Network www.jan.wvu.edu Institute for Community Inclusion U.S. Department of Labor www.dol.gov Social Security Administration www.ssa.gov President's Committee on Employment of People with Disabilities www.pcepd.gov