Maintaining Your Benefits

Maintaining Your Benefits as
You Begin Making a Buck

As a student with disabilities enters middle and high school, teachers, the student, and his or her family begin talking about and planning for the student’s transition from school to adult life. Questions arise such as: What will this young person do after they graduate from high school? What will he do for work? What will she do for fun? Where will he live? What services will she be able to access for the assistance that she will need to live and work in her community? How will this young person support himself?

One resource that is critical to this equation, but often not discussed in transition planning, is Social Security and the disability benefits it manages. Social Security administers two disability benefit programs which provide cash assistance and health insurance to eligible youth and adults with disabilities. Many students and families rely on the medical insurance and the monthly cash assistance provided through these programs. As a result, they may be fearful that working and earning an income might jeopardize the insurance or benefits. Many services such as residential support, employment supports, personal care, and various treatments are funded by Medicaid. It is critical for people who depend on Medicaid and cash assistance for survival to have access to accurate information about how work will impact their benefits so they can make decisions about what will be best for them. As we support young adults in planning for their futures, we need to provide them with information about how income and work impact benefits and the various resources available through Social Security Work Incentives to help them maintain their benefits, until such time as they can replace them in their entirety by working. Some students under the age of 18 may already be receiving Supplemental Security Income (SSI) or a Social Security Survivor’s benefit, and many other youth will begin the application process for SSI at age 18, while they are still in school. In some cases, school staff may be initiating applications or referrals to SSA or assisting families in their application.

School staff need to be knowledgeable about this application process since the information they will be asked to provide to Social Security can either help or hinder the individual’s eligibility determination

Many myths and a great deal of misinformation exist about the impact of work, and thus wages, on Social Security and Medicaid. With planning, Social Security beneficiaries can work and earn wages without jeopardizing their benefits.

This monograph is a compilation of articles and resources written by staff of the Rural Institute on Disabilities Transition Projects and Training Department. We have assembled them for use as a resource to families, young adults, schools, and agency staff who are supporting students in their application for benefits and as a source of reference to assist beneficiaries in their decisions about employment.

This publication will provide information about:

The two disability benefits programs administered by Social Security: SSI and Social Security Disability Insurance (SSDI);
The application process for SSI;
The impact of wages on these benefits;
Social Security’s Work Incentive programs;
Ticket to Work; and
Resources that can provide technical assistance to schools, families and agencies around Social Security issues and can assist in the use of Work Incentives.

Also included in Appendix B are fact sheets on a variety of Social Security topics which can be copied and shared with people needing this information.

What Are SSI and SSDI?
SSI and SSDI are two programs Social Security manages that provide medical and cash benefits based on disability or blindness.

The Supplemental Security Income or SSI program makes cash assistance payments to people who are aged, blind, or disabled (including children under age 18), and who have limited income and resources. The federal government funds SSI from general tax revenues. Some states pay a supplemental benefit to individuals in addition to their federal benefits and sometimes these payments are combined into one monthly check.

To Be Eligible for SSI, You Must:

Have limited income and resources;
Be a U.S. citizen;
Meet disability qualifications or be blind or aged;
Reside in the U.S. or Northern Mariana Islands; and
Not be working, or if working, not performing Substantial Gainful Activity (SGA) when you apply. (Once you are receiving SSI, SGA is no longer an issue.) In 2005, SGA is gross earnings of $830/month; $1380/month if you are blind.

Medical Coverage
In 32 states and the District of Columbia, if someone qualifies for SSI they automatically qualify for Medicaid. The application for SSI serves as the application for Medicaid in these states. If your state does not require a separate application for Medicaid, your Medicaid coverage will begin as soon as you are determined eligible for SSI. You may also be eligible for Medicaid coverage up to three months retroactively.

States in which SSI automatically comes with Medicaid.
Alabama Delaware Louisiana Mississippi Pennsylvania Texas Wyoming	Arkansas Florida Maine Montana Rhode Island Vermont District of Columbia	Arizona Georgia Maryland New Mexico South Carolina Washington	California Iowa Massachusetts New York South Dakota West Virginia	Colorado Kentucky Michigan North Carolina Tennessee Wisconsin
States that have more stringent eligibility criteria for Medicaid, which require people to file separate applications.
Connecticut Missouri Virginia	Hawaii New Hampshire	Illinois North Dakota	Indiana Ohio	Minnesota Oklahoma
States and territories that use the same eligibility requirements for Medicaid as SSI but require a separate application.
Alaska Oregon	Idaho Utah	Kansas N Mariana Islands	Nebraska	Nevada

How Much Financial Assistance Is Provided?
Each year the Federal Benefit Rate (FBR) for SSI increases to reflect a cost of living adjustment. In 2005, the FBR is $579/month. Some states add additional state supplements to this amount. Countable income and various living situations can affect the amount of SSI someone receives monthly. (See the Sharing Worksheet on pg. 19 for an explanation of how living situations impact SSI amounts and see pg. 12 for information about how earned income impacts SSI.)

The Social Security Disability Insurance Program (SSDI) provides benefits to insured workers with disabilities or blindness, and their dependents or survivors. SSDI payments come from the Social Security Trust Fund. This fund is made up of contributions required by the Federal Insurance Contributions Act (FICA), which created Social Security taxes. Benefits are paid based on your earnings or earnings of your spouse or parents.

To Be Eligible for SSDI, You Must:

Meet the disability/blindness qualifications;
Have worked and paid Social Security taxes for enough quarters to be covered under Social Security Disability Insurance;
Have worked within 5 years of applying for SSDI benefits;
Not be working, or if working, not be performing Substantial Gainful Activity (SGA - defined as $830/month in 2005; or $1380 if you are blind); and
Have been disabled for at least 5 months; or
Have insured status as the former worker or the disabled widow or widower of a spouse who is a former worker. Minor children of former workers and their non-disabled parent may also receive benefits on the former worker’s record.

SSDAC (or DAC) - Social Security for the Disabled Adult Child
Adults with disabilities may receive SSDI benefits based on a parent’s work record alone, and some adults may receive SSDI based on their own work record and that of their parent(s).

Requirements to Receive SSDAC Benefits from a Parent’s Work Record Include:

Age 18 or older;
Disabled before age 22;
A child of an insured worker who is currently retired, disabled, or deceased; and
Earnings must never have exceeded the SGA level ($830/month for 2005).

Medical Coverage
If you are eligible for SSDI/DAC you will be eligible for Medicare. Most likely there will be a 24-month wait time between being determined eligible for SSDI/DAC and receiving Medicare. However, if you received SSDI/DAC and Medicare previously stopped work due to a disability and are returning within 5 years with the same related impairment, there will be no wait for Medicare or SSDI/DAC. Children under 18 don’t receive Medicare.

How Much Financial Assistance Is Provided?
The amount of your monthly SSDI/DAC check will depend on how much you, your parent, or your spouse have paid into the insurance system; the age at which you begin to receive benefits; AND how many people are eligible to receive benefits from that one person’s earning record.

Each SSA program has its own rules and regulations. Wages and income affect each of these benefits differently. However, both SSI and SSDI have work incentives available to beneficiaries that enable them to work, or return to work, without fear of automatically losing their financial and medical benefits.

Some beneficiaries are eligible for both SSI and SSDI concurrently. These recipients are known as “concurrent recipients” and must follow the rules of both programs.

The following chart outlines the differences between the SSI and SSDI/DAC programs. This chart was reprinted from RuralFacts, 2004 M. Katz, R. Shelley & N. Maxson.

SSI AND SSDI SIMILARITIES AND DIFFERENCES
	SSI	SSDI
Also Known As	Supplemental Security Income	Social Security Disability Insurance
Eligibility Criteria	Needs based—must have little or no income and resources.	Insured status as a worker, or a child, widow, or widower of an insured worker. No resource limits, no limits on unearned income.
Eligibility Criteria	Federal Benefit Rate (FBR) of $579/month (2005) Check amount depends on: a) living situation, b) earnings, and c) unearned income. Some states supplement the federal amount for some or all living situations.	Either eligible for a full benefit check or ineligible and receive no benefits. Check amount based on: a) earnings history of wage-earner, b) age when benefits begin, and c) number of people in addition to the wage-earner who are receiving benefits. If benefit amount is less than SSI FBR ($579/month in 2005), may also be eligible for SSI.
When Checks Arrive	First day of the month; if the 1st is a holiday or weekend, the check arrives on the business day before the 1st.	• People who qualified for SSDI before May 1997: arrives 3rd of the month. • Qualified after May 1997 and birthday between: 1st -10th: arrives 2nd Wednesday 11th - 20th: arrives 3rd Wednesday 21st - 31st: arrives 4th Wednesday
Funding Source	Annual Congressional appropriation from the “General Fund.”	Social Security Trust Fund, FICA taxes
Laws and Regulations	• Title XVI (16) of the Social Security Act (Title 42 US Code, the Public Health and Welfare, Chapter 7, Subchapter XVI). • Regulations in 20 CFR; Part 416.	• Title II (2) of the Social Security Act (Title 42 US Code, The Public Health and Welfare, Chapter 7, Subchapter II). • Regulations in 20 CFR, Parts 400 - 499.
Medical Benefits	• Medicaid eligible in 32 states. • In other states one must apply separately for Medicaid. (See chart on pg. 4) • Eligible the month of SSI application and possibly three months retroactively.	• Medicare eligible (Parts A and B) 24 months after person qualifies for SSDI.
Monthly Cost (Premium)	None.	SSDI recipients have $78.20 (2005 premium) deducted from their check each month. If SSDI recipient also has SSI, then Medicaid will pay the monthly Medicare premium.
Deductible	None, but there may be “cost sharing” instituted by states for various services.	Yes–in 2005 the Part B deductible is $110 year. If person also receives SSI, Medicaid pays the deductible.
Co-pay	Possibly none, however states may elect to have small co-pays for medications, services, hospitalization. Services and medications can NOT be denied for failure to pay co-pay.	20% of costs deemed allowable by Medicare; 100% of costs not deemed allowable by Medicare. If the person also receives SSI, then Medicaid pays all “co-pays.”
Range of Coverage	Very comprehensive - generally covers doctor visits, prescriptions, dentures, glasses, hospital, hospice care, home help services/personal care, and other costs. Pays Medicare premium for concurrent recipients. Pays premiums for private insurance when cost effective. Coverage may vary from state to state. See www.medicaid.gov for more information.	Covers hospital costs primarily and some home health care and durable medical equipment. Usually does not cover prescriptions, glasses, dentures, day-to-day medical costs, and doctor visits. However, recent changes in Medicare coverage will pay for comprehensive care at select clinics, and a new RX benefit is being added. See www.medicare.gov for more information.
Proof of Coverage	Card comes monthly. Lists person(s) covered, their recipient ID# for billing, Managed Care Provider, and contract number of other insurance (such as Medicare) that should be billed first.	Permanent wallet-sized card (white with red and blue stripe). Names person covered, coverage, and date coverage began and carries the Social Security number of the wage earner.

Social Security Red Book:
A Summary Guide to Employment Support for Individuals with Disabilities Under the Social Security Disability Insurance and Supplemental Security Income Programs.

Information about SSI and SSDI programs;
Explanation of applicable work incentives for each;
Information about application and eligibility for both programs; and
Contact information for SSA offices.

Available at your local SSA offices or at www.ssa.gov.