Download Benefits Team - Coalition On Homelessness and Housing in Ohio

Benefits Consultation
Julie Koehler, Program Director
Ron Swain, Senior Benefits Consultant
John Hartman, CWIC Benefits Specialist
Stephanie Gibson, CWIC Benefits Specialist
Karie Urban, CWIC Benefits Specialist
Mike Keffer, CWIC Benefits Specialist
Carrie Printz, CWIC Benefits Specialist
Tanya Chiles, CWIC Benefits Specialist
The benefits of Benefits Analysis
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To clarify existing
benefits
To assist with
system navigation
To present financial
options
To outline an
individualized plan
Benefits Process
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Referral
COVA Career Developers
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Bureau of Vocational Rehabilitation
Community Mental Health Centers
Social Security Administration
County Boards of MRDD
Job and Family Services
Educational Programs/Schools
Family Support Groups
Community Advocacy Centers
Contact
– by phone
– written letter
– e-mail
Benefits Process
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Collection
– Gather information in person, phone, e-mail, fax
– Contact guardian, representative payee, community
advocate
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Research
– Release of Information signed
– Contact Work Incentive Liaison/ Obtain a Benefits
Planning Query (BPQY) if necessary
– Reconstruct Work History
– Identify the source of Benefits
Benefits Process
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Analysis
– Current position
– With Employment
– Transitioning off Benefits
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Report
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Biographical Information
Current Benefits
Assets and Resources
Employment
Concerns
Options
Work Incentives Planning and
Assistance
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Funded by the Social Security Administration as part of the
Ticket to Work/Work Incentives Improvement Act of 1999
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Currently receiving a Social Security Administration disability
benefit
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Between the ages of 14 and 64
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Living within the 50 counties of central and southeastern Ohio
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Participating in vocational rehabilitation with the goal of selfsufficiency.
Benefits Consultation
Fee for Service
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Work Incentives Benefits Summary
– Work Incentives
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Plan for Achieving Self-Support
Social Security Benefits Eligibility Assessment
(private pay from individuals and families)
– Application for SSDI, SSI, Medicaid
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Benefits Consultation
– Overpayment
– Benefits Case Management
SSDI vs. SSI
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Title II
Gross monthly
wages from 1st to
31st
Based on previous
work credits earned
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Title XVI
Based on the date
the paycheck was
received
Needs based
program
Childhood Disability Benefit
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child must be 18 years of age
disability onset prior to age 22
insured parent is disabled, retired or
deceased
benefits end when child marries
unless to another CDB beneficiary
Income
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EARNED INCOME
– wages
– self-employment net
earnings
– temporary disability
payments
– royalties and
honoraria for
services
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UNEARNED INCOME
– pensions and annuities
– payments such as
SSDI, Railroad
Pension, Veterans
Administration
– workers compensation
– unemployment
– dividends and interest
– alimony and support
In-Kind Support- SSI
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Basic living expenses (food, shelter, and
utilities)
must be at least 18 years of age
FULL - no contribution
– 1/3 reduction of $224 = FBR $448
(approximately)
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PARTIAL - presumed maximum value
– contribution no greater than $224
– pay fair share within $5 to use full FBR
Resources- SSI
$2,000 for individual $3,000 for couple
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EXCLUDED
– home lived in
– car for work, medical
or modified
– $4500 fair market
value of car
– Property Essential to
Self Support
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INCLUDED
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cash
stocks and bonds
land
property
cash surrender value
of life insurance or
burial plan
Federal Benefit Rate
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$674 for an individual
$1,011 for a couple
adjusted annually
affected by income,
living arrangement,
and use of Work
Incentives
Social Security Disability Insurance
& Childhood Disability Benefits (DAC)
Title II
Work Incentives
•Trial Work Period
•Impairment-Related Work Expense
•Extended Period of Eligibility
•Subsidy
•Grace Period
•Unsuccessful Work Attempt
•Expedited Reinstatement
•Extended Medicare
•Substantial Gainful Activity
Trial Work Period
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$700
$670
$620$640
$600
$590
$560$570$580
$530
$500
$700
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$400
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$300
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$200
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$100
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$0
2001
2003
2005
threshold
2007
2009
9 months within
any 60 month time
period when
earnings exceed
threshold
2001 = $530
2002 = $560
2003 = $570
2004 = $580
2005 = $590
2006 = $620
2007 = $640
2008 = $670
2009 = $700
Substantial Gainful Activity
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Earnings less than SGA will continue
payment of benefits
$980 current SGA (is adjusted based
on Federal Work Index)
Countable Income (may use
incentives to subtract from gross
monthly income)
For statutory blindness = $1,640
Extended Period of Eligibility
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36 consecutive months following the Trial
Work Period
earnings below Substantial Gainful Activity
will receive cash benefit; earnings above SGA
result in suspension of benefit for that month
Grace Period is the first month earnings
exceed SGA, cash benefit is issued that
month and the next 2 months
Subsidy
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Employer pays more than the value of
the work performed (extra support,
lower productivity, extra breaks, etc.)
Special Conditions are subsidies paid
by an agency such as BVR, MR/DD
Work Activity Questionnaire to
determine subsidy
used on SSI for eligibility purposes only
Impairment-Related Work
Expenses
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Must be directly
related to
impairment
– personal care
attendant
– special
transportation
– medical equipment
– prosthesis
– medications
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Must be an expense
incurred for work
– equipment such as
interpreters
– training
– job coaching
EXR
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TWWIIA-established safety net
Effective January 1, 2001
For individuals who have stopped receiving
benefits as a result of work and then at a later
date find themselves unable to work because of
their medical condition
Provides for up to six months of provisional
benefits
Provides 5 years of coverage from month of
benefit termination
Supplemental Security Income
Title XVI
Work Incentives
•General Income Exclusion
•1619(a)
•Earned Income Exclusion
•1619(b)
•Student Earned Income Exclusion
•Blind Work Expense
•Plan for Achieving Self-Support
•301 Ticket Protection
Income Exclusions
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GENERAL INCOME
EXCLUSION
– $20 per month
– excluded from unearned
income if possible
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EARNED INCOME
EXCLUSION
– $65 per month
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STUDENT EARNED
INCOME EXCLUSION
– $1,640 per month
– $6,600 annual cap
Impairment-Related Work
Expenses
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Must be directly
related to
impairment
– personal care
attendant
– special
transportation
– medical equipment
– prosthesis
– medications
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Must be an expense
incurred for work
– equipment such as
interpreters
– training
– job coaching
SSI Disincentives
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Resource limit
– No more than $2,000 for an individual
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Immediate reduction in cash benefits
– After Exclusions, $1 reduction for every $2
in earnings
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Overpayment cycle
– Payment on 1st of month, corrections
based on earnings during month
Plan for Achieving
Self-Support
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money to be set aside to obtain a selfsufficiency goal established in a Plan
money from unearned income or
earnings
goals can include education, training,
transportation, etc.
Plan must have specific goals and
milestones
1619(b)
Enters 1619(b) status when income equals
or exceeds the break even point- SSI is
reduced to $0.
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No cash benefits
Retains SSI eligibility and Medicaid with
no Spenddown
Annual threshold of $33,194
EXR
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TWWIIA-established safety net
Effective January 1, 2001
For individuals who have stopped receiving
benefits as a result of work and then at a later
date find themselves unable to work because of
their medical condition
Provides for up to six months of provisional
benefits
Provides 5 years of coverage from month of
benefit termination
How much can I make
and still keep my benefits?
“It’s never that simple!”
Ron Swain
Medicare vs. Medicaid
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Administrated by the
Center for
Medicare/Medicaid
Services (formerly
HCFA)
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Administrated by the
state Job and
Family Services
county departments
has different
criterion based on
state regulations
Medicare
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Eligibility based on aged, blind or
disabled status with SSA
Coverage begins following 24 months
of Title II payments
Part A includes hospitalization
Part B includes other services such as
doctor, lab work or outpatient svcs.
Part D includes prescription drug
coverage
Medicaid eligibility
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Aged
– 65 years or older
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Blind
– Visual acuity of 20/200 or
– receiving SSI due to a visual impairment
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Disabled
– Impairment that will last at least 12 months or
result in death
– receiving SSI, SSDI or County Medical
Service has determined disability
Medicaid eligibility
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FINANCIAL
– Income
• SSI is exempt
– Assets ($1,500 or less)
• e.g. Cash, Savings,
Stocks, Bonds
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NON-FINANCIAL
– Citizenship
– Residency
– Social Security
Number
– Limiting Physical
Factor (e.g.
Disability)
Non-waiver Medicaid
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2009 standards
Income Needs
Standard is $589 &
$1,011 for a couple
Asset Limit is $1500
$2250 for a couple
Income Disregards
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Gross Income
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SSI exempt
$20 General
$65 Earned Income
Impairment-Related Work Expenses
1/2 of remaining income
Cannot receive both Impairment-Related and
Work Expenses for the Blind deductions which
are deducted after the 1/2 remaining income
SPENDDOWN
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Allows for the deduction of
certain medical expenses so
that income will fall within
eligibility guidelines
– Example: Medical insurance
premiums, prescriptions, past
medical expenses
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Determined by the County
Department of Job and Family
Services
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3 Types
– Ongoing
– Delayed
– Pay-In
Spenddown Comparison
Ongoing
Delayed
Pay-in
Medical Premium
Prescriptions
Pays spenddown
amount to CDJFS
Past Medical
Expenses
Doctor Visit
Eligible first
of the month
Eligible date
spenddown
amount is met
Eligible first
of the month
What are Home and Community Based
Services Waivers (HCBS)?
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HCBS waivers are State selected options
that allow individuals to remain in the
community
– Ohio Home Care
– PASSPORT
– Individual Options
– MRDD waiver (Level 1,2 &3)
Patient Liability
Example:
 Childhood Disability Benefits $700
 Total income (both earned and
unearned) up to $1,380 before Patient
Liability is incurred.
$1,380 - $700 = $680 (earnings potential
before patient liability is incurred)
Medicaid Buy-In for Workers with
Disabilities
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Provides health coverage for WORKING
individuals with disabilities
Ages 16 to 64
Allows up to $10,000 in resources
Allows income up to 250% of the FPL
Income above 150% of FPL results in
monthly premium for Medicaid
Premiums charged are 10% of difference
between total family income and 150% of FPL
Creating opportunities that work
Contact
Julie Koehler….………...(614) 294-7117
Program Director
[email protected]
www.cova.org
3770 N. High St., Columbus, OH 43214
QUESTIONS?