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Download Benefits Team - Coalition On Homelessness and Housing in Ohio
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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 To clarify existing benefits To assist with system navigation To present financial options To outline an individualized plan Benefits Process Referral COVA Career Developers – – – – – – – – 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 Collection – Gather information in person, phone, e-mail, fax – Contact guardian, representative payee, community advocate 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 Analysis – Current position – With Employment – Transitioning off Benefits Report – – – – – – Biographical Information Current Benefits Assets and Resources Employment Concerns Options Work Incentives Planning and Assistance Funded by the Social Security Administration as part of the Ticket to Work/Work Incentives Improvement Act of 1999 Currently receiving a Social Security Administration disability benefit Between the ages of 14 and 64 Living within the 50 counties of central and southeastern Ohio Participating in vocational rehabilitation with the goal of selfsufficiency. Benefits Consultation Fee for Service Work Incentives Benefits Summary – Work Incentives Plan for Achieving Self-Support Social Security Benefits Eligibility Assessment (private pay from individuals and families) – Application for SSDI, SSI, Medicaid Benefits Consultation – Overpayment – Benefits Case Management SSDI vs. SSI Title II Gross monthly wages from 1st to 31st Based on previous work credits earned Title XVI Based on the date the paycheck was received Needs based program Childhood Disability Benefit 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 EARNED INCOME – wages – self-employment net earnings – temporary disability payments – royalties and honoraria for services 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 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) 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 EXCLUDED – home lived in – car for work, medical or modified – $4500 fair market value of car – Property Essential to Self Support INCLUDED – – – – – cash stocks and bonds land property cash surrender value of life insurance or burial plan Federal Benefit Rate $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 $700 $670 $620$640 $600 $590 $560$570$580 $530 $500 $700 $400 $300 $200 $100 $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 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 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 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 Must be directly related to impairment – personal care attendant – special transportation – medical equipment – prosthesis – medications Must be an expense incurred for work – equipment such as interpreters – training – job coaching EXR 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 GENERAL INCOME EXCLUSION – $20 per month – excluded from unearned income if possible EARNED INCOME EXCLUSION – $65 per month STUDENT EARNED INCOME EXCLUSION – $1,640 per month – $6,600 annual cap Impairment-Related Work Expenses Must be directly related to impairment – personal care attendant – special transportation – medical equipment – prosthesis – medications Must be an expense incurred for work – equipment such as interpreters – training – job coaching SSI Disincentives Resource limit – No more than $2,000 for an individual Immediate reduction in cash benefits – After Exclusions, $1 reduction for every $2 in earnings Overpayment cycle – Payment on 1st of month, corrections based on earnings during month Plan for Achieving Self-Support 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. No cash benefits Retains SSI eligibility and Medicaid with no Spenddown Annual threshold of $33,194 EXR 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 Administrated by the Center for Medicare/Medicaid Services (formerly HCFA) Administrated by the state Job and Family Services county departments has different criterion based on state regulations Medicare 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 Aged – 65 years or older Blind – Visual acuity of 20/200 or – receiving SSI due to a visual impairment 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 FINANCIAL – Income • SSI is exempt – Assets ($1,500 or less) • e.g. Cash, Savings, Stocks, Bonds NON-FINANCIAL – Citizenship – Residency – Social Security Number – Limiting Physical Factor (e.g. Disability) Non-waiver Medicaid 2009 standards Income Needs Standard is $589 & $1,011 for a couple Asset Limit is $1500 $2250 for a couple Income Disregards Gross Income – – – – – 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 Allows for the deduction of certain medical expenses so that income will fall within eligibility guidelines – Example: Medical insurance premiums, prescriptions, past medical expenses Determined by the County Department of Job and Family Services 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)? 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 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?
