MISSION STATEMENT

1. MISSION STATEMENT The Agency Supports Persons with Developmental Disabilities in Living, Learning, and Working in their Communities. Director Barbara Palmer Governor Rick Scott

2. KATRINA WASHINGTON State Office Operations Review Specialist Phone: 850-595-8329 Cell: 850-556-5859 Fax: 850-595-8020 Katrina.Washington@apdcares.org

3. Knowledge Is Power! You are here to learn exciting new ways to help others or yourself!

4. Acronyms

5. Barriers • High unemployment rate for people with disabilities • Up to 80% unemployed • Unemployment and under-employment among working-age Americans with disabilities continues to be a problem • Fear of losing benefits is a significant barrier • SSA benefits and attached health care

6. (of the System) What if…?

7. RULES OF ENGAGEMENT “Before any rules are discussed, all parties must be clear what benefits a persons is receiving from all sources, private and public, before information is exchanged.

8. ALWAYS CONSIDER THE FOLLOWING: • Age • SSI • SSDI • dual eligible • Married / Single • Live in HUD housing • Receiving food stamps • Over 18 and living at home • Any other information pertinent to their financial situation

9. Expert?You do NOT need to be the expert! • You do need to know how valuable this information is • You do need to educate people • You do need to know about the tools at your disposal

10. Overview SSDI (Title II) (Social Security Disability Insurance) • FICA • Medicare • Federal Rules V E R S U S SSI (Title XVI) (Supplemental Security Income) • General Revenue • Medicaid • State Rules

11. Florida is a 1634(d) State Social Security Act Section 1634(d) allows Florida to use the same eligibility criteria for SSI eligibility as for the state’s Medicaid Program

12. SSDI: Eligibility for Benefits

13. Medicare Federal Health Insurance Program • For people 65+ • People <65 with certain disabilities • People with end-stage Renal Disease

14. Continuing Disability Review (CDR) – SSI and SSDI • Periodic eligibility redetermination • Answers the Question: Does the beneficiary continue to be disabled?

15. CDR Process Occurs every 3, 5, or 7 years. If you have a condition not expected to improve, SSA will review your case, but not as often as every 3 years.

16. SSDI – Title II • F.I.C.A. • Waiting Period • SGA • Eligibility • DAC/CDB • Medicare (1960’s)

17. SSDI You may receive this benefit if: Medicare is usually associated with SSDI

18. Medicare Components Part A - Hospital Insurance Part B - Medical Services Part C - Private Insurance Part D - Prescription Drug Coverage Page 28 - 29

19. SSI Title XVI (1974) • General Revenue • Needs-based • No Waiting Period • Looks at Earned and Unearned Income • Resources Count • Medicaid

20. SSI: Eligibility for Benefits

21. HOW TO FIND BENEFIT CHANGES Social Security • www.socialsecurity.gov • www.socialsecurity.gov/disability • www.ssa.gov Medicaid • http://www.Medicaid.gov/ Federal Poverty Guidelines http://obamacarefacts.com/federal-poverty-level.php Page 38

22. Childhood Disability Beneficiary (CDB) • Requires states to consider Title II Childhood Disability Beneficiaries (CDBs) who lose SSI eligibility as if they were still SSI recipients for Medicaid purposes – keep Medicaid– • As long as they would have remained otherwise eligible for SSI benefits but for their entitlement to (or increase in) their SSDI (Title II) payment (CDB = DAC or Disabled Adult Child)

23. Childhood Disability Beneficiary A DAC or CDB may also be • an adopted child • a step-child • a grandchild or • a step-grandchild

24. Work Incentives Comparison Chart

25. SSDI Work Incentives • Trial Work Period – 9 months with monthly gross earnings of $810.00 or more within a 60-month rolling window of time • Extended Period of Eligibility (EPE) – 36 consecutive months • Grace Period is a 3-month period which runs once upon first earning SGA during or after EPE • Extension of Medicare Coverage – minimum of 93 months Page 51

26. Student Earned Income Exclusion, SEIESSI Only • Must be under the age of 22 and regularly attending school • Can exclude earned income up to a certain amount, which changes annually • Amount earned is reviewed monthly, with a yearly maximum of $7,180.00 • This exclusion applies before any other exclusion • Can carry the balance over the following month Can make up to $1,780.00 per month.

27. SEIE – SSI

28. SEIE – SSI Report the following to the SSI claims representative: • Proof of regularly attending school at least one month during the current calendar quarter or expectation to attend school at least one month in the next quarter • Pay stubs showing the amount of earned income while considered a student and under the age of 22

29. Section 1619(a)– SSI Enables a person to continue receiving an SSI cash payment when earnings exceed SGA

30. Section 1619(a) – SSI • Eligibility for SSI will continue as long as requirements are met • SSA will continue to calculate income as before • A person continues being eligible for Medicaid • This happens automatically when wages are reported to SSI monthly.

31. 1619(b) – SSI When a beneficiary earns enough income to no longer receive an SSI monthly cash payment, 1619(b) provides for the continuation of Medicaid There are qualifications: • Eligibility • Disability • Need Medicaid • Under State Income Threshold

32. Plan for Achieving Self-Support (PASS) – SSI • An income/resource exclusion • Allows a person to set aside income and/or resources for purposes of achieving an occupational objective • Helps an individual to establish or maintain SSI eligibility

33. Property Essential for Self-Support(PESS) – SSI • SSI will not count certain resources that are essential to a person’s means of self-sufficiency • Utilized when initially applying for SSI • Maintains resource eligibility for SSI/Medicaid

34. IRWE – SSI and SSDI Due to out-of-pocket expenses that support a disability to allow a person to earn income, even if those items or services are also needed for non-work activities IImpairment RRelated WWork EExpense Page 83

35. Impairment Related Work Expense (IRWE) – SSI and SSDI • SSI Beneficiaries: IRWE is used to reduce gross income – Why? • SSDI Beneficiaries: IRWE is used to reduce countable earnings below SGA – Why? What is the difference between “gross income” and “countable earnings”?

36. IRWE – SSI and SSDI Examples • Transportation • Medications • Medical Devices • PCA

37. Thanks!