BENEFIT OVERVIEW

1. BENEFIT OVERVIEW

2. BENEFIT PROGRAMS Needs-based Benefits Entitlement-based Benefits Cash Assistance (Income) Medical Assistance

3. DISABILITY • Physical or mental impairment • 12 months or result in death • Prevents engaging in SGA

4. SSDI/MEDICARE ELIGIBILITY • Disability under SS • SSD 5 months after disability • Medicare 24 months after SSD • Prior earnings and payment of SS taxes • Benefits based on parent’s earning history if • Child disabled prior to age 22, and • Parent retired, disabled or deceased

5. SSDI Eligibility depends upon • Sufficient work credits to be insured • Relationship to worker • Disability of • Worker • Dependent

6. SSDI ELIGIBILITY • Necessary work credits range • From 20 for age 42 > • To 40 for age 62 < • Fewer work credits necessary if age 31 > • 20/40 rule: 20 credits in last 10 years • 10 years = 40 credits • Hence: “20/40” rule

7. RELATIONSHIP FOR SSDI • Disabled insured person entitled • On own account if • Worked enough quarters • Earned enough • Children entitled • If minors or disabled adult children • On parent’s account if • Eligible parent disabled, retired, deceased • Adult child disabled before age 22 (CDB)

8. DISABILITY CRITERIA • Determination delegated to State DDS • 2 criteria of physical or mental impairment(s) • Expected to last (or lasted) 12 mos or result in death • Prevents worker from doing “substantial gainful work” existing in national economy considering • Age • Education • Work experience • Disability types • Listed impairment • Functional test (claimant to prove disability) • Seriousness (no substantial gainful work activity) • >$940/month

9. SSDI WORK ABILITY TESTS • First test: can worker do former job • Worker has burden to prove that can’t do former job • Second test: hold any job earning >$940 • SSA has burden to prove gainful work alternative • Available in the national (not area) economy • Vocational expert often used in hearings • Test is relative to • Age (50 < presumed less able for other work) • Education • Work history

10. SSDI BENEFITS • Primary Insurance Amount (PIA) • Cap on total worker/family benefit • “Family Maintenance Amount” • Worker’s family not to do as well as when working • Range from few dollars to about $2000 per month • Lose if earn >$940 (less work-related expenses) • 5-month waiting period • For benefits after disability onset • Medicare eligibility • 24 months after eligible for SSDI benefits

11. RECOVERY FROM DISABILITY • Periodic reviews • Frequency based on recovery likelihood • 5-7 years • 3 years if recovery theoretically possible • 6 to 18 months if recovery expected • Regular income > $940 • Benefits conditioned upon treatment compliance

12. RETURN TO WORK • Trial work period (TWP) • Test ability to work • For 9 months & continue benefits • Earnings >$670/mo • Once per lifetime • Work performance considered evidence that not disabled • Reinstatement if becomes disabled within 15 mos.

13. SSI/MEDICAID ELIGIBILITY • Disability under SS standards • Countable resources < $1,500 Medicaid, $2,000 for SSI • Income levels

14. SSI • Federal income program for persons with a disability who do not have Social Security coverage • SSI is intended to pay for the beneficiary's food, clothing, and shelter and nothing more

15. INCOME • Disregard $20 unearned income • Disregard $65 plus one-half earned income • IRWEs • Deeming • In-kind support and maintenance (charge room & board)

16. EFFECTS OF INCOME ON SSI

17. EXAMPLE • Earnings = $585/month • Less $85 disregards = $500 • Less ½ = $250 • SSI reduced to $387 ($637 – 250)

18. RESOURCES • Owned by the individual • Available to the individual and can be converted to cash • Not “exempt” • Deeming

19. EXEMPT RESOURCES • Household goods (collectibles are not exempt) • Residence • Vehicle • Irrevocable funeral contract • Burial plots • Whole life insurance w/ total face value < $1500 • Back payments of SS (for 9 months) • Special needs or pooled trusts

20. INCOME v. RESOURCES • Receipt of assets is income in the month received • 10 day reporting requirement • If still owned next month, counted as resource

21. VALUE OF BENEFITS • SSI - $637/month • Medicaid • medical/hospital care • prescriptions • rudimentary dental/vision • residential/institutional • Waiver - up to $14,000/month

22. SSI TRANSFER RULES • Gifts within last 36 months disqualify • Gifts from current beneficiary disqualify • Disqualification determined by • Dividing the value of the gift by • SSI rates involved • Maximum disqualification is 36 months • Exceptions for transfers to special needs trust • 42 U.S.C. § 1396p(d)(4)(A) – Payback Trust • 42 U.S.C. § 1396p(d)(4)(C ) – Pooled Trust

23. SSI & DIB BENEFITS COLLIDE • Example: Helen disabled since age 20 • Receives $579 in SSI monthly • Helen’s father, Earl, retires • Receives $1,000 RIB monthly • Helen then Receives $500 CDB monthly • Receipt of DIB unearned income • Reduces Helen’s SSI by $480 • Helen then receives total of $599 • $99 SSI + $500 CDB

24. SSI BENEFITS LOST • Example Cont’d: Earl dies • Helen receives $750 DCB per month • Helen’s $579 SSI eliminated • Helen may lose eligibility for • Non-vendor Medicaid in some states • Unless does “spend down”

25. SS & SSI BENEFITS KNOWLEDGE IMPORTANT • Understanding of benefits • Essential • To estate planning • To special needs trust administration • To avoid jeopardizing eligibility when • Beneficiaries have mental illnesses • Families want benefits to continue • Source • www.ssa.gov

26. REPRESENTATIVE PAYEE • SSA procedures & standard • Refuse to honor DPOA • Refuse to honor guardian/conservator • Appointment & reporting requirements • Not burdensome • Funds Requirements • All to be used for beneficiary • No commingling with other funds (e.g., trust) • However, could use joint tenancy to avoid probate