Please remember this is an example analysis - SSA thresholds change annually and the amounts shown in this example will be outdated.

1. General Information:

   Client (29) is a dual beneficiary. The disability on record with SSA is neurological; client reports paraplegia. Her SSDI is ($513), making her SSI ($52) if she was still eligible for a cash payment. She is covered by Medicare A & B, and Medicaid w/o spend down. The Medicaid is covered by SSA 1619b to be explained later in this analysis. Client is divorced and lives independently in the community with her daughter (7). There is an SSDI payment of ($82) for the child. There may be some child support income, but I was not able to determine that from the profile. The household is not HUD subsidized and she is on the waiting list for the PD waiver. She receives a food stamp stipend of $16. Client worked with a VR counselor in Nebraska and attended college. She used the SSA PASS that started in June 2001. Currently, the PASS is either suspended or terminated according to Mr. Tim McEvoy, the PASS cadre. Client moved to Kansas and started employment with SKIL in July 2002. She currently works part-time, 20 hours weekly for $7.50 hourly. She pays transportation costs of approximately $80 and $50 for medical devices monthly. She owns a modified 1999 Saturn with a $4,735 value, for which she still owes $3744. She has long-term goals to complete her college education and obtain full-time employment with medical benefits.

2. Immediate Cautions, Concerns and/or Suggestions:

1. Client has completed her Trial Work and Extended Eligibility Periods. Client needs to be aware that the achievement of Substantial Gainful Activity ($780 Y02) will be cessation and termination of her monthly cash benefit as well as the cash benefit for her daughter. The same month will also begin her Extended Medicare benefit. If client disagrees with the TWP months that SSA determined, she should contact Becky McDiarmid at the Independence SSA immediately.
2. Client is in jeopardy of an overpayment with SSA due to improper accounting of her PASS. The PASS cadre has outlined the following necessary items as needed immediately:
   1. Grade reports – completed or non-completed
   2. Receipts and/or bank records of money spent on PASS items
   3. Statement of hospitalizations
   4. Statement of trips/moves related to school/work (take a job)

   Client will have to work with the PASS Cadre to restart/amend the PASS if desired.

3. Although the food stamp amount received may be eliminated once income increases, earnings will make up the difference. The beneficiary should be advised to report monthly earnings as required to SRS.
4. SSA 1619a and 1619b will protect her SSI eligibility and Medicaid until her earnings reach the Kansas threshold amount of $24,560 (Y2002).

1. Trial Work Period (TWP) & Extended Period of Eligibility (EPE):

   All SSDI beneficiaries are entitled to 9 months of Trial Work Period. A TWP month is achieved when a beneficiary earns gross wages of $560 (Y2002) or above. Income Related Work Expenses (IRWE’s) cannot be used to reduce gross wages for this work incentive. TWP months do not have to be achieved consecutively.

   Client completed her TWP from December 1993 – August 1994.

   In 1993/1994 the TWP amount was $200, the amount for SGA was $500.

   The Extended Period of Eligibility (EPE) consists of 36 consecutive months beginning the first month after the 9^th TWP month accomplished. During this time, SSA monitors earned income for Substantial Gainful Activity (SGA). SGA is accomplished when an individuals’ work earnings achieve $780 (Y2002) or above. The first month during the EPE that work earnings are $780 or above is called a Cessation month. The beneficiary is still due the SSDI benefit this month and the following 2 months known as the Grace Period regardless of whether SGA is achieved. After Cessation and Grace months during the EPE, if an individual earns over SGA then they are not due the benefit check for that month and they should notify SSA. However, IRWE’s can be used during the EPE and beyond to reduce work earnings below the SGA amount until the individuals can financially support themselves without the additional benefit.Clients EPE ended August 1997. The SGA amount to achieve from 1994-1997 was $500. Cessation did not occur during the EPE.

   In 1997, client must have used Impairment-related Work Expenses.

   Extended Medicare:

   Social Security beneficiaries, who lose the cash benefit due to performance of Substantial Gainful Activity, but continue to be disabled, are eligible for extended Medicare coverage. The extended coverage is for a minimum of 39 months following the conclusion of the nine-month TWP. The Ticket to Work and Work Incentives Improvement Act further extends Medicare coverage for most SSDI beneficiaries who work. Beneficiaries will get an additional 4-˝ years coverage beyond the current limit (for a total of 8-˝ years including the TWP).

   Extended Medicare cannot be graphed at this time due to no SGA achievement.

2. SSI Considerations:

Since this client’s SSI benefit was $52.00, she lost her SSI cash award fairly quickly. Earned income however, quickly exceeds the amount lost. SSA 1619a protects her eligibility and 1619b protects her Medicaid as long as she meets the conditions of eligibility as follows:

• Have been eligible for an SSI cash payment for at least 1 month;
• Still be disabled;
• Still meet all other eligibility rules, including the resources test;
• Need Medicaid in order to work;
• Have gross earned income that is insufficient to replace SSI, Medicaid, and any publicly funded attendant care.

Should client achieve SGA and lose her SSDI, she would then be eligible for SSI payments again until she achieves the break-even point for earnings.

1. Recommendations for Impairment –Related Work Expenses (IRWE’s):

IRWE’s are not used to reduce gross work earnings during TWP.

IRWE’s must be related to the Primary Disability and support ability to work. Expenses must be paid for by the beneficiary and NOT be reimbursable through any other source.

A SSA claims representative must approve all IRWE’s. Documentation from professionals, employers, and service providers in regards to assistance for the disability and costs, along with receipts for actual payment of work expense should be provided to the SSA claims representative for determination prior to use.

Identifiable IRWE’s:

Transportation $80 & Medical devices $50. Total $130.

Consult the SSA Red Book and/or a claims representative for other possible IRWE’s. The cost of co-pays for medication is also deductible as an IRWE.

Transportation – Paid costs

• The cost of structural or operational modifications to a vehicle that one needs in order to travel to work, even if you also use the vehicle for non-work purposes.

• Mileage expenses at a rate determined by SSA for an approved vehicle and limited to travel to and from employment.

Medication – Paid co-pays not reported in Profile

• Regularly prescribed medical treatment or therapy that is necessary to control the disabling condition, even if control is not achieved. This includes: anti-convulsant drugs, blood level monitoring, radiation treatment, chemotherapy, corrective surgery for spinal disorders, and anti-depressant medication. The physician's fee relating to these services is deductible.

Medical Devices – Paid costs

• Wheelchairs, hemodialysis equipment, pacemakers, respirators, traction equipment, and braces.

Attendant Care Services – Paid costs

• Performed in the work setting.

• Performed to help you prepare for work, the trip to and from work and after work, for example bathing, dressing, cooking, and eating.

• Services that incidentally also benefit your family, for example, meals shared by ones family.

• Services performed by a family member for a cash fee where he/she suffers an economic loss by reducing or ending his/her work in order to help. This includes a spouse reducing work hours to help one get ready for work.

Work-Related Equipment and Assistants

• All impairment related work assistant devices, services, methods, or systems, including helper animals.

1. Future Considerations:

• Plan for Achieving Self-Support. Strongly consider the benefits of balancing the current PASS.
• Long-term Benefit Management. Work applications are hypothetical. Exact income and benefit management need to be considered to make decisions about healthcare and employment changes. Maintain regular records and contact with all agencies providing services.
• Ticket to Work. Use of the SSA Ticket to Work for protection from Certification of Disability Reviews (CDR), etc. Tickets are scheduled for Kansas’s beneficiaries in November 2002. Look for or inquire to SSA about a Ticket to Work.

• Expedited Reinstatement of Benefits. If the beneficiary’s SSDI cash benefit ends because or work (within 5 years from the month her benefits end), she does not have to file a new application to restart payment of SSDI. If the situation changes contact SSA and ask how to restart benefits.
• Earned Income Tax Credit. Use the Earned Income Tax Credit on Annual Income Tax. Client also has the option of claiming some of the EITC on a monthly basis.

1. Work Application: Hypothetically based on reported job information.

SSA counts income for SSDI work incentives by amount EARNED not RECEIVED. Client will need to understand how to track monthly earnings.

For SSI recipients, Social Security counts earned income when it is received, depending on the pay periods of the employer.

This benefit analysis will be based on a two-week pay period.

I will use the client’s 4-hour workdays and apply it to 23 workdays for October 2002.

Hourly wage $7.50.Use the labeled information for each column in the benefit analysis chart as follows:

Benefit Only

SSDI and SSI cash only benefits.

Establish transportation and medical device costs as IRWE’s.

With IRWE’s established, increase hours. Without the pre-established IRWE’s, SGA would be obtained and client would lose the cash benefit of BOTH herself and the daughter.

If current situations changes, please re-submit information for additional analysis or to report an unsuccessful work attempt.