Dispelling Myths and Fears About Accessing Employment: Understand How To Use Work Incentives To Choose Work! Presenter: Cheryl Bates-Harris. >> JACQUIE: Good afternoon everyone and welcome to the webcast: Dispelling Myths and Fears About Accessing Employment. Understand How To Use Work Incentives To Choose Work. My name is Jacquie Brennan and I'm with ILRU. I will be moderating today's webcast and voicing your questions to the presenter. You can submit questions any time throughout this webcast. However, I want to encourage you to submit questions you may already have at the beginning of this webcast. You can submit questions by clicking the submit question button at the bottom of your RealOne Player screen or you can send an E-mail to webcast@ilru.org. Questions will be posed to the presenter throughout the webcast as she comes to stopping places and we have a chance to present questions. If anybody has technical difficulties during this webcast, please call us at (713)520-0232. and dial 0 for the operator. This number is both voice and TTY capable. We have a little extra technical difficulty today and we are unable to have the PowerPoint presentation seen as part of the webcast. So you will need to download the PowerPoint and there is also a text only file if you would rather have that for today's presentation. It is under the handouts link at the sign-on screen for the webcast. And I will ask the speaker to let us know as she is changing to a different slide so that she can -- so that you will know when she's moving on to another slide. As I said before, today's webcast is Dispelling Myths and Fears About Accessing Employment: Understand How To Use Work Incentives To Choose Work. It is being presented by Cheryl Bates-Harris with the Training and Advocacy Support Center. Cheryl is a disability -- senior disability advocacy specialist for the Training and Advocacy Support Center of NAPAS where she has been for more than 20 years. She has a lot of experience and expertise working with people with disabilities. She has an in-depth knowledge of cross-disability issues and continues to focus on employment issues of people with disabilities, including vocational rehabilitation, Social Security, Return to Work, TANF and other work programs that impact people with disabilities, including Department of Labor One-Stops. Cheryl has developed a complete knowledge and understanding of Social Security programs and work incentives beginning with the Social Security alternate participant program for which she was responsible for the development of the SSA Protection and Advocacy Dispute Resolution Project and later the development of the protection and advocacy for beneficiaries of social security. In addition, she has lead responsibilities for technical assistance and training to the client assistance programs, those are the CAP programs nationwide. Since the passage of Ticket to Work and Work Incentives Improvement Act, she has conducted national training on that program and vocational rehabilitation services and is considered a leading expert on the intersection issues of the Ticket to Work with state voc rehab services. She was appointed in September 2004 by President Bush to the Ticket to Work and Work Incentives Advisory Panel. Cheryl currently co-chairs the CCD work incentives implementation task force and CCD employment and training task force and is an active member of the CCD Social Security task force. She continues to conduct numerous training programs like the one she's going to give us today and provide ongoing training and technical assistance to the P&A/CAP network on employment issues that impact people with disabilities. I know you have a lot to cover today, Cheryl, so with that I'll turn over the webcast to you. >> CHERYL: Thank you very much. And remind me that we probably need to ditch that introduction. Thank you all for joining me this afternoon. I'm going to kind of go through what I call positive messaging related to how we can encourage people to basically choose work. So I'm going to start with basically slide No. 2 that reads: We have reached a crisis in unemployment and underemployment of people with disabilities. You're probably all aware that people with disabilities have been underemployed or unemployed for many years. And according to a Cornell University study in 2005 called their disability status report, 38 percent of working age individuals who report a disability are employed while 78 percent of working age individuals who report no disabilities are employed. So what that means is that we have a gap of about 40 percent in the employment rate. And if you're looking only at full time or full year employment, 22.6 percent of working age individuals who report a disability are employed while 56.2 percent of working age individuals who report no disability are employed. The math there shows you that the gap is 33.6 percent for full time, full year employment. So moving on to slide No. 3, the cost for excluding people with disabilities from taking an active part in community life is very high. Exclusion leads to diminished productivity and losses in human potential. Decent work is the first step out of poverty and social exclusion. But even knowing this, we know that family members and service providers are often reluctant to promote substantial work. Moving on to slide No. 4, we also know that given the proper combination of services and supports, people can work and assume valued roles in their community. Slide No. 5 says that people with disabilities have demonstrated their ability to work, that there are thousands of occupations that people with disabilities can pursue in their communities based on their interests and skills. But the myths and the fears continue. Looking at slide No. 6 now, and we're going to go through these early slides very quickly, we also know that myths and fears persist and people with disabilities, especially those on Social Security disability benefits are not always aware of their options or how it will affect their benefits. Generally, I think community organizations and rehabilitation programs need to understand the basics of Social Security disability programs. And when they are trying to explain the effect of employment, we need to be positive or at least neutral. So having said that, we'll move on to slide No. 7. One of the latest resources to really help encourage people to return to work is the Ticket to Work and Work Incentives Improvement Act. The Ticket to Work and Work Incentives Improvement Act removes many of the disincentives to employment and provides new choices and opportunities for people with disabilities to achieve steady employment. Slide No. 8, how can you help? With regard to the Ticket to Work and Work Incentives Improvement Act, there are eight general statements that a service provider or advocate can use to dispel myths and fears and begin to assist a Social Security beneficiary in making an informed decision about work. I'm moving on to slide No. 9 now. There are positive -- these are the positive phrases that may make a positive difference in a Social Security beneficiary's decision to look further into becoming employed; but first as I've already indicated, a service provider must understand the basics of Social Security Disability programs. >> JACQUIE: Cheryl, we've gotten a couple of questions in. >> CHERYL: Okay. >> JACQUIE: I wonder if I could ask at least one of those that might be a good preface to this discussion. >> CHERYL: Sure. >> JACQUIE: the question says at our independent living center, we have often referred to Social Security's Redbook for information regarding employment and people with disabilities. Does this publication still exist? >> CHERYL:Yes, it does. The Social Security Redbook does outline all of the various work incentives for both the SSI title 16 program and the SSDI Title II program. They are probably about six months behind in the actual printing of the book, but it is available on their web page in the 2007 version. >> JACQUIE: And that's www.ssa.gov now. >> CHERYL: Social Security is now spelled out, but ssa.gov will get you there and I realize that one of the things that I meant to do and didn't do was to send a list of resources that included the web links for these. So with your permission, I will send it after the teleconference and perhaps can you post it with the archive. >> JACQUIE: You bet. >> CHERYL: Did you have another question? >> JACQUIE: the other one wants to know if you will be talking about Medicaid spend down? >> CHERYL: Not really in this webcast. That's a whole horse of another color. >> JACQUIE: That is really a separate webcast by hit self. >> CHERYL: Yes. >> JACQUIE: I'll interrupt you again when we get some more. >> CHERYL: No problem. Thank you. The important thing to remember here as indicated at the top of slide No. 10 is that all Social Security benefits are not I like. Social Security administration basically has two benefit programs related to disability. They have what's called the Title II disability insurance program which includes childhood disability benefits previously known as disabled adult children. The Social Security disability insurance program and the disabled widow or widowers benefit. And I'm not going to go into a lot of detail about those programs right now other than the fact that those are an insurance program and that in order to be covered by the Title II programs, you must have worked or you must be tied to a wage earner who has worked. And then other disability benefit program is the title 16 which is known as supplemental security income. It uses the same definition of disability that the Title II program uses, but it is basically a program that pays a federal benefit rate to aged and people with disabilities with limited resources. So in slide No. 11, it explains that the Title II SSDI program is an all or nothing program with a 24 month waiting period for Medicare; whereas with the title 16 program, which is the SSI, there is a gradual reduction with Medicaid. The distinction here is that Medicare is tied to the Title II program, the SSDI, and there is a 24 month wait period for the insurance. In 39 states, Medicaid is automatic with the receipt of SSI benefits and in the remaining states, it requires a separate application; but you're still Medicaid eligible with your SSI. And it is important to understand that a lot of people get both, especially as people begin to return to work and gain quarters of coverage. So moving on to No. 12, understanding how work affects benefits is necessary in order to help people attempt work or keep them from quitting a job due to their fear of the loss of their benefits. So now what I'm going to start to talk about is what I call the myths that are out there about what happens with work. I'm going to hopefully couch them in a little more positive frame of reference, because what we want to do is encourage people to try work, to take advantage of the work incentives, to make sure that they understand how employment affects their Social Security benefits, their health insurance, et cetera. So I'm going to walk through these statements and, Jacquie, if a question comes up related to these, feel free to stop me. >> JACQUIE: I will, and I just want to remind us, Cheryl, to slow down a little for our captioner. >> CHERYL: The first statement on slide 13 says if you work you may maintain your benefits, SSDI, maintain your benefits for a period of time also SSDI, maintain some of your benefits in SSI and/or always increase your monthly income. How does this work? Slide 14 I'll walk you through it. The Social Security disability insurance program includes some built in work incentives to encourage people to try work. The first of these is what's called the nine month trial work period. Social Security allows an individual to go back to work and to try work to kind of test the waters, see how they handle it, and basically you can earn an unlimited amount of income for nine months before Social Security is really concerned about your ongoing level of activity. The nine month work period, once you have completed a nine month trial work period, you then -- and those nine months do not have to be consecutive. The nine months could be two months in 2004, three months in 2005 and no earnings in 2006 and then the remainder in 2007. The nine month trial work period occurs over what we refer to as a 60 month rolling work period. Once you have used up your nine month trial work period, you fall into something that's called an extended period of eligibility. And that's basically a period of time where you work and if your earnings go below substantial gainful activity, your benefits will continue. And once an individual goes into the extended period of eligibility, they are able to utilize work incentives and other exclusions which basically would reduce their countable income -- would reduce the countable income during an SGA determination, and so some of the work incentives and exclusions include the cessation and grace period following the trial work period if you go over SGA, you get a cessation month and two additional months of benefits before your benefits are terminated. You also get to deduct what are called impairment-related work expenses, and impairment-related work expenses are the kinds of expenses that an individual with a disability pays for out of pocket and are necessary to enable the individual to continue to work. So, for instance, an example could be an individual who requires specialized transportation in order to go to work, if they didn't pay for the specialized transportation, they couldn't work. That becomes an impairment-related work expense. It could be an individual who needs to take medication or purchase durable medical equipment. So those are the types of general examples of that. And then also subsidies can be considered in making an SGA determination. And a subsidy is a support that a person receives on the job that results in more pay being received than the actual value of the services performed. So, for instance, if an individual is getting some kind of additional on the job support perhaps from a co-worker, perhaps from a job coach, someone who is actually helping that person to either complete their task assignments or remember their tasks or possibly even do their tasks, that would be considered a subsidy because the person may not be considered earning their full wages. >> JACQUIE: Cheryl, I have four questions that have come in. I hate to hold them until the end because they all have to do with what you've just been talking about. >> CHERYL: That's fine. >> JACQUIE: the first one from access to independence says what does gradual reduction mean? >> CHERYL: Okay, if you'll hold that question for the next slide, I'm going to talk about the gradual reduction. So I will answer that question in just a minute. >> JACQUIE: Okay, the next one is can an SSDI applicant who qualifies for SSDI obtain Medicare without having to wait for 24 months? And an example, if the person is medically needy, can Medicare be obtained sooner? >> CHERYL: the answer to that is generally no. The only condition medically needy is a category under the Medicaid state plan, not with Medicare. The only exceptions to the 24 month wait period for Medicare are people who are in end stage renal failure and need dialysis and people with ALS or Lou Gehrig's disease. >> JACQUIE: When I approach employers about hiring individuals with disability, they claim that their insurance premiums will increase dramatically because of increased liability. Is this true and how can I overcome this? >> CHERYL: I think the answer to that is that it's not necessarily true. Again, that's a question -- there are ADA issues in there about the impact. I think generally -- well, we're going to talk about how SSDI and SSI beneficiaries can continue attachment to their health care programs. So I think part of perhaps the discussion with employers needs to be that for individuals who are Social Security beneficiaries and are already covered either through Medicare or Medicaid, that there will be a continued attachment to that which would -- could basically kind of be a wrap-around service to existing insurance, but I think -- I think that's a tough question to answer. I think that's a myth that people -- that employers have. I'm not honestly sure that it's been well documented and I would be happy to do a little bit more research and respond to that person individually if you wanted to provide me that information. >> JACQUIE: Sure. I can do that. And I agree that really is more of an ADA question that we get quite a bit. So I will for sure send you that. And the last one so far is -- says so you'll get both dollars from your employment in addition to SSI? >> CHERYL: Yes, and again I'm going to explain how that happens because in terms of work incentives, an SSI beneficiary is always better off financially working than not working because they have some more favorable earned income in the SSI program and is viewed much more favorably. So I'm going to talk about that. So why don't I go ahead and segue into the SSI program. >> JACQUIE: Perfect. >> CHERYL: So I'm now on slide No. 15 that says, you know, how does this work with SSI? SSI as we know is supplemental security income. In the SSI program, there is what's known as a one for two offset, which means that for every two dollars that a person earns, their SSI benefit check would be reduced by one dollar. And that's after you take what is known as a 20-dollar unearned income disregard and a 65-dollar earned income disregard. So, for instance, let me do some quick math here. Let's say that an individual goes to work and earns $600 a month. You subtract basically the $85 from the 600 and it leaves you with $515 of countable income. That number then would get basically divided by two because for every two dollars they earn their benefit check is reduced by one dollar and of course I have to come up with an odd number. So basically their benefit check would get reduced by $257.50 a month. The federal benefit rate is currently $623 -- I should have done this ahead of time. I apologize. So their federal -- their SSI check would now be $465.50. They get their $600 a month earnings that they've earned, so their total disposable income that month would now be $1,065.50 rather than just the $623 that they were getting on benefits. In addition to that, the SSI program also has some other work incentives that apply. For instance, they have the SEIE and I apologize for not spelling this out sooner. That is called the student earned income exclusion and I'm going to talk about that in a couple of minutes. You can also apply I payment-related work expenses to the SSI calculation. There are also blind work expenses for individuals who meet the legal definition of blindness that, again, are a little more generous than the impairment-related work expenses and you can also establish what's called a plan for achieving self-sufficiency or the PASS plan which I'm also going to talk about. So with SSI it is the more generous program in terms of encouraging return to work. Jacquie, do you have any questions on that yet? >> JACQUIE: No, we are good with questions right now. >> CHERYL: I'm going to go ahead and move on to statement 2 and some of these concepts that I talked about I will talk about a little bit fuller as they come up again. So statement 2 on slide No. 16 says: If you work and earn enough money to leave the SSI benefit roles and you need to return to the rolls again, you may be able to do this through a quick application process and be able to get your benefits again within a few weeks time. Now, what this is, this is a provision in the law called expedited reentry. Slide No. 17 basically describes the parameters of the expedited reentry. According to the law, you must be unable to continue working. And when the original legislation passed, it said you had to be unable to continue working due to your disability. To the credit of the Social Security Administration when they actually formulated the regulations on expedited reentry, they recognized the fact that people with disabilities are often the first people to lose their jobs, especially if it's a low wage position or an unskilled position and they were much more generous in the regulations and basically just said if the individual stops working. And you can apply for expedited reentry after you've used up your 36 months of extended period of eligibility. And you can also use it if you're on the SSI program after one year of suspension from SSI. What happens is you file a reinstatement application and at the time you can receive up to six months of provisional benefits during what's called the redetermination process. Obviously Social Security as a steward of federal funds and to maintain the integrity of the program does a redetermination to basically reaffirm that the disability continues to exist. So the good news is you can go back to work. You may lose your initial entitlement to either your SSI or your SSDI benefit, but if it's still within a 60 month period of time, within a five-year period of time, you can just do an expedited reentry, and get back to the system quickly, get provisional payments and even if you're found to no longer be disabled, those six months of provisional payments are yours to keep. So that's the good news. >> JACQUIE: Now I have some more questions. >> CHERYL: Okay. >> JACQUIE: One says, I'm confused, are the work incentives for SSI different than they are for SSDI? >> CHERYL: and the answer to that is yes. They have some of the same work incentives, but they have -- they are applied differently. For instance, in the SSI program, you have the gradual reduction. Thank you. This reminds me -- it goes back to the gradual reduction. The gradual reduction is where your SSI benefit check reduces by one dollar for every two dollars that you earn. However, in the SSDI program, you do not have that gradual offset. In the SSDI program you're either earning SGA or you're not. And if you're earning SGA, then after nine months your benefits will cease. So they are different. >> JACQUIE: Okay, if a person uses their nine month period and their 64 month trial work period, what determines if they are then taken off SSDI? Is it possible for a person to continue under the 64 month trial work period rules if they continue to stay under the SGA and are work incentives still allowable after that 64 month period? >> CHERYL: I'm a little confused about the 64 month work period. There is a nine month trial work period continued followed by a 36 month period of extended period of eligibility. During the extended period of eligibility, work incentives are applied to any earnings to therefore basically reduce the countable earned income. Once the individual -- if the individual after their trial work period remains at an earning level below SGA, which is -- SGA stands for substantial gainful activity -- the current SGA level for nonblind individuals is 900 a month, for individuals meeting the definition of legal blindness, it's 1500 a month. If the individual completes the trial work period of nine months and never goes over SGA, then their benefits will continue indefinitely. >> JACQUIE: Right. I didn't know about the 64 months either. Maybe that's something in their state or something, I'm not sure. >> CHERYL:Well, there is the extended period of eligibility for Medicare which there is actually three kind of different rules that apply to that, that basically extend the Medicare for an additional four and a half years beyond the extended period of eligibility. And I'm not very good at math, so adding it all up, I'm not sure where the 64 months comes from. >> JACQUIE: Okay, this is from South Dakota. Can you talk about the beneficiary's duty to report income and how well or not so well SSA records the reported wage information? In addition, how, despite reporting income timely, over payment can occur due to SSA not stopping payments despite either cessation should have occurred during the EPE due to earning SGA or termination after the EPE due to earning SGA? >> CHERYL: One of my later statements and points is around reporting income. So, again, I'm going to defer that and address that question later on, I promise. >> JACQUIE: Okay. Can any incentives be used in the nine month trial period? >> CHERYL: No. That is simply an opportunity to demonstrate your ability to work and there are no work incentives supplied during the trial work period. That's why they call it a trial work period. >> JACQUIE: Right. And this is the last one for now, if a person receiving SSDI accepts payments past the nine month trial work period, say, for an additional 12 months, is there any way to ask that the SSA waive the overpayment or the need for the recipient to repay SSA? >> CHERYL: Again, I'll probably address that in greater detail later, but I think -- overpayments are definitely a problem. I think Social Security has taken some very dramatic steps in the last couple ef years to address the whole issue of recording wage earnings. Certainly as part of the Social Security protection act that passed about two years ago, Social Security is now required to supply a beneficiary who reports earnings with basically a wage receipt. There is a whole process to go through with an overpayment starting with, first of all, a request for reconsideration because oftentimes we know that Social Security has not, for instance, considered impairment-related work expenses or subsidies in determines an SGA determination. And so, therefore, once you apply those, it could be that the person was not at SGA which would have continued their entitlement a little bit longer. So there is a process to request reconsideration and then if after the reconsideration Social Security still says you owe us this money, then you can request a waiver. And, again, there is a form and a process for that. In a nutshell, the decision to waive an overpayment rests largely on whether or not the individual was at fault. So if they failed to report their income, chances are Social Security will consider them to be at fault and also the ability to repay and whether collecting the overpayment is in good conscience and there is another phrase that goes with that. So, yes, there is a process to help, but I think the best thing that we can do is to help people understand how the process works and to plan for overpayments because I think overpayments are going to happen despite some of the changes that Social Security has made and I'm going to talk about some of the changes they've made when I get down to statement No. 7. >> JACQUIE: All right, thank you, Cheryl. That's all of my questions for now. >> CHERYL: Okay, so I'm going to move on then to statement No. 3, which is on slide No. 18. And the statement reads: If you work, you may be able to keep your Medicare, Medicaid or buy in to the Medicaid program. And I think what this -- what the message really needs to be here is that it is important for everyone to understand that substantial wages may cause a loss of a benefit check but not of the medical coverage. And I just can't say that enough because I think it's a huge concern to people as they return to work. Under various provisions of law, with SSDI Medicare both Part A and Part B are extended for and a half years beyond the current extended period of eligibility. So, remember, I said with SSDI you have your trial work period. You have your cessation months and then two months grace period and then you have a 36 month period of extended eligibility, during which your Medicare continues. Ticket to Work and Work Incentives Improvement Act extends that for an additional four and a half years. And again, I think part of the thinking and the reasoning there was that people with disabilities, when they go back to work, do not necessarily go back to work at a full time level. Some people are going to have to go back at a part time level, build up their stamina, build up their strength, build up their skills and so hopefully they will work themselves into a regular job with a regular employer who offers the usual benefits. With the Medicaid, the situation is a little different. Just as I indicated that the Social Security work rules for SSI are more generous, Medicaid is also much more generous with return to work. And there is a provision in law called 16.19b which allows your Medicaid to continue if the only thing keeping a beneficiary or an SSI recipient from a benefit check is earned income and the disability continues, they will retain their Medicaid coverage up to the state threshold, and in many states, that state earnings threshold is about $40,000 a year. So the Medicaid continues in most cases with the SSI recipient. Then in addition to that, one of the cornerstones, so to speak, of the Ticket to Work and Work Incentives Improvement Act was the Medicaid buy in option which allowed states to establish a Medicaid buy in program as a work incentive. And this becomes important for people who are on SSDI and Medicare, but they need long-term services and supports and prior to Medicare Part B, perhaps prescription medication ch's were not covered under Medicare. So the Medicaid buy ins were kind of established as a state option to encourage people to go work and they would then be able to purchase the Medicaid at a reduced premium and get the medical, the long-term services and supports that they needed. Any questions on that? >> JACQUIE: I don't have any yet. >> CHERYL: Okay, I'm going to move on to slide No. 20 which is statement No. 4, and this is a statement I would like everybody to give to every special education teacher in the country as well as the parents of special education students because the statement says: Many students can earn money without impacting their SSI benefits. I call this the greatest gift to try work. The student earned income exclusion which is on slide 21 is an SSI work incentive that basically encourages and allows youth with disability to try work. And they do this because they are allowed to exclude up to $1,510 of their gross earned income a month to an annual amount of 6100. So if you have a youth on SSI, they can basically earn $6,100 a year without having any of the gradual reduction of their benefits. And I think what this says is that we should be encouraging youth of transition age to try not just summer youth employment, but perhaps even students who are at college to do what everybody else does during the summer and that's to get a job. In order to qualify for the student earned income exclusion, you have to otherwise meet the parameters of the SSI program and you have to be under the age of 22; but you no longer have to be unmarried: So that, again, was a significant change that Social Security made in their regulatory process last year. And teachers, students and families do not know about this benefit. And just kind of a sideline, there is a youth transition demonstration project in New York through the city university network that basically had all of their SSI youth employed last summer and it was just a phenomenal experience for both them to go to work and for their families to not have to worry that their kids were going the lose their benefits. They were gaining valuable experience. It is a wonderful work incentive. Okay, I'm going to move on to statement No. 5 unless you have questions. >> JACQUIE: No, I'm okay now. >> CHERYL: I'm now on slide 22, and the statement reads: SSA may allow you to set aside some income for school or another vocational goal. And again I'm trying to couch these in positive phrases. And this is what I call the get out of poverty plan. We haven't really talked about the fact that the federal benefit rate at $623 a month for an individual is rough 73 percent of the poverty level. And once you are impoverished, and you have to remain impoverished, we need to help people get out of that track. So the plan for achieving self support better known as a PASS plan allows individuals to set aside income or other resources to reach a specific work goal. It can also be used to establish or maintain SSI eligibility and you can maintain or increase the SSI payment while working towards your goal. So, for instance, generally to be SSI eligible, if you're an individual, you cannot have assets in excess of $2,000. And let's say that an individual needs to purchase a van because they are eventually going to need a van modification in order to go to work and typically while a VR agency will pay for van modification, the VR agency does not purchase the vehicle itself. So you need to save $20,000 in order to purchase a van or you need to save enough money for a down payment. A PASS plan allows you to set aside resources specifically to achieve a vocational objective. So a PASS plan could be for a vehicle purchase for a van modification as I just described. A PASS plan might be to enable someone to save money and set aside resources to cover college expenses. It could be to purchase adaptive technology or computers that a person needs to either engage in an educational program or operate a self-employment. There is a number of things that a PASS plan can do and it's an excellent way to allow an individual to accumulate resources necessary to help them achieve their goals. Now, this is not to say that a PASS plan is for everybody. A PASS plan is a written plan. It requires some thought. It requires approval of the PASS Cadre. Someone has to agree that the vocational objective is feasible and there is some structure and some organization that goes with it, but it is a wonderful program that will help people break out of that trap and accumulate whatever the assets they need to increase their self-sufficiency. Outside the Social Security Administration there is another similar program I'll just mention and that's individual development accounts. Now, individual development accounts are matched funds and sometimes it's difficult to find the match from another organization, but IDA's can be used for educational expenses, for home ownership or for self-employment. So these are certainly two options that people need to be aware of when they are trying to return to work. Any questions or shall I move on to statement 6? >> JACQUIE: Move on. >> CHERYL: Okay, statement No. 6 says: If you receive subsidized housing, your employment income might not increase your share of the rent for a period of time. Now, I'm just going to touch on subsidized housing, but I think most of you are probably aware that if you are in a subsidized housing situation, the general rule of thumb is that one-third of your income is -- you contribute one-third of your income towards your monthly rent. If an individual has been in subsidized housing and they go back to work, it's often a disincentive to all of a sudden have your rent increase while you're trying to work because there is increased work expenses. So there are earned income disregards within certain housing programs and what this does is it will disregard all of your earned income for the first year. 50 percent of your income for the second year, and 25 percent of your income for the third year. And, again, this is a tremendous queue in terms of the fact that return to work comes with associated expenses. You may have clothes and things you need to buy that you didn't have to worry about before. You may have day care issues, transportation issues and for your costs to suddenly increase when you get a job is a disincentive. So these earned income disregards are available. Housing authorities don't always recognize it or are aware of it, so a lot of times the advocates have to do what I call pointing out the obvious. So if anybody has questions about how the earned income disregards work in housing programs, we have volumes of information. I'd be happy to share with you. So my contact information is in the last slide of the PowerPoint. >> JACQUIE: Okay, I have some questions now. >> CHERYL: Okay. >> JACQUIE: One is a situation type question. I have an excellent person on staff who works 20 hours a week. She has had a liver transplant and is on Medicaid. If she works more than 20 hours a week, she will lose her Medicaid medical benefits. She would like to work 40 hours. We would love to have her work 40 hours, but she cannot afford to because of the medical problem. Our insurance, if she worked 40 hours, would have a preexisting condition exclusion for her liver transplant, so she stays at 20. Are there any options so that she can work full time and not lose her Medicaid benefits for the transplant? >> CHERYL: I think the answer to that is yes, but a lot of that information is state specific, and my suggestion would be that you contact the work incentive planning assistance and outreach program in your state or the state protection and advocacy agency a specific answer to your specific question. Off the top of my head, I'm a little confused as to why there is a belief that she would lose her Medicaid if she wept over 20 hours a week? Because again I'm assuming that the Medicaid is tied to the receipt of SSI benefits and as I've already stated, if the only thing keeping an individual from a cash SSI check is earnings, then the Medicaid continues under the 16.19b provision. Now, it could be that your state has a low threshold. There could be a number of state factors there, and I think the best people to answer it would be your local either work incentives planning and assistance program or your local state protection and advocacy agency. And again, I can direct you to that if you want to contact me afterwards. >> JACQUIE: Great. Okay, the next question is are the SSI resource limitations different for the elderly? >> CHERYL: I don't believe they are, but quite frankly I don't focus on the elderly. I focus on the disability programs. >> JACQUIE: Right. >> CHERYL: So I can't imagine that the rules change for the aged. I think SSI is known to keep a number of the aged out of poverty, but I don't believe that they are any different. >> JACQUIE: Okay. Will there be more pressure for all states to adopt a form of Medicaid buy-in? >> CHERYL: I would like to hope so. I think the Medicaid buy-in and the continuation of necessary medical insurance for people trying to work is probably going to be the linchpin of success for employment of people with disabilities. Now, that's the naive, this is what we want the world to look like talking. I think the reality is Medicaid is a state federal match program. States are in a state of fiscal crisis and we have certainly seen over the last few years that there are approximately four states that have passed Medicaid buy-in legislation, but it has not been funded and in a couple of other states the Medicaid buy-in program was defunded by the legislature. So I think the issue is we want to continue to push for it, but there are obvious fiscal restraints within the state that are hampering the ability for it to be effective in all states and territories. >> JACQUIE: One last one. What has been your experience with the regional PASS Cadres insofar as assisting in writing a PASS and what are other organizations are you aware of besides protection and advocacy for beneficiaries of Social Security and W. IP A. that are assisting people in writing a PASS? >> CHERYL: I think that the work incentive planning and assistance programs formerly known as the benefit planning assistance and outreach programs are certainly able to assist in writing a PASS plan. I think PASS plans across the country are generally an under utilized resource. We recently at a ticket panel meeting were provided some information on PASS plan utilization and there are certain states that use it to a much greater degree than other states. A number of your state vocational rehabilitation agencies will purchase PASS plan writing so to speak from private vendors. So I think that the expertise is starting to build. I think the PASS plan itself is about a ten page form. I think it requires some preparation and planning and thought into the development of that, but my experience with the PASS Cadre is that your best to involve them early in the process and they will be extremely helpful in the development of the PASS plan. For instance, they will identify what they consider to be appropriate costs and appropriate services. For instance, I had a situation -- it's been about a year or year and a half now -- where one of the advocates called me and said that an individual's pas plan, she wanted to be a nurse. A nurse would require that she be able to work rotating shifts so she would have to have her own transportation. So her PASS plan was basically to purchase a used vehicle and she wanted to purchase a used vehicle at about a 7,000-dollar cost and the PASS Cadre in her region came back and said you can get a perfectly reliable used vehicle for $4,000 and we're not going to approve any more than that. So, you know, they've been around the block. I think they are there to help people, but they also want to make sure that costs are reasonable and that the expectation is feasible and you should be working with them and talking with them. You know, you can negotiate with them just like you can negotiate with any other provider organization. >> JACQUIE: Okay, I know I've said that was the last one, but then another one came in. >> CHERYL:- Kay. >> JACQUIE: So you're saying that HUD knows that income is not counted in the first year. Is that a calendar year or 12 months of work? >> CHERYL: Oh, that's a really good question. I'm assuming that it is the first 12 months that they are working. I can't imagine that they would work on a calendar year since HUD programs generally operate on a federal fiscal year which would go from October to September. And I guess I need to clarify that it's not every single HUD program. There are certain HUD programs where these earned income disregards apply and I'd be more than happy to fill you in on the details of what those programs are. >> JACQUIE: Thanks. Okay, that's it for now. >> CHERYL: Okay, I'm going to move on then to slide No. 26 which is statement No. 7. And statement No. 7 goes back to the overpayment issue. And the slide reads: It takes awhile for SSA to stop or reduce your benefit checks when you go back to work. And it is very common for individuals who receive overpayment notices from Social Security. Okay, my cautionary note here is you can minimize the overpayment by reporting your income. So I'm going to go on and do slide No. 27 and then I'm going to talk about this. I said that you need to know when to report your earnings, how to report your earnings, and to whom to report your earnings. And the individual should obtain a receipt for your wage report. So let's back up for a minute. Many, many people, including myself, when I was a Social Security beneficiary and I went back to work notified the Social Security Administration -- and granted we're talking 20 years ago -- but I notified the Social Security Administration when I was offered a job. I notified them when I accepted the job and I gave them monthly wage reports. And yet -- and I knew that I had a nine month trial work period, a cessation month and two grace months and yet the checks continued to come for about four and a half years after that. And I knew that I was in an overpayment status. And someone had basically said to me when the checks keep coming, the best thing you can do is put them in a separate savings account. You can earn interest on the money and then you'll have it available when Social Security asks for it back. All of that goes back to the days when Social Security basically was not very good at processing earnings reports. So oftentimes even though you sent them to your local Social Security field office or you took them in to your Social Security field office, most likely they sat on somebody's desk and until such time as somebody actually sat down and entered them into the computer, in the mind of the central computer at Social Security, your earnings had not been reported and huge overpayments resulted, particularly from the SSDI side because, again, it's all or nothing. One of the things that the Social Security Administration has developed over the last few years is a web-based management information system that can be accessed from any Social Security computer in the country. So what that means is if I happen to get a job in Seattle, Washington, and I go into my local Social Security field office and I say to them, my name is Cheryl Bates-Harris, this is my Social Security number, I'm currently an SSDI beneficiary and I'm starting work next week. They would go into e-works which is what the program is called and basically make a note in the record that says I notified them that I was about to start work. Now, assuming I didn't do anything after that, that would be enough information in this computer program -- and I'm over simplifying. Please understand that -- but that would be enough information that in nine months it's going to trigger a review to find out what actually happened. Did I actually go back to work? Did I actually report my earnings, et cetera, et cetera. The same kind of thing would occur if I had actually gone in and said to them, these are my wages for this month's employment. If they didn't hear from me for nine more months because, again, it's the trial work period for the first nine months they are not worried about your earnings. After that, they want to take a look at it to see whether you're earning above SGA. So e-works is just a phenomenal step forward in terms of recording the information in a manner that is accessible then from anywhere in the country. So I work in Seattle for three months. My husband moves and we end up living in Demoine, Iowa. I could go into their Social Security office and they would use the same name and Social Security number that I had used beefed and they would be able to pull up and say to me, Cheryl, we saw you were in the Seattle office on such and such a date. So e-works I think is going to go a long way in reducing overpayments. It also triggers when a wage report is entered into e-works, it automatically generates a letter that serves as a wage receipt. So the person not only has done their wage reporting, but they get a written confirmation that says this is the information that you told us and you get an opportunity to verify whether or not the information is correct. In addition, e-works has some very clever pieces built into it that basically when a claims rep is going to do a work activity review, it automatically triggers questions to ask about does the individual have any impairment-related work expenses? Is the individual blind? If so, do they have blind work expenses, et cetera. So that the questions and the information are all in the same place. They are not stuck in a paper file in Baltimore somewhere. They are easily accessible from anywhere in the country and I think this is just going to have a huge, huge impact in reducing overpayments in the future, but only -- only if beneficiaries are comfortable -- only if beneficiaries utilize it and report their earnings. So I think it's really important to know. Related to that but a little different, when it comes to reporting your earnings to Social Security, we've already touched on the fact that SSDI benefits are impacted differently than SSI benefits. In SSI been fits you get the gradual reduction, the more you work, the more your check is reduced. The general rule of thumb is that with SSI, it takes at least two months for the SSI check to reflect the earnings changes. So if you reported in May that you were working, you're not going to see the changes or the reduction in your check for two more months. So it would be probably your July check. So the budgeting is always going to be a little bit off depending on whether you're working full time or part time, one week you might work 40 hours, the next week you might only work 30 hours. You might only work two weeks of the following month. So beneficiaries need to be aware of reporting their wages and also aware of the impact on their check and to look for those changes. With the Title II benefits, there is not like I said the gradual reduction. With the SSDI check, it's all or nothing. Once you have used your trial work period and you go over SGA the next month, your benefits terminate. So if the checks continue, you need to know not to spend it because you are going to be asked to pay it back even if it wasn't necessarily your fault. I don't know if that answers the questions for the earlier person who wanted to know about the process. Like I said, there is a process to request reconsideration of an overpayment because again first you want to make sure that there really is an overpayment and that it's the right amount and then to request a waiver. I think most of your PASS programs around the country have some basic information to kind of tell you what you need to do in order to address the issue. Never, ever, ever advise somebody to ignore an overpayment notice because it will not go away. Which kind of leads me into the next slide, slide No. 28, that says when all else fails, ask for help. There are resources to help you with an overpayment situation and to keep you working. You know, again, one of the things that I hear continually is an individual gets an overpayment notice. They freak out when Social Security says, you know, please remit $16,000 in the enclosed envelope. They immediately think if they quit their job the situation is going to go away and it doesn't. So we really need to inform people on how to avoid an overpayment and make sure they know who to talk to if they receive an overpayment notice. And there are people within -- I'm at slide 29 now. Social Security staff can help with that. The area work incentive coordinators and the work -- which there is one for each state and also the work incentive liaisons within the office can kind of help you address the situation. They should be able to individuals you of the proper forms to fill out, that kind of information. You have the benefit planners which are now called the community work incentive counselors under the new work incentive planning and assistance program. They should be able to advise you as to how to plan for an overpayment and, again, what to do when the notice comes. It shouldn't come as a big surprise when the checks keep coming, but I think even though there are improvements in the system, we're not quite there yet. And of course there are the protection and advocacy for beneficiaries of Social Security who can also help you understand and respond to an overpayment question. Jacquie, any questions so far? >> JACQUIE: There is one you might want to talk about at the end, but I'll go ahead and tell you. Are there any changes or updates on Medicare Part D? >> CHERYL: We'll hold that to the end. I'll move on to statement No. 8 which is on slide No. 30 and that is even if you don't report your income, Social Security will find out about it. And quite frankly, I think this is -- this often comes as a surprise to people. I think people are maybe misinformed or may not fully understand the difference between the trial work period and SGA. A trial work period is actually a lower income amount than SGA is. And so people think if I didn't work over SGA I didn't use my trial work period month and that's not necessarily true. Social Security has an agreement with unemployment insurance compensation and also with the I. R. S. So if nothing else on an annual basis IRS does a cross check based on your Social Security number with the Social Security Administration. And so if you and an innocent employer has paid you earnings during the year, they are going to report those earnings to the IRS at the end of the year and sooner or later that's going to be cross matched with the Social Security computers and if somebody sees that John Doe earned $12,000 in 2006, they are going to do a quick math -- 12,000 divided by 12 months of the year means the individual earned $1,000 a month. $1,000 a month is over SGA so they are automatically going to assume that the benefits have ended or the benefits should have ended and will take action then to have the benefits terminated and to calculate the overpayment. This is why it's really important that people report their earnings, and it's possible that that same John Doe did earn $12,000 in 2006, but it's also very possible that he earned $3,000 in July, August, September and October, which is only four months of SGA and not over the 12 month period. So, again, reporting your information to Social Security, making them aware of what your earnings are, making them aware of what your expenses are and getting the information into the system will help in reducing overpayments. So I'm going to move on then -- well, No. 8, I'm sorry. The bottom half of No. 8 says: Willfully choosing not to report your income could be considered fraud and SSA can detect earnings through FICA deductions, IRS records and unemployment insurance records. Social Security has a recoupment program that again also catches people by surprise. If you don't respond to an overpayment notice and you continue working and you do not remit the $16,000 in the enclosed envelope, you may find or the individual may find that at the end of the year when they file an income tax return and they think they're going to get a hefty income tax return, that that will basically be seized through that cooperative agreement that the IRS has and the IRS will not send your income tax return to you, they will send it to the Social Security Administration to start to pay down the overpayment. So people need to be aware that there are recoupment measures in place. Now, when an overpayment happens, you've gone through the reconsideration process, you've asked for a waiver and Social Security says, no, absolutely positively not, we are not going to waive this overpayment. You still don't -- people still don't need to panic because the Social Security administration will work out a repayment plan with you. And that repayment plan is going to be based on your monthly expenses and basically your budget and your resources, and then generally work with people on a repayment plan. So, again, people don't need to panic at the overpayment notice, but they do need to address it and respond to it. I'm going to move very quickly through just the end of these and then I'll take any additional questions. I think what's important in this whole return to work process is that consumers become strong self-advocates. They need to know what their rights are. They need to know what their responsibilities are. And what I'm talking rights and responsibilities, I'm not just talking with regard to the Social Security programs that may affect them, but also they need to be aware of their rights in the application and the employment process and they need to think creatively about how the system can best work for them and others in their situation. Education -- slide 32 -- we said educate yourself. People need to become their own best expert. They need to reach out to others with expertise in programs that can assist you and this is where knowing what your local resources are becomes invaluable. I've already mentioned the wipe pa grantees, the work assistance grantees, I've already mentioned the area work incentives coordinator and liaisons that are employed by Social Security. If you're developing a PASS plan, you need to be on working with your PASS Cadre and of course there is the P&A system that will help support people with disabilities in their return to work efforts. So slide No. 33 basically just says what is a protection and advocacy agency? Since that's who I work for, I would be remiss if I didn't say that we are a network of legally-based advocacy that is available in every state and territory. Collectively, the P&A's are the largest provider of legal-based services to people with disabilities in the United States outside of the federal government. And that we're currently comprised of eight different programs that are funded separately that have their own criteria and eligibility for services, but basically if you're a person with a disability who feels they have either been discriminated against, abused or neglected because of your disability, I would suggest that you contact your local protection and advocacy agency and see what assistance they can offer you. So the last slide, 34, has my contact information and I would be happy to answer questions if people have them later and to take the rest of the questions that you have right now. >> JACQUIE: Okay, the only one that I'm still sitting here with is the -- >> CHERYL: Medicare Part D I have not heard -- again, Medicare is a little bit removed from this and the Medicare Part D program, when it was first passed and implemented, the advocates were all up in arms. There was a great deal of concern about the impact it was going to have predominantly on dual beneficiaries because a dual beneficiary would be both Medicaid eligible and Medicare eligible. Prior to Medicare Part D, dual beneficiaries could get their prescription drugs through the Medicaid program. Medicare Part D replaced that and basically made the prescription drugs a responsibility of the Medicare program and the Medicare Part D So there was a great deal of concern about the horrible impact that it was going to have on dual beneficiaries and their ability to continue to receive the same type of medications that they had before, whether it was going to cost them a lot more money, et cetera, et cetera, et cetera. And the reality is, the Medicare Part D program has been a huge success. Is it perfect? Absolutely not. They just issued about 180 pages of regulations and in all seriousness I do not expect any significant changes to the Medicare Part D program in the near future because like so many other new programs, there is going to need to be a period of time for roll out, a period of time to develop the data and the information necessary to analyze it to determine whether or not changes or tweaks are necessary. But that's strictly my opinion and somebody else may know something that I don't. >> JACQUIE: All right, well, that's all the questions I have. Any parting word for us, Cheryl? >> CHERYL: No. I hope that this has been helpful. As I'm sitting here going through this, I think that it can be confusing, but, you know, I think my message would be that we just need to phrase employment in a positive perspective, reinforce the positives and just make sure that the myths that are out there like I can't go to work or I'm going to lose my health care are dispelled, that, you know, I can't go to work because I'll be worse off financially. That kind of information, we need to correct, so that we can actually encourage people to utilize the work incentives to try work and, who knows, they might just like it and it might just improve the quality of their life. >> JACQUIE: Thank you so much, Cheryl. >> CHERYL: Thank you all. >> JACQUIE: I know we all learned a lot. For our listeners, remember that this webcast will be archived on ILRU's website which you can find by visiting ilru.org. I would like to acknowledge the National Institute on Disability and Rehabilitation Research, NIDRR, who funds your host for today's program, the southwest ADA center at ILRU. I would also like to thank the in-house staff at ILRU because without their effort, this webcast would not be possible. They include Marj Gordon, Sharon Finney, Dawn Heinsohn, Vinh Nguyen, Maria del Bosque as well as the technical expertise of Rob Dickehuth and our captioner and miracle worker Marie Bryant. For a list of the upcoming webcasts visit ilru.org. Thanks again for joining us. Thank you, again, Cheryl. Have a dazzling day. >> CHERYL: Thank you. Bye everyone.