Adult Services eligibility while working

[Guest guest]

We have a good problem (I guess) to have. Our 22 year old adult disabled

daughter is due to start a position with a starting wage over $10.00 per hour.

Her employer is willing to work with us to ensure we don't disqualify her for

government benefits. While we don't care if she receives an SSI check, we do,

however, want to ensure we don't disqualify her from the possibility of ever

receiving adult services as she needs the support to be able to work and live.

I understand the " asset " rule...what I am unclear on is if she makes more than

$1000.00 per month will that disqualify her from SSI eligibility? If the

Section 1619 of SSI/Medicaid indicates Illinois' threshold is $27,000.00 doesn't

that then constitute as gainful activity and disqualify her from SSI? She

starts work in a couple of weeks so I'd like to be crystal clear to her employer

just what she can and cannot do. Thanks so much.

[Guest guest]

----- Forwarded Message -----

From: Sherri Schneider <benefithelpss@...>

" IPADDUnite " <IPADDUnite >

Sent: Monday, December 19, 2011 7:56 AM

Subject: Re: Adult Services eligibility while working

 

For SSI:

If you are a full time student & under the age of 22:  you are allowed to earn

$6600 @ year (2011 #) before income will affect SSI.

If you are not a full time student or you are 22 or older: the first $85 earned

monthly, will not affect your SSI. Then, for every $2 you earn monthly, they

will subtract $1 of SSI monthly.

 

 

 

HOW DOES WORKING AFFECT MEDICAL BENEFITS?

 

Medical coverage, both Medicaid and Medicare, are extremely important to a large

number of people with disabilities. It is critical for them to understand that

going to work does not mean that their medical coverage will immediately end.

Unfortunately, this is a myth that has long been prevalent in the disability

community.

 

Ø     Work does NOT automatically cause loss of health care benefits.

 

 

For individuals who receive SSI:

 

-        There is a safety net called 1619( that protects from the loss

of Medicaid when an individual goes to work.

-        1619 ( is available to SSI recipients whose SSI decreases to

zero due to their work earnings.

-        In order to be eligible for 1619(, it must be earned income or

wages that force the SSI check to zero.

-        In addition, the individual must continue to meet all of the

other SSI eligibility requirements.

-        He or she must continue to be disabled according to SSA

standards and have resources less than $2000.

-        Individuals can keep their Medicaid through 1619( until they

earn what is called their state threshold. This is an amount that varies from

state to state and can range from $15,000 per year to $49,000. The threshold for

Illinois in 2011 is $26,141.

-        Some individuals who receive SSI have extremely high medical

costs and the state threshold amount for the state in which they live is not an

incentive to return to work. For these individuals, it is possible for them to

receive what is called an individualized threshold through the local SSA office.

 

For Individuals who receive SSDI:

 

-        If they have never worked while on benefits, they will have at

least eight and a half years of Medicare coverage when they do begin working.

-        The first nine months of Medicare would be covered under what is

called a Trial Work Period.

-        The following 93 months are called Extended Medicare Coverage.

-        Even after the Extended Medicare Coverage ends, it does not mean

that the individual will lose this medical benefit.

-        Following Extended Medicare, individuals are able to purchase

their Medicare coverage. This means that they would pay a premium to keep their

Medicare.

 

 

 

________________________________

From: Jerue Family <jeruefamily@...>

IPADDUnite

Sent: Sunday, December 18, 2011 10:31 AM

Subject: Re: Adult Services eligibility while working

 

Congratulations to your daughter, yes, that IS a good problem to have. I could

take a stab at this, but would rather hear from Marsie or others first on this

list. They will do a better job than me! I’m forwarding this on to M’s

attention right now.

L.

From: cpropheter@...

Sent: Sunday, December 18, 2011 9:18 AM

IPADDUnite

Subject: Adult Services eligibility while working

We have a good problem (I guess) to have. Our 22 year old adult disabled

daughter is due to start a position with a starting wage over $10.00 per hour.

Her employer is willing to work with us to ensure we don't disqualify her for

government benefits. While we don't care if she receives an SSI check, we do,

however, want to ensure we don't disqualify her from the possibility of ever

receiving adult services as she needs the support to be able to work and live. I

understand the " asset " rule...what I am unclear on is if she makes more than

$1000.00 per month will that disqualify her from SSI eligibility? If the Section

1619 of SSI/Medicaid indicates Illinois' threshold is $27,000.00 doesn't that

then constitute as gainful activity and disqualify her from SSI? She starts work

in a couple of weeks so I'd like to be crystal clear to her employer just what

she can and cannot do. Thanks so much.

[Guest guest]

More to Chris’ question about maintaining benefits eligibility while working

– thanks to Sherri and Marsie for all the info.

From: Marsie Frawley

Sent: Monday, December 19, 2011 5:02 PM

'Jerue Family' ; cpropheter@...

Subject: RE: Adult Services eligibility while working

First of all, Congratulations to your family member with this opportunity to

work. Smart employer! This opportunity sounds like a win-win-win situation

for your daughter, employer and community!

I’d like to piggy-back on what Sherri and have weighed in on regarding

the several ways to maintain eligibility for Medicaid for working.

Many folks on this listserve have reinforced that working is great! They have

also noted the responsibilities that you need to be keenly aware of regarding

the work incentives and reporting income. I truly believe that the first step

is to connect with your Community Work Incentives Coordinator to make sure that

you get EXACTLY the facts that pertain to your family member. Not knowing where

you live, the easiest way to look up who covers your area is to go to:

http://www.iltech.org/wipaserviceareas.html If by chance you are in the north

or west suburbs of Chicago, the CWIC is Mariel Hamer and her phone number is:

(630) 219-4025. Since she has a job offer pending, she would receive high

priority services in getting a detailed benefits analysis on how work income may

impact ALL of her public benefits, including Waiver Services.

There are two general answers to your questions – yes, she will maintain

Waiver services through 1 of 3 ways that she can be Medicaid eligible. You are

right to be aware that Medicaid eligibility is the key. Second, her working at

a level above Substantial Gainful Activity - $1,010 gross earnings per month in

2012, does not negatively impact her continued eligibility for SSI.

Here is a further explanation and I apologize for the length . . . I appreciate

that you are concerned about maintaining eligibility for the Developmental

Disability Medicaid Waiver. Besides meeting the definition of having a

developmental disability, DD Waiver services require being eligible for

Medicaid. As, Sherri noted there are 3 ways to be eligible for Medicaid. The

first is the way your daughter likely gets Medicaid now – being eligible for

Medicaid and SSI and having income below $928 a month and resources below

$2,000. The second, is as you noted, the federal work incentive called 1619

(. 1619 allows a working person who had been receiving SSI, who has monthly

gross earnings in 2012 greater than $1,481 and no longer receives a SSI cash

benefit – can have earnings up to $26,141 and still be Medicaid eligible!

FYI – at a $10/hour job, the SSI cash benefit might go away if she is working

more than 34 hours per week. You can also ask SSA to compute an

‘individualized threshold’. SSA will take into account the Medicaid

Expenditures paid out on her behalf, as well as, any Impairment Related Work

Expenses, or PASS Plan expenses. It is likely her threshold could be even

greater than $26,141 (this amount will change in 2012) due to Waiver Services

being paid out! So, should she work more than 34 hours per week, please keep in

mind the individualized threshold as another ‘work incentive!’ The 3rd way

to maintain Medicaid eligibility is as Sherri explained – Health Benefits for

Workers with Disabilities.

I’m glad that you asked about maintaining eligibility if earnings are above

the Substantial Gainful Activity limit which will be $1,010 for a person who is

not blind in 2012 ($1,690 if blind). Since the work incentives for SSI are

different, SSA does not look at SGA as it does for a person who receives Social

Security Disability Insurance. The SSI work incentives include the 2 for 1 rule

that Sherri described; Student Earned Income Exclusion; Impairment Related Work

Expenses, PASS and 1619 as you noted; etc.,. I know that this is complicated,

but please know that a recipient of SSI, who is continuing Medicaid while

working can continue to maintain SSI eligibility as long as – the disability

continues (sometimes a person living with a mental illness will show medical

improvement, but a person with a developmental disability will always have the

DD); the person sees a doctor once a year – showing that they need Medicaid in

order to work; and have resources below $2,000 each month – then the

disability eligibility continues. Cool, huh?

Since your daughter is 20, she could potentially earn SSDI on her own record

within the next year and a half!!! WOOOO HOOO. You’ll want to work with the

CWIC again at that time to determine if her signing up for HBWD would be a good

option or whether 1619 is still what would work for her!

This is all VERY exciting! I’m so happy for this opportunity! Please feel

free to contact me anytime with any questions that may arise, but I believe that

your CWIC will be your new best friend! GOOD LUCK!

Marsie

Marsie L. Frawley

Statewide Coordinator, Rural Illinois Customized Employment Sustainability

Project

RICES, an investment of the Illinois Council on Developmental Disabilities

-Hammis Associates, LLC

mfrawley@...

920 559 6364