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BENEFITS MANAGEMENT
FOR WORKING PEOPLE WITH DISABILITIES
AN ADVOCATE'S MANUAL
2002 EDITION
Edited by Edwin Lopez-Soto. Esq. and James R. Sheldon. Jr.. Esq.
Table Of Contents
Introduction i
chapter 1
Social Security & SSI Disability Programs 1-
Introduction to Social Security Disability Insurance and Supplemental Security Income 1-1
Overview Of The Appeals Process 1-1
The Two Disability Programs 1-4
chapter 2
SSI Income & Resource Rules 2-
Income 2-1
Resources 2-4
Deeming of Income and Resources 2-7
Conditional Payments 2-12
Transfer of Assets 2-13
Monthly Parent-to-Child Deeming Example 2-15
Monthly Parent-to-Child Deeming Worksheet 2-16
Monthly Spouse-to-Spouse SSI Deeming Example 2-17
Monthly Spouse-to-Spouse SSI Deeming Worksheet 2-18
chapter 3
Work Incentives 3-1
The Major Work Disincentives: The Substantial Gainful Activity Rule and the Continuing Disability Review. 3-1
Avoiding Consequences of the SGA Rule in SSDI Program 3-4
There are several ways to avoid or limit the application of the SGA rule 3-4
Earnings above $780 in 2002: a "rebuttable presumption" of SGA 3-5
Income Averaging Rules 3-6
The Unsuccessful Work Attempt 3-7
Establishing That "Countable Wages" Are Equal to or Less Than $780 3-8
Trial Work Period (TWP) 3-11
Extended Period of Eligibility 3-12
Expedited Reinstatement (EXR) of SSDI 3-12
Continuing Eligibility for Medicare While Working 3-13
SSI's Major Work Incentives 3-14
chapter 4
Plan for Achieving Self-Support (PASS) 4-1
SSA Continues to Aggressively Promote the PASS 4-1
Where to Find The Law 4-1
Concept of a PASS 4-1
Criteria for PASS Approval 4-2
What Qualifies as a Feasible Occupational Objective? 4-4
What Expenses Are Allowed Under an Approved PASS? 4-5
Effective Date of an Approved PASS 4-8
Time Limits 4-9
Most Likely Candidates for a PASS 4-9
Amendments to an Approved PASS 4-11
Approval of a New PASS 4-11
Suspension or Termination of a PASS 4-12
Progress Reviews 4-12
The PASS Application Packet: Items One Should Generally Submit With a PASS Proposal 4-13
Other Considerations Which Relate to the PASS 4-14
Using the PASS to Access Section 1619(b) Medicaid 4-16
PASS Example 4-17
chapter 5
Impairment-Related Work Expenses 5-1
Where to Find the Law 5-1
Concept of an Impairment Related Work Expense (IRWE) 5-1
What Items Or Services Can Count As IRWEs ? 5-1
Alternative Methods Of Allocating IRWE 5-4
chapter 6
Subsidies 6-1
Where to Find the Law 6-1
Concept of a Subsidy 6-1
How Subsidies Can Help 6-1
Indicators That a Subsidy May Exist 6-2
Calculating the Value of a Subsidy 6-2
Types of Employment Where Subsidies May Exist 6-3
chapter 7
Overpayments 7-1
Common Overpayment Cases 7-1
Where to Find the Law 7-2
What Is an Overpayment? 7-2
Who Does SSA Seek to Hold Liable for an Overpayment? 7-4
How Does an Overpayment Case Begin? 7-5
Challenging an Alleged Overpayment - Introduction to Reconsideration and Waiver 7-5
Time Periods to File Requests 7-7
Preserving Current and Retroactive Eligibility 7-9
The Two-Pronged Standard for Obtaining Waiver 7-11
Developing an Overpayment Case for Presentation at Each Level of Review 7-14
Appeals of Denial of Reconsideration, and/or Denial of Waiver 7-15
What Happens Following a Final Unfavorable Decision? 7-17
chapter 8
Report Writing 8-1
How to Explain Work Activity to the Social Security Administration 8-1
How Reports about Work Activity are Used by SSA 8-1
What is in a Good Report to SSA 8-2
Examples of Sentences for Report Writing 8-4
Sample Letters and Other Documents which Report Work Activity to SSA 8-7
Initial Placement Letter 8-9
Response from Vocational Rehabilitation Program to SSA
Request for Information about Work Activity 8-10
Termination of Unsuccessful Work Attempt 8-11
Vocational Report 8-12
Response from Supported Employment Program 8-13
chapter 9
Continuing Disability Reviews 9-1
Triggering of Continuing Disability Review (CDR) 9-1
What Should Happen When A CDR Begins 9-2
The Medical Improvement Standard 9-3
When Medical Improvement Related To Recipient's Ability To Work Exists 9-4
Continuing Benefits Pending Appeal 9-4
chapter 10
Vocational Rehabilitation 10-1
State Vocational Rehabilitation Agencies - What Are They? 10-1
Eligibility for Vocational Rehabilitation Services 10-3
Services Available Through the State VR Agency 10-5
Financial Need Criteria 10-7
Individualized Plan for Employment (IPE) 10-8
Due Process Rights When Services Are Denied By a State VR Agency 10-10
Client Assistance Program 10-11
chapter 11
The Ticket To Work and Self Sufficiency 11-1
Where to Find the Law 11-1
Who is Eligible for a Ticket? 11-1
What is the Ticket? What Does It Look Like? 11-2
How Will Tickets Be Distributed 11-2
The Program Manager 11-3
The Role of Employment Networks 11-4
The Role of State Vocational Rehabilitation Agencies 11-5
The Individual Work Plan (IWP) and Specific Services Available 11-6
Assignment, Retrieval and Re-assignment of Tickets 11-7
Elimination of Medical Continuing Disability Reviews While Using a Ticket 11-7
The Two Employment Network Payment Systems 11-10
Dispute Resolution Under the Ticket Program 11-11
Appendices APP-1
SSI Budget Worksheet APP-2
Monthly Parent-to-Child Deeming Worksheet APP-3
Monthly Spouse-to-Spouse Deeming Worksheet APP-4
SSA Programs Circular 89-2 - Job Coach Services in Supported Employment APP-5
1619(b) Medicaid Threshold Amounts for 2002, as Listed in POMS SI 02302.200 APP-8
Acronyms App-10
Countinuing Disability Review Sequential Evaluation Chart APP-11
SSI Monthly Budget Worksheet for PASS Applicants APP-12
Resources App-13
Publications App-13
Web Sites App-13