Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
372625859
label
Social Security [1986]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
372625859
contentType
document
title
Social Security [1986]
citationUrl
collections
Lex Frieden Collection: Records on Disability Rights
Printed Materials
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
372625859
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
f2aa75df599d19f0
ocrText
Originally Processed With FOIA(s):
FOIA Number:
S
S
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
Donated Historical Materials
Collection/Office of Origin:
Frieden, Lex, Collection
Series:
Printed Materials
Subseries:
Reference Materials
OA/ID Number:
52161
Folder ID Number:
52161-003
Folder Title:
Social Security [1986]
Stack:
Row:
Section:
Shelf:
Position:
TASKS AND TIME-LINE FOR SSDI/MEDICARE CONFERENCE
Tasks
By Whom
Critical Dates
Dec
Jan
8
9
10
11
12
15
16
17
18
19
22
23
24
25
26
29
30
31
1
2
5
6
7
8
9
12
13
14
15
16
19
20
21
22
23
26
27
28
29
30
0 Procurement delivered to GCS
LINZER
X
o Meeting of Steering Committee
HERRELL
X
Contact person at Social Security
Meeting rooms
Typing
Duplication
Mailing-Envelopes/Labels
Recorder for day two
Name tags
o Working paper
Draft
CONSUL/SSA
X
Final
CONSUL
X
Typing
HOLMES
Duplication
HOLMES
o Participant lists
CONSUL
X
Typing
HOLMES
Duplication
HOLMES
o Letter of invitation (final-day 1)
CONSUL
X
Typing/AS signature
HOLMES
Duplication (25)
HOLMES
o*Letter of invitation (final-day 2)
CONSUL
X
Typing/AS signature
HOLMES
Duplication (45)
HOLMES
o Agenda (day 1 and day 2)
Draft
CONSUL
X
Final
CONSUL
X
Enter on AS calendar
LINZER
Typing
HOLMES
Duplication
HOLMES
PAGE 2.
TASKS AND TIME-LINE FOR SSDI/MEDICARE CONFERENCE
Tasks
By Whom
Critical Dates
Jan
Feb
Mar
26
27
28
29
30
2
3
4
5
6
9
10
11
12
13
16
17
18
19
20
23
24
25
26
27
2
3
4
5
6
9
10
11
12
13
16
17
18
19
20
0 Mailing
HOLMES/
Procure envelopes/labels (60)
LINZER
Assemble enclosures:
HOLMES/
Letter of invitation, background
LINZER
papers, participant list(s),
agenda
40 day one pkgs., 20 day 2 pkgs.
X
Mail
HOLMES
X
0 Confirmation of participants
CONSUL
X
0 Conference logistics: (3/2 &3/3)
Reserve meeting room
X
Procure conference supplies
(40 participants day 1/20 day 2)
Name tags/tents
Tablets, pencils
Rubberbands
Staplers
Magic markers/Easel
Masking tape
HOLMES
X
Assemble materials for meeting:
Agenda
Pencils
Sign-in sheet
Name tags
Tents
HOLMES/
Participant lists
LINZER
X
*Interpreters
Readers
LINZER
Sign-Language
LINZER
0 Meeting
Recorder (day 1)
CONSULT
X
Recorder (day 2)
X
Resource support for AS (day 2)
CONSULT
X
PAGE 3.
TASKS AND TIME-LINE FOR SSDI/MEDICARE CONFERENCE
Tasks
By Whom
Critical Dates
Mar
Apr
May
16
17
18
19
20
23
24
25
26
27
30
31
1
2
3
6
7
8
9
10
13
14
15
16
17
20
21
22
23
24
27
28
29
30
1
4
5
6
7
8
0 Final Report
Draft
CONSULT
X
X
Final
CONSULT
X
Typing
HOLMES
Duplication
HOLMES
o Submission to AS
HERRELL
0 Presentation to Disability Adv.
Council and Commission of Soc. Sec.
(Revision 1: 12/3/86) DRAFT
Economics of Disability - SSDI/Medicare
Introduction
The service system for disabled Americans creates major work disincentives
for many beneficiaries. The number of disabled Americans not returning to work
for fear of losing their benefits is currently unknown, but we believe that the
number is substantial. There are increasing indications that many disabled
Americans of working age are capable of finding, being placed in, or returning
to employment that pays substantial wages. However, there are about 5.9 mil-
lion working age adults who are receiving disability benefits from Social Secu-
rity Disability Insurance or Supplemental Security Income programs because they
are not working and they have been evaluated as having an impairment that is so
severe that they are not able to perform any job in the national economy. De-
spite these Federal entitlement evaluations, we believe that current SSA work
disincentives are major factors contributing to the large number of Americans
receiving benefits for total disability and not trying to reenter the work
force.
On February 24, 1986 a forum on disability was convened before the U.S.
Department of Education, National Institute of Handicapped Research on the
Economics of Disability. The meeting was much a needed opportunity for key
policy officials, with a recently honed awareness of the nature of severe im-
pairments and their implications, to reassess the potential many disabled peo-
ple have to return to productive, active lives. As an outgrowth of this
conference, we are proposing a second conference focusing specifically on the
issues involving individuals who have left gainful employment due to a
disabling condition and the disincentives for them returning to work.
Objectives
We proceed with the premise that, whenever possible, disabled Americans -
including persons who have incurred severe handicaps, should be encouraged to
return to regular job sites. It is our belief that the fear of losing disabil-
ity cash benefits or medical benefits from Social Security Disability Insurance
or Supplemental Security Income is a significant disincentive for working age
adults who might, with some form of continuing support, choose to return to
work. As Federal policy begins to respond to this issue, a conference will be
held involving rehabilitation professionals from many disciplines. The confer-
ence will help to:
develop a concept of SSDI/Medicare disincentives as seen by rehabilita-
tion experts, consumers, and advocates,
develop recommended policy options for dealing with the SSDI/Medicare
disincentives.
convene a small group of key policy officials to begin to build a con-
sensus around some of the recommended policy options.
2
Structure
The conference will be sponsored by the Office of Special Education and
Rehabilitative Services (OSERS), U.S. Department of Education, and take place
over two consecutive days during early March in Washington, D.C. The forum
will purposefully provide linkages to other related activities at the Federal
level.
During the first day, approximately 30 to 40 individuals representing
government, business, congress, consumers and disability advocacy groups will
work together to develop a precise definition of SSDI/Medicare disincentives.
This group will also present a set of policy options for dealing with these
disincentives. The Social Security Administration will provide staff support
with actuarial data and program impact statements SO that the conferees will
have available the most current information for their deliberations. On day
two of the conference, a working group consisting of 10-15 key policy officials
will be charged with building a consensus around some of the options proposed
by the larger group during day one.
This group will further examine the issue of disincentives and develop a
concept paper that provides an analysis and recommends a course of action grow-
ing out of a consensus by the group on some of the recommended policy options
that resulted from the first day of the conference. This concept paper will
result in a report to the Assistant Secretary, Office of Special Education and
Rehabilitative Services.
The consensus building process is critical in attaining the objectives for
the conference. The Assistant Secretary, Office of Special Education and Re-
habilitative Services, will then present the report to the Disability Advisory
Council and the Commissioner of Social Security for consideration.
3
The Disability Advisory Council was recently appointed by the Secretary of
HHS pursuant to a provision of P.L. 99-272. This bill directed Secretary Bowen
to establish an advisory council to study and make recommendations concerning
SSA's disability programs so that more beneficiaries will be encouraged to
return to work. The Council consists of leaders in rehabilitation, industry,
unions, disability advocacy groups and the medical profession as well as inter-
ested private citizens. The Council will be looking to enhance incentives to
work and to remove disincentives. The Council will meet monthly from January
to October and has also scheduled 4 field hearings on these issues.
Management
OSERS will hire a consultant to develop the background packages, work with
Social Security Administration, and serve as the Secretary to the group. The
Steering Committee members will be responsible for providing administrative
services. These services include: secretarial support, lists of participants
and logistical support.
A list of the Steering Committee members is attached.
4
STEERING COMMITTEE
Marty Ford
Doug Badger
Association for Retarded Citizens
Social Security Administration
1522 K Street, N.W. Suite 516
Room 114 Altmeyer
Washington, D.C. 20005
6401 Security Blvd.
Woodlawn, MD 21235
785-3388
8-934-8177
Dave Esquith
Committee on Education and Labor
John Wodatch
Room 535
Coordination and Review Section
House Annex 2
Civil Rights Division, DOJ
3rd and D Streets, S.W.
320 First Street, N.W.
Washington, D.C. 20151
HOLC Bldg./Rm. 850
Washington, D.C. 20531
226-3110
724-2227
Don Galvin
Washington Business Group on Health
Judy Boggs
National Rehabilitation Hospital
HCFA/HHS
102 Irving Street, N.W.
Hubert H. Humphrey Bldg.
Washington, D.C. 20010
Room 314 G
200 Independence Ave., S.W.
877-1122
Washington, D.C. 20201
Jay Rochlin
245-8502
President's Committee on Employment
of the Handicapped
Michael Herrell
1111 20th Street, N.W.
OAS/OSERS
6th Floor
Room 3120 MES
Washington, D.C. 20036
U.S. Department of Education
330 C Street, S.W.
653-5044
Washington, D.C. 20202
Lex Frieden
732-1439
National Council on the Handicapped
800 Independence Avenue
Suite 814
Washington, D.C. 20591
267-3235
Jim Young
Deputy Executive Director
PCMR/OHDS
U.S. Department of Health
and Human Services
330 Independence Avenue, S.W.
Washington, D.C. 20201
245-7634
FEDERAL DISABILITY POLICY:
A FORUM ON WORK DISINCENTIVES
Agenda
9:00 A.M.
Opening Remarks. - Dr. David Gray
Director, National Institute on
Disability and Rehabilitation Research
9:15 A.M.
Structure of the Forum: The Charge to the Participants
Dr. Leonard Perlman
9:30-
Panel #1 - - Income Support (SSDI) and Work Disincentives;
10:40 A.M.
The Effects of SGA and Other Structural Issues.
10:40-
Break
11:00 A.M.
11:00 A.M.
The Honorable Madeleine Will and The Honorable Steve Bartlett
to provide Welcoming Remarks.
11:20-
Panel #2 - Medical Benefits (Medicare) and Work Disincentives.
12:30 P.M.
12:30-
Lunch Break
1:30 P.M.
1:30-
Panel #3 - Eligibility Conditions, Entrance Requirements,
2:40 P.M.
and Their Effects (SSDI and Medicare).
2:40-
Break
3:00 P.M.
3:00 P.M.
Summary of Key Options to be Considered
3:30 P.M.
Adjourn
PANEL MEMBERS
PANEL #1: INCOME SUPPORT
1. Douglas Badger
Social Security Administration
Room 114 Altmeyer Building
6401 Security Boulevard
Woodlawn, MD 21235
8-934-8177
2. Ms. Marty Ford
Association for Retarded Citizens
1522 K Street, N.W.
Suite 516
Washington, D.C. 20005
(202) 785-3388
3. Martin Gerry, *
1 Thomas Circle
Suite 350
Washington, D.C. 20005
(202) 223-0570
4. David Gray, Ph.D.
Director, NIDRR
U.S. Department of Education
Mary Switzer Building
330 C Street, S.W.
Room 3060
Washington, D.C. 20202
(202) 732-1134
5. Mr. Dale Hanks
Commonwealth of Virginia Vocational Rehabilitation Services
4901 Fitzhugh Avenue
P.O. Box 11045
Richmond, VA 23230
800-552-5019
* Moderator
PANEL #2: MEDICAL
1. David Esquith
Committee on Education and Labor
Room 535
3rd and D Streets, S.W.
Washington, D.C. 20151
(202) 226-3110
2. Ms. Karen Franklin
Policy Associate
United Cerebral Palsy Association
Community Services Division
1522 K Street, N.W.
Suite 1112
Washington, D.C. 20005
(202) 842-1266
3. Mr. Allen Jensen
Subcommittee on Public Assistance and
Unemployment Compensation
Room B-317 Rayburn House Office Building
Washington, D.C. 20515
(202) 225-3625
4. Douglas Martin, Ph.D.
Culver City Senior Center
4153 Overland
Culver City, CA 90230
(213) 202-5864
5. Malcolm Morrison, Ph.D. *
Office of the Associate Commissioner for Disability
Social Security Administration
Room 100 Altmeyer Building
6401 Security Boulevard
Baltimore, MD 21235
8-934-0301
6. John H. Noble, Ph.D.
School of Social Work
University of Buffalo
Allen Hall
3435 Main Street
Buffalo, NY 14214
(716) 636-3381
7. Gail Schwartz
Washington Business Group on Health
229-1/2 Pennsylvania Avenue, S.E.
Washington, D.C. 20003
(202) 877-1526
* Moderator
PANEL #3: ELIGIBILITY
1. Ronald Conley, Ph.D.
Administration on Developmental Disabilities
Department of Health & Human Services
Room 347-D Hubert Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 245-2890
2. Lex Frieden
National Council on the Handicapped
800 Independence Avenue
Suite 814
Washington, D.C. 20591
(202) 267-3235
3. Edward Hester, Ph.D.
Rehabilitation Programs
Menninger Foundation
700 Jackson 9th Floor
Topeka, KS 66603
(913) 233-5501
4. Richard Melia *
NIDRR
U.S. Department of Education
Mary Switzer Building
330 C Street, S.W.
Room 3428
Washington, D.C. 20202
(202) 732-1195
5. Mr. Claude Myer
State Director
Department of Vocational Rehabilitation Services/State Office
620 Northwest Street P.O. Box 26053
Raleigh, NC 27611
(919) 733-3364
6. Mr. David A. Rust
Associate Commissioner for Disability
Social Security Administration
Room 508 Altmeyer Building
6401 Security Boulevard
Baltimore, MD 21235
(301) 594-2730
* Moderator
WORLD INSTITUTE ON DISABILITY/
NATIONAL COUNCIL OF INDEPENDENT LIVING
SSDI WORK INCENTIVE PROPOSAL
Section I Background Information on SSI Work Incentives
During the 99th Congress, the major SSI Work Incentives -
Section 1619 A and B - were permanently authorized. Section
1619 provides special cash payments to SSI recipients at
a reduced level so they can obtain or continue in part-time
or full-time employment. Section 1619 B allows recipients
to maintain SSI status once they are ineligible for cash
payments, in order to receive Medicaid benefits under "Title
XIX". These two provisions have provided a significant oppor-
tunity for disabled individuals on Supplemental Security
Incone (SSI) to obtain employment, reduce dependency on the
government, and contribute to our society.
In addition to permanent authorization of Section 1619 A
and B, this legislation:
1.
Repeals the "Trial Work Period" and the "Extended
Period of Eligibility" provisions that formerly
applied to SSI.
2.
Permits an individual to move from one category of
eligibility to another (ie, Regular SSI payments, 1619
A, and 1619 B) based on earnings.
3.
Provides for the continuation of regular SSI payments
through the second full month for Section 1619 re-
cipients in public institutions and medical facilities.
4.
Requires that the cost of impairment related work ex-
penses for the disabled and the cost of achieving a
"Self Support Plan, together with the value of publicly
funded attendant services, be added to the consideration
of whether an individual's earnings provide a "reason-
able equivalent" of benefits which the individual other-
wise would have been entitled to in the absence of
earnings.
Clarifies that state supplementary payments are to
be considered in such determinations.
Requires that the "reasonable equivalent" of benefits
criteria under Section 1619 B be based upon informa-
tion and data that are updated at least once a year.
5.
Mandates continued Medicaid coverage in Section 209 B states
to those SSI recipients who are eligible for Medicaid under
a state's more restrictive criteria, beginning with the
time they became eligible under Section 1619.
6.
Provides that the Social Security Administration should
have among its employees persons who are specifically
knowledgable about the Section 1619 program, and that
such persons be available to provide assistance to SSA
District Offices.
7.
Requires the Secretary of Health and Human Services to
automatically notify individuals receiving SSI on the basis
of disability, of their potential eligibility under Section
1619 at the following: times:
- when eligibility is intially awarded
- when earned income first exceeds $200 per month
- periodically thereafter so long as earned income
exceeds $200 per month
8.
Provides continued Medicaid coverage for those individuals
who lose their eligibility for SSI when their income
increases because they become newly eligible for SSDI
as a "Disabled Adult Child" (DAC), or because of an
increase in their benefits as a DAC.
The SSI work incentives have opened the doors for disabled
individuals to fully participate in their community and achieve
independence. The SSI work incentives are the foundation and
model for developing a similar work incentive for SSDI beneficiaries.
Section II Proposed SSDI Work Incentives
Purpose
To improve the Work Incentives for permanently disabled persons
receiving Title II, Social Security Disability Insurance (SSDI)
benefits, so that they will be encouraged to work to their full
potential. Under current law, although several work incentives
exist, the following groups of SSDI beneficiaries experience
serious disincentives to employment:
-2-
dual SSDI/SSI recipients (persons who receive a 1ow SSDI
benefit, and an additional SSI payment)
SSDI beneficiaries with significant medical problems,
who depend upon Medicare coverage now and will always need
need medical coverage in order to function and to work.
SSDI beneficiaries with earning capacity in excess of
$300 per month
Policy Options
The following is a list of widely ranging policy options which we
believe would greatly enhance the work incentives in Title II.
Some of the options are relatively complete in themselves and
others are only partial solutions which require additional pro-
visions to bring about a comprehensive work incentive. The
most complete options are listed first with partial solutions
following. In addition, actual case histories are cited in
support of various provisions.
1.
Develop an SSDI program similar to the SSI "1619 A" program
that allows disabled individuals to obtain employment and
receive partial cash benefits based on earnings, until a
"break even" point is reached (similar to 1619 A)
- Monthly benefits would be reduced when the person passed
the SGA level, one dollar for every two dollars of
earnings over SGA.
2.
Create an SSDI program that extends Medicare eligibility
in the same way that Medicaid is extended under SSI 1619 B
- This incentive is important because it protects Medicare
benefits when earnings are too high for cash benefits,
but not high enough to offset the loss of Medicare.
- currently, many beneficiaries do not want to pursue
employment in fear of losing Medicare benefits after
36 to 48 months (the current limit)
- this is significant to persons pursuing part-time
employment because health benefits are not generally
provided to part-time workers
3.
Develop a work incentive for SSDI/SSI recipients that are
dual enrollees. The SSI 1619 program addresses their SSI
payments. However, no work incentive addresses their SSDI
benefits.
--3-
- Title II payments are now provided dual enrollees on
an all or nothing basis while they work. For the first
12 months of work activity they receive Title II payments
with no reduction based on earnings. After 12 months
of work activity above SGA, the Title II payments stop
completely, and after 24 months beyond the extended
period ofeligibility (EPE), Medicare ceases. An
incentive could be provided by applying the SSI benefit
reduction formula, as a result of earnings, to the
Title II payment of dual enrollees - that is, use the
standard $65 per month earned income exclusion and
one-half the remainder to determine countable income and
in turn the Title II monthly benefit amount.
Allow the application of impairment related work expense
exclusions (IRWE) in calculating the monthly Title II
cash payment amount for dual enrolless; also allow the
same exclusions for a PASS.
- Broaden Section 1619 eligibility for dual enrollees to
include receipt of a Title II (Section 202) payment as
well as the current criteria of receiving Title XVI
(Section 1611) payments.
- Eliminate the 9-month Trial Work Period and 15-month EPE
as it applies to Title II for dual enrollees in favor
of their direct usage of Section 1619.
- Define the extended period for Medicare benefits as 48
consecutive months after the first month of work activity
above SGA instead of 24 months from the end of the EPE.
- Include for dual enrollees the cash-out value of Title XVIII
in the calculation formula for determining the reasonable
equivalent of earnings threshold (RET) for Section 1619(b).
Currently, dual enrollees have a disincentive to work
activity in that their upper level of earnings (RET) does
not take into account the value of Medicare payments
which reduce outlays by Medicaid. This results in a
lowering of the upper limit on their earnings as compared
with SSI only recipients. This suggestion would eliminate
such a discrepancy. It also provides for a method of
continuing Medicare eligibility beyond the extended 48-
month period should a person's income not provide an
equivalent for the loss of these benefits.
-4-
- Set the order of cash benefits reduction because of
earnings as first the Title XVI Federal Benefit Rate,
then the State Supplemental Portion (where applicable),
and finally the Title II amount.
4.
Make the Title II Substantial Gainful Activity (SGA) amount
for disabled persons equal to that provided blind recipients
by Section 223 (d) (4) of the Social Security Act. This would,
in effect, make the current SGA level $680 per month and
would be the same as the "exempt amount" under Section 203(f) (8).
The "exempt amount" is the amount of earned income which a
person age 65 to 70 may have without reducing their Social
Security retirement benefits.
5.
Eliminate the first 24-month Medicare waiting period for
Title II recipients.
6.
Extend indefinitely the time a working disabled person is
given during which he or she may return to Title II recipient
status without triggering a second 24-month Medicare waiting
period. This would be in lieu of the current 5-year (7-year
Disabled Adult Children) maximum time limit.
7.
Allow Title II beneficiaries who are working to pay a premium
for continuing Medicare at the end of the 48-month extended
coverage period; premiums would not exceed more than 8% of
their income. (This option was proposed by Senator Broyhill
last year in S. .2686.)
8.
Add a "hold harmless" provision to the Title II computation
of earnings formula equivalent to that afforded blind
recipients. Such a provision would assure Title II
recipients who work despite having a continuing disability
that their future cash payments would not be reduced
because their post-disability earnings averaged less than
those prior to their disability. In effect, this provision
would guarantee a working Title II recipient that should
they ever need to again receive Title II cash payments
the payment amount would be equal to the amount they
received prior to SGA plus any actual cost of living adjust-
ments given Title II recipients as a whole.
Presented by Douglas Martin, Ph.D.
at the Department of Education SSDI
Work Incentives Forum April 9,1987,
Washington, D.C.
For more information contact (213) 202-5864
-5-
CASE HISTORIES
See Options
Problem: John is a paraplegic who graduated from High School
#1 and #2
in 1974 and was in a motorcycle accident in 1977. John is
married and has two children and is on SSDI. After his accident,
he entered work activity at a local shelter workshop and ended
up using three months of his Trial Work Period Service Months.
John did not realize that he used up three months of his Trial
Work Period while employed at the shelter workshop. His employ-
ment to the shelter workshop did not provide sufficient income
to support his family. If he would have continued and used up
all nine months of his Trial Work Period, John would have been
cut off the SSDI Program and not have sufficient income to
support his family. Also, he would not receive continued
Medicare benefits after three years. As a result, John has
been forced to stay on the system and not pursue employment
opportunities.
Solution: Develop an SSDI Work Incentive Program similar to
the SSI 1916A Program that would allow disabled individuals to
obtain employment and receive partial cash benefits based on
earnings. Another solution is to create an SSDI Program that
extends Medicare eligibility in the same way that Medicaid is
extended in SSI | 1619B. These two solutions would allow John to
obtain part-time employment or some kind of employment and receive
partial cash benefits to support his family until he earns
significant income.
-6-
See Option Problem: Mary is a respirator dependent quadriplegic who lives
#3
in a state that does not supplement Title XVI. She was receiving
Title II and Title XVI before she began working January 1985.
The last month of her EPE was December 1986. She is now
(March 1987) on the third month of her 24 month extended
Medicare coverage. She is also covered by Medicaid under
Section 1619(b). Her actual monthly respirator cost is $670.00.
Of this Medicare approves $464.00/ month and pays $371.00/month.
Medicaid pays the remainder of $299/month. Mary recently had an
opportunity for promotion at work which made her ineligible for
continued 1619(b) status because her earnings exceeded the
reasonable equivalent of earnings threshold (RET). This would
not have happened to an identical person who was SSI eligible
only because such a person would have been covered exclusively
by Medicaid which would have paid the entire $670.00 monthly
for her respirator and this full amount would have been a part
of the RET calculations, not just the $299.00/month in Mary's
case. Currently, the value of Medicare is not counted as part
of the RET. In this example the disincentive for being a dual
enrollee is $371 per month.
Solution: Add the cash-out value of Title XVIII to the calcu-
lation of the RET which now includes only Title XVI, XIX and
publically funded attendant services.
-7-
Problem:
See
Option Peter is a quadriplegic who lives in a state with a federally
#3
administered supplement. He is a dual enrollee and has been
working for 6 months. He earns $750/month gross wages. This
is his first work attempt. He receives $395 Title II and
$185 Title XVI. Peter's IRWE's are $350/month. He needs a
driver to take him to and from work as well as personal assist-
ance on the job. He also uses a specially equipped van.
Peter cannot claim IRWE's in this case solely because he
is a dual enrollee. If he were a Title XVI only recipient
this exclusion would be applicable. Under present rules
(20 CFR 416.1112(c) (5) and 416.2030) in order to claim IRWE's
a recipient must have total countable income after the IRWE
exclusion that does not exceed the full FBR of Title XVI.
Solution: Provide for a $1 for $2 spend down on Title II and
allow IRWE exclusions to calculate cash payments with reduction
sequence: Title XVI, then SSP, then Title II.
See Option Problem:
#3
Carol is a paraplegic with a seizure disorder. She lives in a
state with a federally administered supplement. She is a dual
enrollee with $360 Title II and $220 state supplement. She
needs Medicaid for expensive medication to control her seizures
in order to work. She began working one year ago. Six months
before her first work her father retired and she began to receive
-8-
Title II payments. Her gross wages were $665 per month and at
the end of 9 months of SGA she was found ineligible for Section
1619 and continuing Medicaid because she did not receive at
least $1 of federal benefits under Title XVI. Her Title II
payment had replaced this benefit and SO rendered her ineligible
for the medical coverage she needed to continue working. She
was not yet eligible for Medicare because of the 24 month
waiting period.
Solution: Allow Section 1619 eligibility for dual enrollees to
include receipt of a Title II (Section 202) payment as well as
the current Title XVI (Section 1611) payments.
-9-
PAYING A PRICE TO WORK
Disabled from a stroke and le-
gally blind, Deborah McKeithan,
33, travels to Capitol Hill today to
lobby against work disincentives
for the handicapped. The problem:
Switching from a volunteer job to a
salaried position, she'll lose Social
Security Disability Income bene-
fits, including the all-important
Medicare insurance. "I want to be-
come a taxpayer," she said. "But
my last major setback cost $20,000,
and insurance companies say I'm
uninsurable. I must have Medi-
McKEITHAN: Fight-
care, and I'm willing to pay my fair
ing for handicapped
share." From a motorized scooter-wheelchair, the energet-
ic North Carolinian is pushing Fair Share Incentive Plan to
let the working disabled buy Medicare insurance on a slid-
ing scale based on income. McKeithan - founder and pres-
ident of Handicapped Organized Women, a support group
based in Charlotte with 140 chapters in 43 states - will be
on hand when the bill is introduced today by Rep. Alex Mc-
Millan, R-N.C., and Sen. David Durenberger, R-Minn.
WASHINGTON TODAY
President Reagan lunches with sponsors of the Bicen-
tennial Commemorative Commission on the Constitution.
Senate hearing on Medicare hospital-payment rates.
House hearing on EPA pesticide program.
Written by Paul Leavitt. Contributing: Leslie Phillips,
Jeannie Williams, Johanna Neuman and Margaret G.
Bigger.
need for functional exam
eligablity - phasic disablitys
SSDI like SSI
Insurance and income
cross cutting view of costs and benefits
advocates waiting
Supplemental Security Income
means that when past work is precluded the primary focus of the disability defini-
Supplemental Security Income (SSI) was added to the Social Security Act in
tion is whether an individual can do work and not whether the person can get work.
1972 as Title XVI. SSI provides monthly cash payments to aged, blind and disabled
needy persons. There are nationally uniform federal eligibility standards. SSI
The Social Security Administration uses a five step sequential process in deter-
replaces state welfare programs to the same group of eligible persons.
mining whether there is a disability for both SSDI and SSI purposes.
SSI recipients must meet certain income and resource limits to become eligible
Step 1 - Determine whether the individual is working, and does it constitute
for benefits. The regular Federal SSI benefit standard for an individual for 1985 is
substantial gainful activity.
$325 a month and $448 for a couple. States may supplement the regular federal SSI
Step 2- If the individual is not engaged in SGA, determine whether the in-
payment standard. The result is often a combined state-federal payment which can
dividual has a severe impairment which causes a significant restric-
vary from state to state. Individuals who are in a public hospital or other public in-
tion in performing work related functions.
stitution where most of the bill is paid by Medicaid, the monthly federal SSI pay-
Step 3- If a severe impairment is present see if the impairment is listed in SSA
ment is reduced to $25 to allow for small personal expenses while they are in the
regulation and/or whether it meets the duration requirement (12
hospital or institution. There are complex regulations which take into account the
months) and level of severity.
living situation, income disregards, in kind support, resources and deeming of in-
come to determine the monthly payment level.
Step 4 - Determine whether the individual can do work which he/she has
previously done.
While many, if not most, SSI recipients are covered by Medicaid, states have
three options on how to cover recipients.
Step 5 — If the person cannot do previous work, determine whether he/she
can engage in SGA based on residual functional capacity for work
1) Automatic eligibility through agreement between SSA and the state.
and vocational factors such as age, education and prior work ex-
2) Automatic eligibility but with separate Medicaid application.
perience. If the person is determined not to be able to engage in SGA
3) State imposed Medicaid eligibility requirements that are usually more restric-
at this stage then the disability is allowed.
tive than federal criteria.
Contact should be made with the appropriate state agency to determine which
Substantial Gainful Activity
method is used in your state.
It is important that the concept of substantial gainful activity (SGA) is
understood since it is used in determining whether a disability exists and also plays
Definition of Disability
an important role in several of the work incentives.
While eligibility criteria differ greatly between Social Security Disability In-
The primary consideration in determining whether work activity is SGA is the
surance beneficiaries (Title II) and Supplemental Security Income recipients (Title
countable earnings derived from the employment. The current countable earnings
XVI), the definition of disability is the same for both programs. The Social Securi-
guideline representative of SGA for nonblind employees is earnings averaging over
ty Act sets out a unique definition of disability.
$300 per month (called the primary guideline). There is also a secondary SGA
guideline for employees which is currently $190 per month of countable earnings.
The statute provides in essence: That an individual must have a medically deter-
The significance of the SGA secondary guideline is that earnings below the secon-
minable impairment which has precluded or can be expected to preclude any
dary amount are generally presumed not to be SGA. For earnings between the
substantial gainful activity (SGA) for twelve months or terminate in death. Fur-
primary amount ($300) and the secondary amount ($190) it is necessary to consider
ther, the impairment must not only prevent a person from doing his/her past work,
certain nonmonetary criteria to determine if the work is SGA.
but also prevent him/her from doing any other substantial gainful work that exists
in the national economy. The statute specifically requires consideration of an in-
The nonmonetary criteria involve two tests.
dividual's age, education, and past work experience in determining disability;
1. Test of Comparability - Does the work compare to that done by unim-
however, it precludes consideration of any matters that go to the issue of employa-
paired individuals in the community engaged in the same or similar occupa-
bility, e.g., job openings, or whether the person would be hired if applied for the
tions for their livelihood and
job. In essence, the critical issue is whether the impairment and the individual's
2. Test of Worth - Is the individual's work clearly worth more than the
age, education, and past work experience precludes the performance of SGA. This
primary earnings guideline ($300 per month)?
2
3
For individuals employed in a sheltered workshop or similar rehabilitation
facility, the SGA secondary guideline is of little significance. If their earnings are
below the SGA primary guideline ($300 or less), the earnings are generally presum-
ed not to be SGA.
By reason of specific legislation in 1978, there is no secondary guideline for the
blind under Title II and there is a larger SGA earnings guideline for the blind. It is
currently $550 per month and the guideline increases with the Consumer Price In-
dex. The blind, under Title XVI, are not subject to the SGA tests.
In determining countable earnings of employees for SGA purposes, any sub-
sidies provided by an employer plus impairment-related work expenses (IRWE)
are deducted from gross earnings.
Impairment related work expenses can be deducted from gross earnings before
determining countable earnings for SGA purposes. The Social Security Ad-
ministration also allows deductions of subsidies from gross earnings. A subsidy
will be found to exist when wages exceed the value of services performed. Subsidies
will be found to exist where an individual requires unusual supervision or assistance
in order to perform work or where individual productivity is not used to determine
wage level.
In some instances periods of employment above the SGA level can be considered
an unsuccessful work attempt (UWA). To qualify as a UWA, the work must have
been of 3 months duration or less and been discontinued or markedly reduced
because of the impairment or removal of conditions essential to further perfor-
mance, such as special hours, equipment, or other assistance on the job. With ad-
ditional qualifications the unsuccessful work attempt can last up to 6 months.
4
I. BASIC PROVISIONS OF SSI AND SSDI
Social Security Disability Insurance Program
The Social Security Disability Insurance program (SSDI) provides monthly cash
benefits for workers under age 65 who become disabled. Coverage for the Social
Security Disability Insurance Program is basically the same as for the Social Securi-
ty Old Age Survivors Insurance (OASI) program. However, there are differences
in insured status and administration of the programs.
A percentage of the Social Security taxes paid by workers is allocated to the
Disability Insurance Trust Fund. This is the source of funds for monthly benefits
paid to the disabled worker and dependents and for administrative expenses of the
program. In addition, the revenue derived from the taxation of disability benefits is
also deposited in the Trust Fund.
There are four types of disability beneficiaries:
1) Disabled Worker
2) Spouse Benefit
3) Child's Benefit
4) Disabled Child's Benefit
Note that many clients receive SSDI benefits because they were disabled prior to
age 18 or they are the son or daughter of an insured parent who has retired, become
disabled or died.
To receive disability benefits, a worker must have the requisite number of
quarters of coverage. Workers age 31 or over who are not blind must have 20
quarters of coverage during the preceding 40 quarters. Workers under age 31 must
have been covered for at least one half of the quarters since they reached age 21.
However, a minimum of six quarters is required.
The amount of SSDI benefits is based on the earnings and length of employment
of the worker. Benefits may be reduced if other federal state and local benefits are
being received.
Disability determinations are made by state agencies which make determina-
tions following guidelines and regulations issued by SSA. SSA may review state
determinations and under the 1980 amendments must review non-permanently
disabled persons every three years. Benefits may be terminated if there has been
medical improvement in the person's condition and the person is able to engage in
substantial gainful activity (SGA).
1
FEDERAL DISABILITY POLICY:
A FORUM ON WORK DISINCENTIVES
Agenda
9:00 A.M.
Opening Remarks - The Honorable Steve Bartlett
9:10 A.M.
Introduction to the Forum - The Honorable Madeleine Will
9:20 A.M.
Structure of the Forum: The Charge to the Participants
(Chairperson to be selected)
9:30-
Panel #1 - Eligibility Conditions for SSDI and Their
10:40 A.M.
Effects ; Determinants of Employability
10:40-
Break
11:00 A.M.
11:00-
Panel #2 - Medical Benefits and Work Disincentives;
12:30 P.M.
Issues of Medicare, etc.
12:30-
Lunch Break
1:30 P.M.
1:30-
Panel #3 - Income Support and Work Disincentives; The
2:40 P.M.
Effects of SGA and Other Financial Issues.
2:40-
Break
3:00 P.M.
3:00 P.M.
Summary of Key Options to be Considered
3:30 P.M.
Adjourn
PARTICULARS
LOCATION: The L'Enfant Plaza Hotel is located at 480 L'Enfant Plaza, S.W.
in Washington, D.C.
(202) 484-1000
LODGING: You will need to make your own transportation and hotel
reservations. The hotel rate is $120.00 per night for a
single room. A block of rooms has been reserved under the
Department of Education Social Security Disability Conference.
Due to a very limited amount of rooms, please make your
reservations as soon as possible.
MEALS:
At participant's own expense.
STATEMENT OF EDUCATION
UNITED STATES DEPARTMENT OF EDUCATION
OFFICE OF THE ASSISTANT SECRETARY
FOR SPECIAL EDUCATION AND REHABILITATIVE SERVICES
UNITED STATES OF FAMERICA
Lex Frieden
National Council on the Handicapped
800 Independence Avenue Suite 814
Washington, D.C. 20591
Dear Mr. Frieden:
You are cordially invited to be a panelist at a meeting on Social Security
Disability Insurance entitled, "Federal Disability Policy: Forum on Work
Disincentives," to be held on Thursday, April 9, 1987, from 9:00 A.M.
until 3:30 P.M. The Forum will be held at the Loews L'Enfant Plaza Hotel
in Washington, D.C.
Enclosed please find an agenda of the day's events. Should you have any
questions, please feel free to contact Mr. Leonard Perlman at
(301) 460-1397.
We are very excited about this Forum and are anxious to hear your views
and perspectives. I look forward to participating with you in this
important event.
Sincerely,
Madeleine Scill
Madeleine Will
Assistant Secretary
Enclosure
400 MARYLAND AVE., S.W. WASHINGTON, D.C. 20202