|
Transitioning to Work
While contemplating returning to work, there are some financial,
health and employment related issues and concerns that should be
taken into consideration.
This fact sheet will address some of the financial considerations
relevant in deciding whether to return to work. Specifically, we
will discuss the effects of returning to work on public benefits
such as SSDI, SSI, Medicaid and Medicare.
Information about the effects of returning to work on private
health and disability insurance and debt management is available
in the GMHC Legal Department's brochure, "Life After Disability:
Returning to Work." To receive a copy of the brochure or to ask
questions about these topics, please call 212/367-1040.
This fact sheet was designed to provide you with a general overview
of the effects of returning to work on public benefits. For more
detailed information or for assistance, please call the GMHC Advocacy
Helpline Monday through Friday, 2:00 – 5:30 pm: 212/367-1125.
Benefits from Employers:
New York State
Disability (NYSD)
Most employees in New York State are eligible for New York State
Disability (also known as short term disability) regardless of
how many employees their employer employs. Some employers also
provide Long Term Disability Insurance. These are disability benefits
that come from an insurance company that has a contract with your
employer to provide disability income for employees who are temporarily
or permanently disabled.
Eligibility for NYSD is based on whether or not you are too disabled
to work, therefore, the general rule with NYSD is that if you return
to work, even with limited hours of work, you will lose the benefits
entirely. Long Term Disability Insurance can work differently.
Consult with the GMHC Legal Department if you have questions about
Long Term Disability Insurance.
Public Entitlements:
AIDS Drug Assistance
Program (ADAP)
ADAP is a federally funded program administered by the New York
State Department of Health which was developed to ensure that everyone
in New York State who is HIV positive or has HIV symptoms or AIDS
has access to costly medication used to treat HIV illness. Free
HIV-related drugs are provided for those who are uninsured, underinsured,
and who do not have Medicaid. ADAP also provides a primary care
program (ADAP Plus), and a third ADAP program provides skilled
nursing and homecare. A fourth program, ADAP Plus Insurance Continuantion
(APIC) pays health insurance premiums for those who meet certain
qualifications.
ADAP could play a very important role if you return to work. If
you do not have health insurance or your employer does not provide
it or you lose your Medicaid coverage, you may still be eligible
for services from ADAP. An individual is allowed to have annual
income (before taxes) of up to $44,000. A family of two is allowed
$59,200 and a family of three or more is allowed up to $74,400.
Any household, regardless of size, cannot have resources of more
than $25,000. For more information, please call ADAP at 1-800-542-2437
or the GMHC Advocacy Helpline.
Social Security Benefits
The Social Security Administration (SSA) provides two benefits
for the disabled. One is called SSI (Supplemental Security Income)
and the other is SSDI (Social Security Disability Insurance).
SSI is a program for those who have limited resources and income.
SSDI provides disability income based upon the F.I.C.A. taxes
that you paid throughout your entire work history.
SSI
If you return to work while receiving SSI, your earnings will be
taken into consideration and the SSA will have to review your
SSI budget. You are allowed to have gross monthly earnings (before
taxes) of up to $85 before your benefits are affected. This is
called a "disregard." If you are receiving a combination of SSI
and SSDI, the amount of disregard would be $65 instead of $85.
Your SSI check will be reduced by one dollar for every two dollars
of gross earnings in excess of $65 or $85, as applicable.
Documented expenses for services or items related to your impairment
which are needed in order to work will be deducted from your gross
earnings. This also applies to SSDI. Some examples of these expenses
(disregards) are prosthetic devices needed to work, a wheelchair
and special transportation needs like a car service or ambulette
service.
Example:
SSI recipient returning to work and grossing (before taxes) $600
per month. This person provided Social Security with documentation
indicating that she needed to use a car service in order to return
to work.
| |
SSI benefits |
$710
|
| |
Gross monthly earnings |
$600
|
| |
Gross income disregard |
-$85
|
| |
|
|
| |
|
$515
|
| |
Impairment related travel expenses (car
service) |
-$115
|
| |
|
|
| |
|
$400
|
| |
divided by 2 = |
$200
|
The $200 left is the amount that her SSI would be reduced by leaving
her with $510 per month in SSI benefits. Her overall income would
be the net amount (after taxes) of her wages plus the $510 in SSI
benefits.
There is a break even point where if your gross
earnings are high enough in a particular month you would not receive
any SSI. The break even point would be $1,505 if you do not have
any impairment related expenses and are receiving the full $710
a month (benefit amount for 2005). Because some people's earnings
are different every month, it is possible that in one month you
may be eligible for some SSI and in other months, because your
gross income is higher ($1,331 or more), you will not be eligible
for SSI. If you incur 12 consecutive break even point months, you
may lose your SSI benefit.
It is important to know that anyone receiving Social Security
benefits (SSI or SSDI) can be subject to a continuing disability
review (CDR) to determine if they are still considered
to be medically disabled. The risk of triggering a CDR increases
if you return to work. If the SSA determines that you are no longer
disabled and can continue work, your benefits will stop.
SSDI
If you are receiving SSDI and feel that you are able to return
to work, SSDI has a trial work period which
allows you to return to work for up to 9 months within a 60 month
period while still receiving benefits. The nine months do not
have to be consecutive. During the trial work period, you can
earn any salary you are able to earn while also receiving your
monthly SSDI checks. If your gross monthly earnings are $640
or more, that will constitute a trial work month. If your gross
monthly earnings are under $640, these earnings will not be counted
towards the trial work period and should not affect your ability
to keep your SSDI.
For those who continue to work after completing the nine month
trial work period, there is a three month grace period where your
SSDI checks will continue even if earnings are above $900 (which
is considered substantial gainful activity — SGA).
If you continue to perform SGA after the grace period, your payments
will stop.
Following the 9 month trial work period, the Social Security Administration
recognizes a 36 month period of extended eligibility. If, during
this 36 month extended period of eligibility, you have to stop
working or your earnings fall below $900, you would be eligible
for benefits without having to make a new application for SSDI
or incur a waiting period. If that happens, get a letter from your
employer stating the date you stopped working or the date your
monthly gross income (salary) fell below $900. Your SSDI checks
should start shortly after presenting the letter to your Social
Security Office.
After returning to work for the nine month trial work period and
continuing to engage in substantial gainful activity (earning $900
or more per month) you could trigger a continuing disability
review (CDR). CDRs are conducted by Social Security to
determine if a recipient is still medically disabled.
It is not advisable to perform substantial gainful activity
(earning $900 or more per month) within the twelve month period
following the date Social Security determined that you were disabled because
that will almost always trigger a CDR and could result in alleged
overpayments of SSDI. This is because one of the conditions under
which you are approved for SSI or SSDI is that you have a disability
that is expected to last for at least 12 months.
Ticket to Work and Work Incentives Improvement Act of
1999
President Clinton signed the Ticket to Work and Work Incentives
Improvement Act of 1999 on December 17, 1999. Provisions of the
law have become effective at various times, generally beginning
one year after enactment.
Some of the provisions include:
Expanded availability of health care services by expanding Medicaid
(establishment of a state buy-in for those who work) and Medicare
(extended free Part A coverage for those who work).
Establishment of The Ticket to Work And Self-Sufficiency Program
which will allow SSI/SSDI disability beneficiaries who receive
a "ticket" to obtain vocational rehabilitation and other employment
support services from an approved provider of their choice. These
services will be free of charge.
Effective January 1, 2001, when a person's SSI or SSDI has ended
because of earnings from work, he or she would be able to request expedited
reinstatement of benefits without filing a new application
within 60 months from the month their benefits are terminated.
They may also receive temporary benefits for up to six months while
their case is being reviewed.
Maximus is the company that has been awarded a contract requiring
them to provide information to the general public about the program.
The toll-free number for Maximus is 1-866-968-7842. You can also
contact the GMHC Client Advocacy Unit for more detailed information.
Plan for Achieving Self Support (PASS)
PASS is a plan that the Social Security Administration offers to
SSI and/or SSDI recipients who have a vocational and/or educational
goal backed by a clearly defined plan to achieve it. In order
to open a PASS, you must submit a written application (Social
Security form SSA 545) to Social Security that details how you
plan to become financially self sufficient within a specified
period of time.
PASS allows you to set aside income and resources which would
be used for expenses incurred in achieving your goal. Examples
of these expenses would be equipment, tools, child care, tuition,
books, job search or relocation expenses.
Opening a PASS may allow you to become eligible for SSI, retain
your existing SSI or become eligible for an increased SSI payment
despite work income or other financial resources including money
from Pension Plans, SSDI, or family members. The resources and
income, which would normally count towards your eligibility for
SSI, will not effect your SSI payments (see examples below).
A PASS can be approved for up to 18 months and may be extended
for an additional 18 months. If the plan includes a lengthy education
or training program, the plan may be extended for an additional
12 months. After the 48 months, PASS may be extended in intervals
of six months. All extensions must be approved by the Social Security
Administration.
Anyone can help you with a PASS, including your vocational rehabilitation
worker, or the designated PASS representative in your Social Security
office. Applications for PASS must:
- state a clear and realistic occupational work goal.
- be in writing and state the amount and sources of income or
resources that will be set aside.
- state a specific period of time for achieving the objective.
- state how the recipient will spend the money.
- increase the individual's prospects for self support.
Example 1:
PASS plan for an SSDI recipient who receives $740 per month:
This SSDI recipient submitted a proposal to Social Security for
the following PASS plan which Social Security approved: The proposal
allows for this recipient to take out a bank loan for the purchase
of equipment to be used for a business (self employment) she wants
to start. The loan calls for monthly payments of $400.
She can pay $400 a month from her SSDI checks of $740 leaving
her with $340 in SSDI. With a pass plan, the Social Security Administration
would treat her as if she was just receiving $300 per month in
SSDI. She could then apply for SSI and if approved, she would receive
up to $386 in additional income from Social Security (SSI), giving
her a total of $1,086 per month from SSI/SSDI.
Without the PASS plan, she would not be eligible for any SSI because
the most she could receive from SSI and SSDI, if receiving both,
is $730 (in 2005).
Example 2:
PASS plan for an SSI recipient receiving $710 a month:
This SSI recipient submitted a proposal to Social Security for
the following PASS plan which Social Security approved: This recipient
is going to start working as a delivery person in about a year.
In order to achieve his goal, he will need to purchase a small
van. His parents agreed to give him $680 a month (unearned income
which is treated as a dollar-for-dollar reduction by Social Security)
to be saved toward the purchase price of the van.
Typically, $680 in monthly unearned income (not wages, which are
considered earned income) would make this recipient ineligible
for SSI benefits and as the monthly donations from his parents
accumulate, the recipient's resources would eventually become higher
than the allowable SSI resource limit of $2,000.
With the PASS plan, this recipient can continue to receive $666
a month in SSI benefits despite the additional income of $680 or
his eventual resources in excess of $2,000.
Medicare
Medicare is the Federal Government's health insurance plan which
is offered to most people once they reach the retirement age
of 65. Disabled individuals are offered Medicare once they have
been receiving SSDI payments for two years. Medicare is divided
into two parts: Hospital Insurance (Part A) and Medical Insurance
(Part B). While you do not have to pay a premium for Part A,
you must pay for Part B if you want it. The monthly Part B premium
is $93.50 (2007).
You will continue to receive Medicare as long as you are receiving
SSDI. If you return to work, you will be able to continue to receive
Medicare for 36 months from the time the nine month trial work
period ended. During that period, Part A remains free and you will
continue to pay the Part B premium.
In the past, if you continued to need Medicare after the 36 month
period, Medicare used to immediately start charging you a premium
for part A (a much higher premium than part B). This was in addition
to the premium you were already paying for part B. Because of the "Ticket
to Work and Work Incentives Improvement Act of 1999," you can now
keep your part A coverage free of charge for 93 months from the
time your extended period of eligibility (EPE) ends.
HIV/AIDS Services Administration
(HASA, formerly DASIS)
HASA provides specialized services which include enhanced monthly
rental assistance as well as enhanced nutritional and transportation
allowance to individuals and families in New York City with AIDS
or advanced HIV illness. In 2000, HASA started the Work Opportunity
Program. The program was developed to address the needs of those
persons with HIV/AIDS who would like to participate in relevant
vocational rehabilitation activities, to develop marketable skills,
and to prepare for entry into or return to the work force. The
HASA Work Opportunity Program is a voluntary program that offers
a variety of incentives and benefits for participants. One of the
incentives for those who chose to participate in the HASA Work
Opportunity Program is that, on a case by case basis, HASA may
apply more generous disregards which may allow you to keep more
of your Public Assistance and Food Stamp benefits. Being in the
program may also allow for continued Medicaid coverage.
If you do not apply to be in the HASA Work Opportunity Program,
the procedure HASA should follow when they factor in your wages
on your Public Assistance budget is the same procedure that non-HASA
Public Assistance follows when a recipient transitions to work
(see Public Assistance section of this fact sheet).
If you apply to be in the Work Opportunity Program and are accepted, HASA will start by looking at your gross (before taxes) monthly income (countable monthly income). They will pro-rate the two extra paychecks you receive per year over twelve months and add that amount to the figure you gave them to determine the new higher countable monthly income. They will then reduce the countable monthly income by $90 if you are working full time (the $90 disregard). If you are working part time, they will give you a 60% disregard on the countable monthly income that does not exceed 185% of the Federal Poverty Level (further reducing what they count as your monthly income). If you have any impairment related expenses that are necessary in order for you to be able to work (like a van services if you are unable to use public transportation), your countable monthly income may be reduced further by the monthly cost of the expense. What is left is what HASA will count as your monthly income. They will then reduce your HASA/Public Assistance benefit by that amount. If your income from work is so high that even with the above disregards, you are still not eligible to retain any of your Public Assistance, HASA will most likely leave your Medicaid active for up to one year. This program is a transitional program that is intended to help you transition to work. After the transitional period which is usually a year, HASA will do an evaluation of where you are in the transition to work.
Example 1 (John was accepted into the HASA
Work Opportunity Program):
John lives alone in a $600 a month apartment. The only income he
receives is from HASA/Public Assistance (no SSI, SSDI or any other
income). John's HASA Public Assistance benefit would be $930 per
month (his rent of $600 plus the $330 in monthly cash benefits
that he is allowed as a HASA client).
John accepted a part time job which will pay him $200 a week or
$800 per month before taxes (gross). John will need to use a car
service to get to work which costs $120 per month. HASA approved
that as an impairment related expense.
| |
Gross Monthly Salary |
$800.00 |
| |
Divided by 4 = $200 3 4.333 =
(pro-rates the 2 extra pay checks) |
$866.60 |
| |
|
|
| |
60% disregard for P/T job
(60% of $866.60 = $519.96 |
-$519.96 |
| |
|
|
| |
|
$346.64 |
| |
|
|
| |
Impairment related expense
(countable monthly income) |
-$120.00 |
| |
|
|
| |
Countable monthly income |
$226.64 |
John's HASA/Public Assistance benefit of $930.00 per month would
be reduced by $226.64(final calculated amount) leaving him with
a monthly HASA/Public Assistance benefit of $703.36. John
would still qualify to have his full rent of $600 paid
but his cash benefit would be reduced from $330 to $103.36.
Example 2 (If John did not apply for the
HASA Work Opportunity Program):
If John did not apply for the HASA Work Opportunity Program the
following Public Assistance budget calculation would apply:
| |
Gross Monthly salary |
$800
|
| |
Divided by 4 = $200 x 4.333 =
pro-rates the 2 extra pay checks) |
$866.60
|
| |
$90 gross income disregard |
$90.00
|
| |
|
|
| |
Countable monthly income |
$776.60
|
In this example, because John did not apply to participate in
the HASA Work Opportunity Program, he was not allowed the 60% disregard
or the disregard for the impairment related expense. Since his
HASA/Public Assistance monthly benefit is $930 and his countable
monthly income is $776.60, he will have his Public Assistance reduced
from $930 per month to $153.40 ($930.00 minus $776.60 = $153.40).
As you can see by these examples, John is much better off being
in the HASA Work Opportunity Program as he is able to keep more
of his monthly Public Assistance Benefit.
Public Assistance (PA)
For non-HASA Public Assistance recipients returning to work, the
rules are not the same for Safety Net Assistance (SNA), defined
as individuals and certain families receiving Public Assistance,
and Family Assistance (FA), defined as families with dependant
children. FA and SNA households which include a dependent child
receive a $90 standard work disregard from their gross monthly
income (wages) and an additional 43% income (wages) disregard.
SNA households that do not include a dependent child (individuals
and childless couples) only receive the $90 standard work disregard.
(See examples in HASA section.)
If you meet certain income guidelines, you may receive up to 100%
reimbursement for the cost of child care for up to 12 months from
the time you lose PA eligibility because your wages are too high
for PA to make payments to you. If you return to work and your
wages are low enough that you are still eligible for some PA, you
may receive up to 75% reimbusement for child care costs.
Public Assistance applies a "185% gross income test" (185% of
what Public Assistance normally allows you to have in monthly income).
If your gross earnings are higher than those which appear on a
gross income chart (see below), you will no longer be eligible
for Public Assistance and your case will be closed. (The chart
only applies to those who receive regular Public Assistance budgets
which do not include enhanced rent.) If your monthly gross income
(wages) is less than the figures listed on the chart, you will
be rebudgeted and your Public Assistance will be reduced accordingly.
To determine your gross monthly income, Public Assistance takes
the average of your last four weeks gross income (wages) and multiplies
it by 4.333 to establish the amount of gross monthly income by
which they will reduce your Public Assistance benefits.
| |
185% Gross Income Test
|
| |
Family Size
|
Maximum Monthly Gross Income
|
| |
1
|
$651.39
|
| |
2
|
$866.73
|
| |
3
|
$1,067.45
|
| |
4
|
$1,272.25
|
| |
5
|
$1,481.30
|
| |
6
|
$1,635.77
|
If you start working, it is important that you report your earnings
to Public Assistance right away. You are eligible for adjustments
to your gross monthly income, but the work incentives and income
disregards will apply only if you report your income to Public
Assistance when you find a job or no later than when you receive
your first check.
Medicaid
Medicaid is an entitlement program which is administered by the
City of New York's Family Independence Administration. It guarantees
health coverage to those who qualify for the program.
Recipients of Medicaid usually have it because they are receiving
SSI, or because it was requested by their PA or HASA caseworker
when their Public Assistance case was being opened.
If you return to work and continue to receive any SSI at all,
you will automatically continue to receive Medicaid. There is a
provision under SSI called the 1619B program which allows for continued
Medicaid coverage even if your monthly income is too high for you
to be eligible for an SSI check. You can keep your Medicaid coverage
as long as your annual gross income is not more than $41,771 and
you meet certain conditions. You still must be considered disabled.
You must also meet all SSI requirements other than the income requirement,
and have received an SSI payment within the previous 12 months.
Under the Welfare Reform Act, two new categories of Medicaid recipients
have been created: Low Income Families (LIF), which are families
with children under age 21, children under age 21 who are not living
with caretaker relatives, and pregnant women; and Single/Childless
Couples (S/CC), which are single individuals and childless couples
who are not certified blind or disabled and who are between the
ages of 21 and 65. The blind or disabled would not receive Medicaid
under these categories but would most likely be eligible through
the SSI related Medicaid-only eligibility group.
If you have Medicaid and return to work and do not receive SSI
but are still considered disabled by Medicaid, you may still qualify
for Medicaid with a surplus income spenddown, a monthly deductible
which can be met with paid or unpaid medical bills (see Meeting
The Medicaid Surplus Income Spenddown Fact Sheet).
Most families who receive Medicaid should receive transitional
Medicaid (TMA) for 6 months once they return to work. This is possible
provided there is a dependent child in the household who is under
21 years of age and you have been receiving Medicaid apart from
LIF because there is a disabled person in the family. You could
also qualify because you have been receiving Medicaid under LIF
for three of the previous six months and you are losing eligibility
for Medicaid due to increased income from employment.
Medicaid Buy-In Program
The Medicaid Buy-In Program allows full Medicaid coverage to people
with disabilities who are working and earning more than the allowable
limits for regular Medicaid.
Congress created the Medicaid Buy-In option in the balanced Budget
Act of 1997. This state by state option was enhanced through the
Ticket to Work and Work Incentives Improvement Act signed by President
Clinton in December, 1999. In January 2002, Governor Pataki signed
state legislation allowing New York State to provide the Medicaid
Buy-In. The Program started in New York State on July 1, 2003.
New York State residents, at least age 16 but not yet 65, who
have a disability as defined by the Social Security Administration
and who are engaged in full or part time paid work may be eligible
to apply for the Medicaid Buy-In. An individual can have a gross
income (before taxes) of up to $50,028 and the amount for a couple
is $67,020 (for 2006). These amounts may
even be higher if you claim any impairment related work expenses
(IRWI's) that are necessary in order for you to work and if they
are approved by Medicaid. An example would be if you are not able
to take public transportation and have to pay for a van service.
Resources such as bank accounts, stocks, bonds and vacation homes
are permitted up to $10,000 in value.
You may be required to pay an affordable premium for the coverage,
depending on how much your income is. If you will be required to
pay a premium, the amount will be determined when you apply for
the Program. Because this is a new Program, nobody will have to
pay a premium until a date is determined.
The GMHC Client Advocacy Unit has the application and is available
to assist you. For more information, please call our Helpline:
212/367-1125, Wednesdays 2 pm to 5:30 pm. Walk-in services are available
Tuesdays and Thursdays, 10 am to 1 pm.
AIDS Health Insurance
Program (AHIP)
AHIP is a program administered by Medicaid which pays health insurance
premiums only for those who are not Medicaid eligible and who have
limited income. Unlike other "means based" entitlements, AHIP does
not take resources into consideration when determining eligibility.
They base your eligibility on the amount of your monthly income.
If you return to work, you may be eligible to have AHIP pay your
health insurance premium if your monthly income is below 185% of
the federal poverty level. In 2007, an individual is allowed to
have gross income of up to $1,468. A family of two is allowed income
of up to $1,559 and a family of three is allowed up to $2,096.
The GMHC Advocacy Helpline can send you the application and answer
any questions you may have about the program.
Food Stamps
If you return to work while receiving Food Stamps, you may continue
to receive Food Stamps as a disabled recipient if you meet certain
qualifications. For non-disabled applicants and recipients, Food
Stamps uses a "gross income test" to determine eligibility. However,
if you are disabled, Food Stamps will apply more liberal rules
in determining continued eligibility and the amount you will
receive. Some things that could allow for continuation of Food
Stamps include: if you have a disabled member in your household
who would be included in the Food Stamp budget; if you have a
household member who is 60 years of age or older or if your gross
monthly income is low enough that you are still eligible for
some SSI.
If you are not deemed exempt based on disability, the gross income
test involves a chart that has monthly income limits for your family
size. The income limits are established at by taking 130% of the
federal poverty level for each family size. If your income is above
the allowable amount for your family size, you will not be eligible
for any Food Stamps. If your income is below the allowable amount,
Food Stamps will rebudget you and adjust your Food Stamps accordingly.
| |
Food Stamp gross income
test:
|
| |
Family Size
|
Maximum Monthly Gross Income
|
| |
1
|
$1,062
|
| |
2
|
$1,430
|
| |
3
|
$1,799
|
| |
4
|
$2,167
|
| |
5
|
$2,535
|
| |
6
|
$2,904
|
The Client Advocacy unit of GMHC provides, at no cost,
fact sheets, in both English and Spanish which contain specific
information on all of the benefits and entitlements discussed
in this particular fact sheet. To request any of the fact sheets,
or if you have any questions about returning to work or benefits
and entitlements or other questions involving benefits and entitlements,
please call the GMHC Advocacy Helpline: 212/367-1125, Wednesdays
2 pm to 5:30 pm.
Walk-in services are available Tuesdays and Thursdays,
10 am to 1 pm.
Revised 4/07
© 2007 Gay Men's Health Crisis
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