Blind Work Expense

If individuals who are receiving Supplemental Security Income because they meet Social Security's rules for being blind, they may use a work incentive called Blind Work Expense (BWE’s). These are documented expenses needed in order to work. When reported to the Social Security Administration with wage reports, BWE’s will be calculated into the countable income formula to retain more of the SSI check.

Disability Determination Services Bureau (DDS)

The state agency under contract with the Social Security Administration to determine medical eligibility for disability benefits.

Disregard ( Indiana Medicaid)

When calculating eligibility for Medicaid, Indiana will disregard certain amounts of income in the countable income formula. This normally includes a $20 General Income Disregard and a $65 Earned Income Disregard (if the individual is working).

Dual Eligibles

Individuals who are covered by both Medicare and Medicaid and receive benefits from both programs. There are four categories of Dual Eligibles; this includes Qualified Medicare Beneficiaries (QMB), Specified Low-Income Beneficiaries (SLMB), Qualifying individuals (QI-1), and Qualified Disabled Working Individuals (QDWI). Depending on an individual’s income, they may be in one of the four categories.

Earned Income

Earned income is salaries, wages, tips, or other amounts of compensation received from performing work activity.

Earned Income Disregard (Indiana Medicaid)

Indiana Medicaid will disregard $65 of income from earnings when calculating the countable income formula to determine eligibility for Medicaid.

Earned Income Exclusion (Supplemental Security Income)

For individuals receiving SSI, Social Security will exclude $65 dollars of earnings when calculating the countable income formula and determining the amount of an individual’s SSI check.

Earned Income Tax Credit

Federal income tax credit for low income working individuals and families. The tax credit reduces the amount of money owed in federal taxes, and may result in a refund check from the Internal Revenue Service.

Employment Network

An employment service agency or group of agencies that are approved by the Social Security Administration to provide a variety of services related to employment, including job readiness services, placement services, vocational rehabilitation, training, job coaches, and other supports. Employment Networks were developed under the Ticket to Work and Work Incentives Improvement Act of 1999. Individuals receiving a Ticket to Work in the mail may assign their ticket to an Employment Network to get assistance with choosing, getting and keeping employment, and working their way toward self-sufficiency.

Expedited Reinstatement of Benefits (EXR)

Individuals who have worked their way toward self-sufficiency and have stopped receiving SSDI or SSI benefits may be eligible for EXR if they have to cease working and feel they cannot work at the SGA level due to their disability. This provision is available for up to five years after the individual's social security file is closed (terminated due to earnings).

Extended Period of Eligibility (EPE)

A work incentive timeline for Social Security Disability beneficiaries that begins immediately following the completion of the 9th Trial Work Period (TWP) month and lasts for 36 consecutive months. During the EPE, if a person earns over Substantial Gainful Activity (SGA), a three month grace period begins, allowing a beneficiary to continue receiving SSDI payments. If earnings continue to be above SGA after the grace period, a beneficiary will not receive a benefit check for additional months during the EPE. However, if earnings fall below SGA the beneficiary does not have to reapply for benefits during the 36 month timeline. After the EPE is completed, if an individual is consistently earning SGA, eligibility for benefits will cease.

Federal Benefit Rate (FBR)

The national benefit amount, established by the Social Security Administration to determine the basic monthly payment for SSI recipients. The FBR, as of January 1, 2009, is $674.00 per month for an individual and $1011.00 per month for a couple. The FBR is reviewed annually and revised based on the cost of living.

Federal Poverty Level (FPL)

Every year the department of Health and Human Services issues the Federal Poverty level guidelines in the Federal Register. Federal Poverty Guidelines are used to determine eligibility for state and federal programs, including Indiana’s MED Works.

Federal Insurance Contribution Act (FICA)

FICA is the Federal income tax that is deducted from earnings. The money from FICA is allocated to the Social Security Trust Fund. FICA contributions are measured in credits. One SSDI credit equals one quarter of a year, or three months. Four SSDI credits are accrued in a twelve month period. The Social Security Administration will check the number of credits an individual accrues if an individual qualifies for SSDI. Generally, an individual needs 20 credits in the 10 years prior to the onset of their disability to qualify for SSDI. Individuals who are disabled before age 31 need less work to qualify.

General Income Disregard (GID) (Indiana Medicaid)

The $15.50 of income that is not considered when Medicaid determines eligibility. This is the first disregard in Indiana’s Medicaid Countable Income Formula.

General Income Exclusion (GIE) (Supplemental Security Income)

The $20 of income that is not considered in Social Security’s countable income formula to determine the amount of the SSI check.

Grace Period

If individuals are determined by the Social Security Administration to be earning Substantial Gainful Activity following the completion of their Trial Work Period, they will receive their full benefit check for three months before the cash benefit ceases.

Gross Earnings

The amount of money you would receive for work prior to any taxes or other deductions are withheld.

Impairment-Related Work Expense (IRWE)

An SSI and SSDI work incentive that allows an individual to deduct the amount documented expenses for services or items related to an impairment that are needed in order to work. IRWE expenses must be paid for by the individual in the months in which they work, and must be reasonable expenses.

Income

Cash, in-kind services available to an individual that can help obtain food, clothing, or shelter.

Income Averaging

A method used by the Social Security Administration to average earnings for SSDI beneficiaries to determine if earned gross income is consistently over the Substantial Gainful Activity levels.

Individual Work Plan (IWP)

Under the Ticket to Work Program, and IWP is a formal agreement between the ticket holder and an Employment Network that describes how services will be achieved, what steps will be taken and the time frames to reach an employment goal.

MAXIMUS

A private organization authorized by the Social Security Administration to manage the Ticket to Work Program. MAXIMUS provides training and outreach to Employment Networks, information to Ticket Holders, and processes payments to Employment Networks for outcomes under the Ticket to Work.

Medicaid

In Indiana, a jointly funded federal/state-funded health insurance program, that assists low-income individuals with disabilities, families and the elderly who have limited resources with health insurance. Medicaid programs vary from state to state; each state’s Medicaid programs provide federally mandated services, and optional services.

Medicaid Buy-In

This is an optional Medicaid program that allows individuals with a disability who work to retain Medicaid coverage. Individuals may pay a premium on a sliding fee scale based on their income. In Indiana, this program is called MED Works.

Medicare

Medical insurance for the elderly (age 65 or older) and/or disabled individuals who are Social Security beneficiaries. Individuals with disabilities must complete a five-month waiting period from their disability onset before their Social Security benefits begin. There is an additional 24 month waiting period (Medicare Qualifying Period) after eligibility for cash benefits before individuals are entitled to Medicare benefits. There are two parts to Medicare. Medicare Part A pays for hospital inpatient care and certain follow-up care.

Medicare Part B is an elective coverage, and is paid for by monthly premiums by individuals who enroll. For some individuals who are also eligible for Medicaid, Medicaid will pay for the Medicare premiums (these individuals are known as “dual eligibles”). Medicare Part D IS Medicare’s prescription drug program available to Medicare beneficiaries to help pay for prescription drugs.

MED Works

An Indiana program to provide Medicaid coverage to working individuals with disabilities who otherwise would lose or be ineligible for Medicaid coverage. It has separate eligibility requirements and a recipient premium structure based on a sliding fee scale for those individuals with disabilities who work.

Milestones or Interval Steps

Significant and discernible events in a PASS that depict the individual’s progress toward the attainment of his/her occupational goal.

Occupational Goal or Objective

The individual’s work goal in a PASS (e.g., the job or profession that an individual plans to attain).

Plan for Achieving Self-Support (PASS)

An SSI work incentive which allows an individual to set aside income or resources for a specific work goal or to purchase items, equipment, services or to start up a business, that will lead to increased independence in getting and keeping a job and becoming self- sufficient.

Pre-existing condition

A condition in which medical care (including prescription drugs and doctor’s services) was provided three or more months prior to the effective date of insurance coverage.

Insurance companies may have a pre-existing condition exclusionary period in which coverage for the pre-existing condition can be limited or not provided.

Premium

A regularly scheduled payment for health insurance, such as Medicare, Indiana MED Works, or other health insurance programs.

Presumptive Disability

The Social Security Administration may grant immediate payments of benefits for up to six months to individuals who meet the medical criteria of SSA’s Listing of Impairments and also meet the resource and income criteria for Supplemental Security Income.

Qualified Disabled Working Individual (QWDI)

Individuals who were eligible for Medicare Part A, but have lost Medicare Part A due to earnings may have their Medicare Part A premium paid by Indiana Medicaid. This program is for working individuals whose income does not exceed 200% of the Federal poverty level, who meet Indiana’s resource guidelines, and who are not otherwise eligible for Medicaid benefits.

Qualified Individual (QI)

Individuals who are entitled to Medicare Part A may have also have their Medicare Part B premium paid for by Indiana Medicaid. These individuals must meet Indiana’s income and resource guidelines.

Qualified Medicare Beneficiary (QMB)

Individuals who are entitled to Medicare Part A may have their Medicare premiums, deductibles and co-insurance paid by Indiana Medicaid. Individuals eligible under this category must have income below the 100% of Federal Poverty Level and who meet the Indiana Medicaid resource limits of $4,000 per individual and $6,000 per couple.

Reasonable Accommodation

An adjustment or modification to a job or workplace that enables an employee to perform the essential duties of the job successfully.

Recipient

An individual who receives Supplemental Security Income (SSI benefits).

Resources

Goods and items that an individual owns that have some monetary value, including savings and possessions.

Retroactive Payments

Payments made by Social Security that are retroactive from the date of application to the disability onset.

Social Security’s 1619a Provisions

For SSI recipients, 1619a allows individuals who earn above Substantial Gainful Activity to continue to be eligible for a special or reduced SSI cash payment up to a “break-even point” as long as they meet eligibility, income and resource requirements. 1619a also allows SSI recipients eligible for Medicaid to retain Medicaid coverage while working. Once individuals reach the “break-even point”, SSI cash payments will cease.

Social Security’s 1619b Provisions

For SSI recipients, 1619b allows individuals remain eligible for Medicaid coverage (without a spend-down) after their eligibility for SSI cash payments has stopped, until their income reaches a “threshold” level. In Indiana, the 2009 “Threshold" level is $32,615 per year.

Social Security Disability Insurance (SSDI)

Also known as Title II, this entitlement is earned, requires a medical disability, and gross countable earnings below SGA. The cash payment remains the same, regardless of other income, as long as a person does not perform SGA.

Social Security Disabled Adult/Child (SSDAC)
Also known as Disabled Adult Child Benefits (CDB)

This program is similar to SSDI with the exception that the person receiving these benefits is paid based on his/her parent’s contributions to the system, not his/her own. The parent must be disabled, retired, or deceased. An individual receiving SSDAC benefits must be over the age of 18 and become disabled before age 22.

Special Low Income Medicare Beneficiary (SLMB)

Individuals who are entitled to Medicare Part A may have the Medicare Part B Premium paid for by Indiana Medicaid. To be eligible for SLMB protection, individuals must have income below 120% of the Federal poverty level and resources below $4000 for an individual and $6000 for an eligible couple.

Spend-down

For Medicaid, if a person’s income is above the Medicaid income standards, he/she may be required to pay out-of-pocket for some of the medical services (the spend-down amount) before receiving Medicaid coverage each month. Each month when the individual’s medical expenses equal or exceed the spend-down amount, Medicaid can help pay the remaining medical expenses. This is similar to a deductible for private insurance.

Subsidy

A work incentive that applies primarily to Social Security Disability Insurance beneficiaries during the Extended Period of Eligibility. It is considered the support provided by an employer to an employee that may result in an employee receiving more pay than the actual value of the services or work performed by the employee. The Social Security Administration determines the percentage of support provided to the individual by the employer and applies a dollar amount to this support to determine if the individual has reached Substantial Gainful Activity.

Substantial Gainful Activity (SGA)

The performance of significant physical or mental activities in work for remuneration or profit. It applies to the SSDI program during initial application and on an on-going basis. It applies to the SSI program only in determining whether a person is initially eligible for SSI disability payments, and does not apply to SSI recipients who are blind. Since 2001, the SGA has been automatically adjusted annually based on increases in the national average wage index. In 2009, the SGA amount is $980 per month for individuals who are not blind and $1,640 for individuals who are blind.

Supplemental Security Income (SSI)

Also known as Title XVI, this is an income benefit program for people who are 65 or older, or who are blind, or who have a disability, and who have little or no income meet resource guidelines. The cash payment varies in amount, depending on the amount of income (earned and unearned) a person has.

Temporary Assistance for Needy Families (TANF)

Welfare program that provides income support and access to Medicaid for low income adults with children.

Ticket to Work Program

A Social Security Program for SSDI and SSI beneficiaries who are between ages 18-65. This program helps individuals obtain support for choosing, getting and keeping employment through the assistance of an Employment Network.

Trial Work Period (TWP)

An SSDI work incentive which allows a person receiving SSDI to try to work without jeopardizing his/her SSDI benefits. Each person receives 9 TWP months.

For a TWP month to be counted in 2009, the person’s gross earnings must be at least $700.00 for that month. During TWP months, the person continues to receive an SSDI check, regardless of the amount of his/her earnings. TWP months do not have to be consecutive.

Unearned Income

Disability payments or other funds that an individual receives without any physical or mental work performed. Examples of unearned income may be Social Security Disability Insurance Benefits, income from a trust, investments, support payments or funds received from any other source other than work.

Unsuccessful Work Attempt

An effort to do substantial work, which was stopped or reduced to below SGA level after a short period of time (6 months or less). This change must have resulted because of an individual’s impairment or because special conditions (for example job coaching, or other support) related to an impairment are no longer available to the individual, and the individual is no longer able to perform work at the SGA level.

VR Evaluation

The process whereby a public or private vocational rehabilitation agency performs a diagnostic study or evaluation of an individual in order to determine the appropriate services to offer.

Work Incentives

Provisions and programs that help people receiving Social Security benefits or Medicaid who are working to pay for items and services that they need to work, maintain cash benefits longer until they are stable in employment, and recover the costs of services and items that they need in order to work. Work incentives are designed to assist individuals to achieve gainful employment, increase independence, facilitate empowerment, and acquire self-support.