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New York Makes Work Pay
OPWDD Benefits Planning and Work
Incentives Webinar Series:
SSDI Work Incentives
Edwin J Lopez-Soto
Ray Cebula
New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure Grant (Contract No. #1QACMS030318) from the U.S. Department of
Health and Human Services, Center for Medicaid and Medicare Services to the Office of Mental Health on behalf of New York State. It is a joint effort of the Burton
Blatt Institute at Syracuse University and the Employment and Disability Institute at Cornell University with the collaborative support of the Employment Committee
of the New York State Most Integrated Setting Coordinating Council to remove barriers to employment and develop pathways to work for New Yorkers with
disabilities.
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The Nitty Gritty of Work Incentives –
Phase I
Trial Work Period [TWP]-Once on SSDI
 a 9-month period, within 60 months, in which a person on SSDI can
work and earn any amount of money without the earnings affecting
their SSDI eligibility
 Each month an SSDI recipient earns more than $720 counts as one
month of the TWP
 These months need not take place one after another
 If you work more than one job, SSA looks at your total gross earnings
to decide if the month counts toward your TWP
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The Nitty Gritty of Work Incentives –
Phase II
Extended Period of Eligibility [EPE]
 A period of eligibility that starts with the month after the TWP
ends and continues for the next 36 months.
 For any month during this period that the person’s countable
earned income is less than the SGA level they continue to receive
their SSDI check.
 When their countable earned income is more than the SGA level,
Social Security will plan to stop the benefits - but will allow the
person to receive a check for that month and for 2 more months
as a “grace period” before stopping checks altogether.
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The Nitty Gritty of Work Incentives –
Phase II (cont’d)
Extended Period of Eligibility [EPE]
 After the grace period ends, the person’s SSDI stops in any month their
earnings go above the SGA level.
 If the person’s countable earnings again fall below the SGA limit in any of
the EPE months, the individual will be entitled to SSDI benefits in those
months.
 Because SSDI checks are paid one month behind (checks received in May
are for June), if the reporting is timely, the lag should be no greater than
one month.
Polling Question #1
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Substantial Gainful Activity [SGA]
 SSA looks at countable gross earned income over a set
amount each month.
 Currently, in 2011, the set amount is $1000/month for all
SSDI recipients who are not legally blind. ($1010 in 2012)
 Currently, in 2011, the set amount is $1,640/month for
those that are statutorily blind. ($1690 in 2012)
Polling Question #2
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The SSDI SGA Rule Looks at Monthly
Wages “When Earned”
Roger is paid on Sept. 4th for the two-week period ending
Aug. 29th. Gross earnings for period = $500.
 For SGA purposes, the $500 is counted in August because
it was earned in August.
 When analyzing earnings under the SGA rule, advocates
will review day to day earnings and only count wages
earned within the month being reviewed.
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The Following Are Available To Reduce
Gross Monthly Wages From Above SGA
to Below SGA
 Paid time off: vacation, personal, holiday and sick
pay is not counted
 Impairment Related Work Expenses
 Subsidies
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Deductions for Paid Time Off
 Paid time off includes vacation, personal, holiday and
sick pay.
 Amounts received as paid time off are deducted from
gross pay to determine “countable wages.”
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Case Scenario – Paid Time Off
Darlene earns $1,040 gross per month.
 In December she receives $40 in holiday pay for Christmas
Day.
 She also receives $20 in holiday pay for Christmas Eve and
$20 for New Year’s Eve (a half day paid each day).
 Her countable wages for December are reduced by $80 to
$960 – below the $1000 SGA level for 2011.
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Impairment Related Work Expenses
[IRWEs]
There is a 3 part test to determine if an IRWE exists:
 The individual with a disability pays for the item or
service
 The item or service is related to an impairment of the
person on benefits
 The person would not be able to work if he or she did
not spend the money and receive the item or service
Remember - SSA must approve all IRWEs
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Sample IRWE Expenses
 Supported employment services
 Attendant care services
 Transportation costs
 SSA-approved mileage allowances
 Medical devices
 Prosthesis
 Work-related equipment & assistance
 Residential modifications
 Routine drugs/medical services
 Diagnostic Procedures
 Non-medical appliances and devices
 Similar items and services
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Case Scenario - IRWE
Harry works and earns $1,100 in gross monthly earnings.
 Harry has cerebral palsy, uses a cane and cannot walk to
the bus stop.
 Harry pays $150 per month for door-to-door
transportation from home to work.
 Does this meet the three-part test to qualify as an IRWE?
Polling Question #3
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Case Scenario Answer - IRWE
Harry has met the three-part test for an IRWE.
 First, Harry pays for the transportation out of his own
money.
 Second, Harry needs the transportation due to an
impairment (cerebral palsy).
 Third, Harry needs the transportation in order to work.
Without it, he could not work.
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IRWE Calculation
STEP ONE
$1100
- 150
$ 950
Gross Monthly Earnings
Minus IRWE
Equals Adjusted Gross
Earnings (Non-SGA)
$1100
+ 650
$1750
- 150
$1600
Gross Earnings
Plus SSDI
Equals Monthly Income
Minus IRWE
Equals Total Usable Income
STEP TW0
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Subsidies
A Subsidy Exists When the Employer:
 Pays the employee more in wages than the value of
services performed; or
 Receives full value only because some agency provides
extra services to the employee.
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When is it a Subsidy?




Sheltered employment
Childhood disability involved
Mental impairment involved
The amount of pay is higher than the value of the employee’s
work
 Claimants or someone else alleges that claimants do not earn
their pay
 The employee gets extra help from others in doing the work due
to his or her disability
 Government-sponsored job training or employment programs
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Employer Subsidy
 In developing subsidies employers are requested by the
SSA to submit statements documenting the actual value of
workers’ services.
 If the employer does so, the value assigned to the subsidy
is accepted by SSA without question typically.
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Employer Subsidy: Example
 Ed’s employer, Empower, drafts a letter detailing the actual
value of Ed’s services (“Employees doing Ed’s job without
the extra supervision get paid the same as he does-$10
hour but his real value is $7.50 an hour”) and the extra
supports that it provides to Ed (“All employees get about 3
hours of supervision a week but Ed gets 12 hours of
supervision”).
 Once Empower details the value of Ed’s services, it is
accepted by SSA without question typically.
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Subsidies – Special Conditions
 Human services agencies may provide support and
services to people with disabilities - potentially subsidizing
a particular individual’s ability to work at an SGA level.
 By regulation, a subsidy should be computed using the
employee’s hourly wage.
 There are other arguments that are more beneficial to
recipients – (i.e., computing the subsidy based on job
coach’s hourly wage). Those arguments can only succeed
at appeals to the hearing level.
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Subsidy for the Self-Employed
 Unpaid help (i.e., a relative helps you in your business but
isn’t paid)
 A business expense NOT paid for by the individual
(i.e., vocational rehabilitation agency purchases a
computer for your business)
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Calculating Effects of a Subsidy
FIRST POSSIBILITY
STEP ONE
10
x $ 10
$ 100
Hours of job coach intervention (on-site) per month
or number of hours of additional supervision given
Multiply by hourly wage of worker
Equals monthly subsidy
STEP TWO
$1060.00 Monthly Gross Earnings
- 100.00 Monthly Subsidy
$ 960.00 Equals Gross Wages Counted
Against SGA Rule
Countable wages are less than $1000 SGA level.
Polling Question #4
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The Nitty Gritty of Work Incentives –
Phase III
Expedited Reinstatement [EXR]
 SSDI benefits shall be reinstated without a new
application if the person:
 was eligible for SSDI; and
 lost SSDI due to working at or above substantial gainful activity
(SGA)
 files a request for reinstatement within 60 months of the last
month that the individual received SSDI income
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The Nitty Gritty of Work Incentives –
Phase III (cont’d)
Expedited Reinstatement [EXR]
 If the individual is disabled by a condition that is the same as (or
related to) the physical or mental disability that was the basis for their
original claim; and
 The individual is no longer able to work at SGA due to the original (or
related) disability.
 If the individual stops performing SGA and meets other EXR criteria,
you do not need to show that the termination of work or reduction in
hours is related to the individual’s disability.
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The Nitty Gritty of Work Incentives –
Phase III (cont’d)
Expedited Reinstatement [EXR]
 SSDI dependent’s benefits may be reinstated if the dependent meets
all of the requirements for entitlement to the benefits
 Provisional benefits may be received up to 6 months while the
reinstatement application is reviewed by SSA (only for the wage
earner)
 Once the individual receives 24 EXR checks, not necessarily
continuous, he or she will be eligible for a new trial work period,
extended period of eligibility and expedited reinstatement period
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Extended Medicare Eligibility
 An SSDI recipient is entitled to continued Medicare coverage
during a nine-month trial work period and for at least 93 months
following the ninth trial work month.
 During this entire period, hospital coverage is automatic and costfree. Outpatient coverage continues to be optional and subject to
premium payment. That premium will be $99.90 in 2012
 This means that the SSDI recipient who goes to work can keep
Medicare for at least 102 months (or nearly 9 years)!
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Conclusion
 For more information, contact the NY Makes
Work Pay hotline:
1-888-224-3272 VOICE
1-877-671-6844 TDD
 Remember work pays in more ways than one
can imagine
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New York Makes Work Pay
Partnering Organizations
New York Makes Work Pay is a Comprehensive Employment System Medicaid Infrastructure
Grant (Contract No. #1QACMS030318) from the U.S. Department of Health and Human Services,
Center for Medicare and Medicaid Services to the Office of Mental Health on behalf of New York
State. It is a joint effort of the Burton Blatt Institute at Syracuse University and the Employment
and Disability Institute at Cornell University with the collaborative support of the Employment
Committee of the New York State Most Integrated Setting Coordinating Council to develop
pathways and remove obstacles to employment for New Yorkers with disabilities.
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