Benefits Planning, Assistance and Outreach (BPA&O) and Protection for Beneficiaries of Social Security (PABSS)
TABLE OF CONTENTS
INTRODUCTION
A Framework for Benefits Planning, Assistance and Outreach
Benefits Planning, Assistance and Outreach as an Emerging Field
Definition
Major Practice Domains
Benefits Planning, Assistance and Outreach Construct
Benefits Planning
Benefits Assistance
Outreach
Counseling
Implications for Staff Preparation and Service Delivery
BPA&O Job Functions and Domains
BPA&O Driving Values
The P&A System: A Brief Summary
Description of the Individual P&A Programs
PABSS Priorities
PABSS Staffing
P&A Standards
SECTION ONE: OVERVIEW OF SSA DISABILITY PROGRAMS
CHAPTER 1: OVERVIEW OF SSA AND DISABILITY DETERMINATION
Frequently Used Acronyms and Definitions
Organizational Structure and History of SSA
Work Incentives
Adult Definition of Disability
Sequential Evaluation Process
Childhood Definition of Disability for SSI
Disability Determination Service (DDS)
Continued Disability Review (CDR)
Continuing Disability Review (CDR) for Children
Redetermination of Eligibility at Age 18
Continued Payment of Benefits for Children and Those Turning Age 18 Who
Medically Recovered and are Participating in an Approved VR Program
Continued Payment of Benefits to Those Who Medically Recovered and are
Participating in an Approved VR Program
Supporting Forms and Documentation
CHAPTER 2: OVERVIEW OF TITLE II DISABILILTY PROGRAMS
Additional Social Security Eligibility Requirements
Credits
Social Security for Disabled Adult Children (SSDAC)
Disabled Widow(er) Benefits
Supporting Forms and Documentation
CHAPTER 3: OVERVIEW OF SSI
Additional SSI Requirements
Income Test
Federal Benefit Rate (and state supplements)
SSI Income Exclusions
Earned and Unearned Income
Deemed Income
Deeming Chart 2005 (Federal)
Living Arrangements
In-Kind Support
Resource Test
SSI Resources (counted/not counted)
Property Essential to Self-Support (PESS)
SSI Redetermination Review
Benefits for the Homeless
Eligibility Case Study
CHAPTER 4: APPLICATION PROCESS
SSA Contact Information
Application Process and Information Needed
Types of Information Needed
Other Eligibility Information
Emergency Advance Payments and Immediate Payments
Presumptive Eligibility
Representative Payee
SSI/Social Security Comparison Chart
CHAPTER 5: APPEALS PROCESS
Level I: Reconsiderations
Level II: Administrative Law Judge Hearing
Level III: Appeals Council Review
Level IV: Federal Court Review
BPA&O and PABSS Role During Appeals
Waivers
Supporting Forms and Documentation
SECTION TWO: IMPACT OF EMPLOYMENT ON SOCIAL SECURITY TITLE II BENEFITS
CHAPTER 6: SOCIAL SECURITY TITLE II BENEFITS
Introduction
Trial Work Period (TWP)
Substantial Gainful Activity (SGA) Determination
Income Averaging
SGA Determination Process
Unsuccessful Work Attempt
TWWIIA CDR Protections
Extended Period of Eligibility (EPE)
Expedited Reinstatement of Benefits
Medicare Coverage
Two Part Medicare
Medicare Premiums
Extended Medicare Coverage Pre-TWWIIA
Extended Medicare Coverage Under TWWIIA
The Medicare Wizard
TWWIIA Extended Medicare Coverage Decision Tree
Examples/Exercises
Medicare Buy-Back Option
Exercise Questions
Flowchart of Social Security/TWP
Flowchart of Extended Period of Eligibility
CHAPTER 7: SUBSIDIES AND SPECIAL CONDITIONS
Introduction
Employer Subsidies
Special Conditions
Unincurred Business Expense
Indicators of Possible Subsidy
Example: Subsidy Impact on Social Security
Worksheet: Calculating Effect of Specific Subsidy
Determining Subsidy
SSA Work Activity Questionnaire
CHAPTER 8: IMPAIRMENT-RELATED WORK EXPENSE AND SSDI
Effects of IRWE on Benefits
Allowable IRWE Deductions
Sample Deductible and Non-Deductible IRWE Expenses
Supported Employment
Attendant Care Services
Transportation Costs
SSA Approved Mileage Allowances
Medical Devices
Prosthesis
Work-Related Equipment and Assistants
Residential Modifications
Routine Drugs and Medical Services
Diagnostic Procedures
Nonmedical Appliances and Devices
Similar Items and Services
IRWE Computation
Participant Exercise
Example: IRWE Calculations - Impact on Social Security Benefits
IRWE Summary
SECTION THREE: IMPACT OF EMPLOYMENT ON SUPPLEMENTAL SECURITY INCOME
CHAPTER 9: SUPPLEMENTAL SECURITY INCOME
Impact of Income on SSI
Participant Exercises:
Example: Unearned Income and General Income Exclusion
Worksheet: Calculating Unearned Income and General Income Exclusion
Example: Earned Income and Exclusions
Worksheet: Calculating Earned Income Only
Example: Earned and Unearned Income
Worksheet: Calculating Earned and Unearned Income
Example: Eligible Couple
Example: In-Kind Support and Maintenance (VTR)
Worksheet: Calculating In-Kind Support and Maintenance
Example: In-Kind Support and Maintenance (PMV)
Student Earned Income Exclusion (SEIE)
SEIE Reporting
Example: Computing SEIE
Worksheet: Computing SEIE
SSI Eligibility for Students Temporarily Abroad
Overview of 1619 Special Provision Statuses
1619(a)
Break-Even Point (BEP)
Participant Exercise:
Example: Break-Even Point Without State Supplement
1619(b)
Medicaid Covered Services
Medicaid "Needs" Test
Medicaid Administration
Medicaid Buy-in
Importance of the 1619(b) Provision
Continuing Disability Review (CDR)
CDR Protection Under TWWIIA
Expedited Reinstatement of Benefits (EXR)
Flowchart of SSI Benefits
CHAPTER 10: IMPAIRMENT-RELATED WORK EXPENSE AND SSI
Effects of IRWE on SSI Benefits
Allowable IRWE Deductions
Sample Deductible and Non-Deductible IRWE Expenses
Employment Services
Attendant Care Services
Transportation Costs
SSA Approved Mileage Allowances
Medical Devices
Prosthesis
Work-Related Equipment and Assistants
Residential Modifications
Routine Drugs and Medical Services
Diagnostic Procedures
Nonmedical Appliances and Devices
Similar Items and Services
Participant Exercises
Example: IRWE Calculations - Impact on SSI
Worksheet: IRWE Calculations - Impact on SSI
Example: IRWE Calculations - Impact on SSI and Social Security
Benefits
Worksheet: IRWE Calculations - Impact on SSI and Social Security
Benefits
IRWE Summary
CHAPTER 11: BLIND WORK EXPENSE AND SSI
Definition
Allowable Expenses
Exercises and Examples
Example: Calculating Effect of BWE
Worksheet: Calculating Effect of BWE
CHAPTER 12: PLAN FOR ACHIEVING SELF-SUPPORT (PASS)
Purpose for a PASS
Effect of PASS on Benefits
PASS Summary
Earned and Unearned Income
Resources
PASS Approval Requirements
Examples of Possible PASS Expenditures
Non-Approvable Expenditures
Supported Employment as an Excludable Expense
PASS Candidates
Developing a PASS
Starting a Business Under a PASS
Components of a Business Plan
Calculating PASS
Participant Exercise:
Examples: Effect of PASS on Unearned and Earned Income
Worksheet: Effect of PASS on Unearned and Earned Income
Two Factors Effecting PASS and SSI Check Amount
Participant Exercises:
Example: Expense Exceeds FBR
Worksheet: PASS Comparison
Example: Expense Exceeds Total Countable Income
Worksheet: PASS Exceeds FBR
Effect of the One-Third Reduction Rule (Full In-Kind Support)
Participant Exercise:
Example: Calculating PASS with In-Kind Support (VTR)
The Presumed Maximum Value Rule (Partial In-Kind Support)
Participant Exercise:
Example: Calculating PASS with In-Kind Support (PMV)
Deciding Between PASS or IRWE
Participant Exercise:
Example: Calculating PASS and IRWE
Participant Exercise:
Example: Calculating
PASS and Social Security
Participant Exercise:
Example: Example Without PASS Applied
Example: SSI Example with PASS Applied
Final Comments on PASS
PASS Case Study
PASS Format
PASS Review Process
Exhibit 1 -
Exhibit 2 - PASS Progress Review
SSI/Social Security Comparison Chart
Concurrent Exercise
SECTION FOUR: IMPACT OF EARNINGS ON OTHER SUPPORT PROGRAMS
CHAPTER 13: TEMPORARY ASSISTANCE FOR NEED FAMILIES AND FOOD STAMPS
Temporary Assistance for Needy Families (TANF)
Characteristics of Each State Program Funded Under TANF
TANF and SSI
TANF and SSDI
State TANF
TANF Financial Eligibility
Food Stamp Program
State Food Stamp Information/Hotline Numbers
CHAPTER 14: FEDERAL HOUSING SUBSIDIES
Introduction
Eligibility for Federally Subsidized Housing
Calculating Rent Payments in Federally-Subsidized Housing
Definition of Family in Federally-Subsidized Housing
Section 504 Requirements
Federal Preference Rules
Public Housing Programs
The Family Self-Sufficiency Program
Section 8 Housing Choice Voucher Program
Section 8 Project-Based Assistance
Section 811 Supportive Housing for the Elderly and Persons with
Disabilities
Housing Opportunities for People with AIDS (HOPWA)
Pilot Program for Homeownership Assistance for Disabled Families
Other Project-Based Subsidy Programs
Helping People with Disabilities Determine the Impact of
Employment on Housing Costs
Income Exclusions and Disallowances
Setting Aside Rent Increase for Family Use
Federally-Subsidized Housing Resources
CHAPTER 15: UNEMPLOYMENT INSURANCE PROGRAM
Introduction
Covered Employment
Eligibility for Unemployment Insurance Benefits
Unemployment Benefit Amount
Duration of Unemployment Insurance Benefits
Application Process
Right to Appeal
Affect of Unemployment Benefits on SSI and SSDI
North American Free Trade Agreement (NAFTA) and
Trade Adjustment Assistance (TAA)
CHAPTER 16: WORKERS' COMPENSATION
General Provisions
Coverage
Workers' Compensation for Federal Government Employees
Effect of Workers' Compensation Benefits on SSDI and SSI
CHAPTER 17: EARNED-INCOME TAX CREDIT
Introduction
Eligibility
Rules for Everyone
Rules to Determine if there Are Qualifying Children
Rules if There Are No Qualifying Children
Rules for Computing and Claiming the EITC
Calculating EITC
Advance Payment of EITC
Impact of EITC on Certain Welfare Benefits
EITC Eligibility Checklist
CHAPTER 18: MEDICAID AND STATE CHILD HEALTH INSURANCE PROGRAMS
Introduction
Services Covered by Medicaid
Eligibility for Medicaid
Using SSI as the Conduit to Automatic Medicaid Eligibility
Four Provisions Allow Former SSI Recipients to Retain Medicaid
Obtaining Medicaid Through the Medically Needy or Spend Down Program
Home and Community-Based Waivers
The Medicaid Buy-in Program
Appealing Medicaid Decisions
Medicaid Resources on the Internet
Introduction to State Child Health Insurance Program
Program Overview: The Basics of SCHIP
SCHIP Eligibility Criteria
Available SCHIP Services
Cost Sharing
Conclusion
SECTION FIVE: BENEFITS PLANNING
CHAPTER 19: EFFECTIVE COMMUNICATION STRATEGIES
Introduction
Active Listening Skills
"Values-Free" Communication
Expressive Communication
Body Language
Voice Tone/Inflection
Words
Interviewing Skills
Negotiation Skills
Six Rules of Successful Negotiation
Mediation
Final Thoughts
CHAPTER 20: INFORMATION GATHERING, ANALYSIS, ADVISING, AND REPORTING
BPA&O Decision Tree
Data Collection and Profiling
Gathering Personal Demographic Information
Gaining Understanding of Personal Directions and Future Outlook
Completing a Summary of Personal Demographics and Future Outlook/Exercise
Describing and Reporting Disability
Collecting Information On and From Other Service Providers the
Person May be Involved With
Summarizing Monthly Income
Reporting Monthly Income
Preparing a Monthly Budget/Exercise
Identifying and Summarizing Resources
Identifying Property Essential to Self Support
Developing and Reporting Employment History
Conducting a Trial Work Period Analysis
Conducting an Extended Period of Eligibility Analysis
Applying Expedited Reinstatement of Benefits
Formulating Health Insurance Needs
Reviewing, Projecting and Documenting Health Insurance Needs
Identifying and Reporting Impairment-Related Work Expenses
Identifying and Recommending Use of Blind Work Expenses
Analyzing, Projecting, and Documenting Subsidy
Exploring Plan for Achieving Self Support: History and Potential Use
Ticket to Work
Keeping Comprehensive Notes
Verifying the Profile
Data Collection Exercise
Profile Scripts
Developing a Comprehensive Report
Documenting Scenario Analysis and Providing Computation of
Useable Income/Example
Scenario Computation/Exercise
Making Closing Comments and Final Scenario Recommendations
Verifying Soundness of Advise to be Given Using the Profile for Counsel
Short-Term Advisement and Counsel
SECTION SIX: BENEFITS ASSISTANCE
CHAPTER 21: SUPPORT PLANNING
Introduction
Support Plans
Comprehensive Benefits Support Plan
Completed Comprehensive Benefits Support Plan
Additional Thoughts on Support Planning
Introduction to Other Support Systems
History of SSA and Vocational Rehabilitation
Ticket to Work and Self-Sufficient Program
Ticket Eligibility
The Ticket
Continued Disability Review (CDR) Protection and Use of a Ticket
Ticket Termination
Program Manager
Employer Network(s) (ENs)
State Vocational Rehabilitation Agencies
The Individualized Support Plan
Employment Network Payment Systems
Election of an EN Payment System
Payment Under the Two EN Payment Systems
Payment to State VR Agencies
Limitations on Payments to ENs
Dispute Resolution
Disputes Between Beneficiaries and State VR Agencies
Disputes Between Beneficiaries and ENs
Representation of Beneficiaries in Ticket Disputes
Dispute Between ENs and Program Managers
Questions and Answers on the Ticket to Work
Integrated Benefits Planning and Assistance Supports
Into Existing Service Delivery Constructs
The IEP and Transition Planning
Statement of Needed Transition Instruction
Developing the IEP
Coordinated Set of Activities
Continued Payment of Benefits
The IPE and State VR
The ISP and Other State Programs
Support Plan Case Study
CHAPTER 22: LONG-TERM BENEFITS ASSISTANCE
Introduction
Benefits Assistance Characteristics
Proactive Benefits Monitoring and Assistance Strategies
Benefits Assistance Meetings
Critical Transition or Touchpoints
SSI Touchpoints
SSDI Touchpoints
Touchpoints Applying to Both the SSI and SSDI Programs
Notice of Action from SSA
Information and Referral
Problem Solving and Crisis Management
Problem Solving Strategies
Do's and Dont's of Crisis Management
Crisis Intervention Plan
Crisis Management Case Studies
Case-Load Management Strategies
Establishing and Maintaining a Case Record
Importance of Consistent and Accurate Reporting to SSA
SECTION SEVEN: OUTREACH
CHAPTER 23: OUTREACH AND
Introduction
What is a Network
Important Stakeholders
Beneficiaries and Recipients
Family Members
Advocates
Service Providers
Planners/Case Managers
Support Personnel
SSA
Stakeholder Analysis/Exercise
Strategies for
Important Steps in Developing a Network
Creating Mutual Gains
Establishing Trust
Building Collaboration
Maintaining an Effective Network
SECTION EIGHT: ETHICS
CHAPTER 24: ETHICAL CONSIDERATIONS
Applying the Information in This Handbook
Ethical Considerations
Examples of Ethical Dilemmas Faced by Benefits Specialists
Code of Professional Conduct
Next Steps
SECTION NINE: STATE SPECIFICS
This section has been provided to insert state-specific information you may collect.
SECTION TEN: SUPPLEMENTAL MATERIALS
This section has been provided to incorporate materials distributed at the training or other support materials relevant to this program.
APPENDICES
A. Sample Job Descriptions
B. Work Incentive Resources, Publications, and References
C. State SSI Supplements
D. 1619(b) Thresholds by State
E. Accessing SSA Information and Other Resources Online
F. Data Collection: A Model Questionnaire (Blank and Completed)
G. Data Collection: A Series of Sample Reporting Formats/Templates
H. Stakeholder Analysis
I. Contact Log
J. BPA&O Self-Assessment Checklist
K. Standard Release of Information Forms
L. Field Assignment/Practicum
M. Training Evaluation Form