The Difference Between SSI & SSDI | How to Apply for SSI & SSDI

Most people with a mental health diagnosis want to work. It is important for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries to understand that they can still receive benefits while they try to work. Families of a SSI or SSDI beneficiary should encourage them to contact the Social Security Administration (SSA) and ask about the different work incentives and how they can affect their benefits. Some work incentives provide support over a period of years to allow a disabled person to test their ability to work and gradually become self-supporting and independent.

Understanding the definition of Substantial Gainful Activity (SGA) is important in using the work incentive programs. SGA is the performance of significant and productive physical or mental work for pay or profit. The SGA level is average countable earnings over $700 per month. SGA applies to SSDI in determining initial and continuing disability entitlement. It applies to SSI only in determining initial eligibility for SSI disability payments.

Work incentive programs for SSDI include:

. Impairment-Related Work Expenses
. Continued Payment under a Vocational Rehabilitation Program
. Trial Work Period
. Extended Period of Eligibility
. Continuation of Medicare Coverage

Work incentive programs for SSI include:

. Impairment-Related Work Expenses
. Continued Payment under a Vocational Rehab. Program
. Earned Income Exclusion . Plan for Achieving Self-Support (PASS)
. Section 1619 Work Incentives

SSI & SSDI - Impairment-Related Expenses

An impairment-related expense is the cost of certain items and services that a person needs to work that are deducted from gross earnings in figuring SGA, even if these items and services are also needed for non-employment activities. Impairment related expenses could include attendant care services, transportation costs, medical devices, residential modifications, routine drugs and medical services. The deductions can be made only if the cost of the item or service is paid by the person with the disability and the person has not been, and will not be, reimbursed for the expense. The amount a person pays towards the cost of the items and services is deducted from the gross earnings. Only after these expenses are deducted is a determination made as to whether the earnings represent SGA. The cost of the impairment related work expense may reduce earnings below the SGA level ($700 average per month). The impairment related expense is also excluded from earned income when figuring an SSI beneficiary's monthly payment amount.

SSI & SSDI - Continued Payment Under a Vocational Rehabilitation Program

This applies to persons who are receiving SSDI or SSI benefits who improve medically and therefore are no longer considered disabled by the SSA. SSDI and SSI benefits will continue if, at the time disability medically ceases the person is actively participating in a public or private vocational rehabilitation program and completion or continuation of the program is likely to enable the person to work permanently. Cash payments and health insurance will continue until the rehabilitation services are completed or until the person ceases to participate in the program. The SSA determines the eligibility for continued payments based on the criterion that the person's participation in the vocational rehabilitation program will increase the likelihood of permanent self-sufficiency and independence from the disability rolls.

SSDI - Trial Work Period

People receiving SSDI are provided with a trial work period as an incentive to return to work. The trial work period lets people test their ability to work for at least nine months without affecting their SSDI disability benefit. They continue to receive full benefits during the trial work period no matter how much they earn.

Any month in which earnings exceed $200 (or over $200 in net earnings, or more than 40 hours of work in a month for the self-employed) is counted as a month of the trial work period. When the SSDI beneficiary has accumulated nine such months (not necessarily consecutive) in a 60-month period, the trial work period is complete.

After the trial work period, the SSA reviews the beneficiary's case to redetermine their ability to participate in SGA. If a person has SGA earnings and will be able to continue their employment despite their disability, they will most likely lose their SSDI eligibility. If the work is not SGA, SSDI benefits will continue. Only one trial work period is given to a beneficiary for the entire length of time they receive benefits.

SSDI - Extended Period of Eligibility

The extended period of eligibility is a consecutive 36-month period during which cash benefits will be reinstated for any month the person does not work at the SGA level. Benefit checks can be started again without a new application, disability determination or waiting period. This reinstatement of cash benefits saves critical time for the beneficiary and replaces the loss of earnings.

The extended period of eligibility begins the month following the end of the trial work period. Cash benefits can be reinstated within the 36-month period. However, benefits may be paid for an even longer period of time if a person is unable to perform SGA.

SSDI - Continuation of Medicare Coverage

SSDI beneficiaries can receive at least 39 months of hospital and medical insurance after the trial work period. This provision allows health insurance to continue when a person goes to work and is engaging in SGA. The continuation of Medicare begins immediately after the completion of the trial work period.

SSI - Earned Income Exclusion

This provision allows most of a person's earned income, including pay received in a sheltered workshop, to be excluded when figuring the SSI payment amount. The SSA excludes the first $65 of earnings in a month plus one-half of the remainder. This means that less than one-half of a person's earnings are counted when figuring the SSI payment amount.

SSI - Plan for Achieving Self-Support

A Plan for Achieving Self-Support (known as a PASS) allows a person with a disability to set aside income and/or resources (assets) for a specified period of time for a work goal. For example, a person could set aside money for an education, vocational training or starting a business. The plan can help a person establish or maintain SSI eligibility and can also increase the person's SSI payment amount. A PASS does not affect an SGA determination for initial eligibility decisions.

A PASS must be designed in writing especially for the person applying. It must include a specific work goal, which the person is capable of performing, and have a specific timeframe for reaching that goal. It must show what money and other resources will be used to reach the goal and how the money will be used. Any money set aside will need to be kept identifiable from other funds. The PASS must be approved by the SSA and be reviewed periodically to assure compliance.

SSI - Special SSI Payments for People Who Work, Section 1619

This incentive allows SSI beneficiaries to receive SSI cash payments even when they are earning more than the SGA level of $700 average earnings per month. To qualify for this incentive, the person must be eligible for an SSI payment for at least one month prior to the date they begin work at the SGA level, still be disabled and meet all other eligibility rules. The person's SSI payment amount will be calculated in the same way as for someone who is not working at the SGA level. During this period of time the person will remain eligible for Medicaid.

SSI - Continued Medicaid Eligibility, Section 1619(b)

This incentive continues Medicaid coverage for SSI beneficiaries when their earnings become too high to allow an SSI cash payment. To qualify for this incentive a person must have been eligible for SSI cash payments for at least one month and still meet the disability requirements. They must prove they need Medicaid to work and have gross earned income that is insufficient to replace SSI and Medicaid.

The SSA uses a threshold to measure whether a person's earnings are high enough to replace the SSI and Medicaid benefits. The threshold amount is based on the amount of earnings, which would cause SSI cash payments to stop in the person's state and the annual per capita Medicaid expenditure for that state. In New York State the threshold amount is over $28,000 per year.

If the person's gross earnings are higher than the state's threshold amount, the SSA can figure an individual threshold if the person has impairment-related work expenses, a PASS or medical expenses above the state per capita amount.

SSI - Special Benefits for Section 1619 Recipients Who Enter a Medicaid Facility

This provision allows an individual who is eligible under section 1619 to receive an SSI cash benefit for up to two months while in a Medicaid facility or a public medical or psychiatric facility.

Usually when an SSI recipient enters a Medicaid facility (i.e. a facility where Medicaid pays more than 50% of the cost of care), the SSI payment is limited to $30 per month minus any countable income. However, if the person is eligible under section 1619, the benefit continues at the full rate for up to two months.

Usually when an SSI recipient enters a public medical or psychiatric facility (state-run psychiatric hospital), they are not eligible to receive an SSI payment while in the facility. However, if the individual is eligible under section 1619, the SSI cash benefit will continue for up to two months. For this provision to apply, the facility must enter into an agreement with the SSA allowing the person to keep all of the SSI payment.

SSI - Reinstating Eligibility Without a New Application

This provision enables people to regain eligibility for SSI cash payments or continued Medicaid coverage after a period of ineligibility without filing a new application.A person who is eligible for continued Medicaid coverage under section 1619(b) can begin receiving SSI cash benefits at any time earnings drop below the break-even point. (The break-even point is defined as the dollar amount at which total income precludes SSI payment. As countable income increases, SSI payments decrease until the person is no longer eligible for any SSI payment. A person's break-even point varies with earned/unearned income mix and applicable income exclusions.)

A person who is ineligible for continued Medicaid coverage because earnings exceed the threshold can regain eligibility for SSI cash payments if income drops below the break-even point within twelve months.

A person who is ineligible for continued Medicaid coverage because earnings exceed the threshold can regain eligibility for Medicaid coverage if earnings drop below the threshold within twelve months.

Summary

Anyone considering working who receives SSDI or SSI should contact the SSA prior to beginning employment. During employment, the beneficiary should report all earnings on a monthly basis. Frequent reporting of earnings will lessen the likelihood of a benefits overpayment occurring. Anyone considering returning to work should obtain the "Red Book on Work Incentives" at their local Social Security Office. The SSA can be contacted at 1(800) 772-1213. Please feel free to call NAMI-NYS as well.

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