WISE Ticket to Work Webinar Ticket to Work: Healthcare and the Path to Employment April 28, 2021 Speakers: Sarah Hyland (Moderator), Ray Cebula (Presenter) SARAH>> Good afternoon, and welcome to today’s Ticket to Work webinar: Ticket to Work: Healthcare and the Path to Employment. My name is Sarah Hyland, and I am a member of the Ticket to Work team. I will be your moderator for today’s webinar. We are so glad you were able to take time to spend with us today to learn about Social Security’s Ticket to Work Program and how it can help you as you start the path to financial independence through work. Each of us has our own path to follow, and we hope you find some information today that will assist you in moving forward on your path to employment and financial independence. Let’s get started by going over some of the functions of the webinar platform so that you can interact and get the most information out of today. 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These updates will not affect today’s webinar, but if you experience any technical difficulties, please use the Q&A pod to send us a message, or you can send us an email at the Ticket to Work email address, which is webinars@choosework.ssa.gov. On the Adobe Connect platform, you will notice that on your screen there are four different boxes. These boxes are called pods. We have the Presentation pod where the slides appear. Below that is the Closed Captioning pod. In the top right-hand corner, you will see the Q&A pod. And below the Q&A pod is the Web Links pod. We will talk about these pods in more detail in just a few moments. If you need assistance navigating Adobe Connect, an Accessibility User Guide with a list of controls is available at http://bit.ly/adobe-accessibility. This link is also available in the Web Links pod at the bottom right-hand corner of your screen and is titled Adobe Accessibility User Guide. Real-time captioning is available and is displayed in the Captioning pod which is the box that appears below the slide that is on your screen right now. The Captioning link can be found in the Web Links pod under the title Closed Captioning. If you are fluent in ASL and would like support for today’s webinar, follow the link below that provides instructions to connect with an interpreter through the Federal Communications Commission, FCC, Video Relay Service, VRS. The ASL User Guide can also be found in the Web Links pod under the title ASL User Guide We are here today to answer any questions that you may have about the Ticket to Work Program. Please send in your questions to us at any time throughout the webinar by typing them into the Q&A pod. We will direct the questions to our speaker during the Q&A portions of our webinar. We will be addressing questions at two different points throughout today’s presentation. So, go ahead and send in those questions, and we will do our best to answer as many of them as possible. If you are listening by phone and are not logged in to the webinar, you may ask questions by sending an email to Ticket to Work. The email address is webinars@choosework.ssa.gov. Another resource that we think you will find extremely helpful in connecting to different resources that are mentioned today is the Web Links pod. You will find that at the bottom right-hand side of your screen. This pod lists all of the links to the resources presented during today’s webinar. To access any of the resources, please highlight the topic that you are interested in and would like to connect to, and then select the Browse To button at the bottom of the pod. You will then be taken to the website requested. If you are listening by phone and not logged in to the webinar, or you don’t have access to the Web Links pod, you can email the Ticket to Work email address, webinars@choosework.ssa.gov, or reference the confirmation email that you received for today’s webinar for a list of available resources. Also, please note that SSA cannot guarantee and is not responsible for the accessibility of external websites. Today’s webinar is being recorded, and a copy of it will be available within two weeks – two weeks, excuse me – on the Choose Work website which can be accessed at http://bit.ly/WISE_OnDemand. This link as well as others that are shared today can be found in the Web Links pod and it will be titled WISE Webinar Archives. We hope that everyone has a great experience on the webinar today. However, if you run into any technical difficulties, please use the Q&A pod to send us a message. Or you an email the Ticket to Work email address, which is webinars@choosework.ssa.gov. As I mentioned earlier, my name is Sarah Hyland, and I am a member of the Ticket to Work team. I am excited to be here with you today as your moderator. We are also delighted to have Ray Cebula with us today to share his knowledge of the Ticket to Work Program. Ray received his law degree from the University of New Hampshire’s Franklin Pierce School of Law. He spent three years providing legal services to individuals with disabilities in their interactions with Social Security. He became part of Cornell University’s Work Incentive Support Center in 2000, and in 2005, he joined the staff of Cornell’s Yang-Tan Institute on Employment and Disability where he now serves as the program director of YTI Online and Cornell’s Work Incentive Practitioner Credentialing Program. Again, I want to thank you for joining us today. We are going to discuss how Social Security’s Ticket Program can help you and answer your questions relating to work incentives, the impact that choosing to work may have on your Medicaid and Medicare benefits, and benefits counseling, and service providers. And it is our hope that at the close of today’s webinar, you will better understand your Social Security disability benefits, that you will understand how the Ticket Program can help you if you choose to work, in recognizing the myths and facts surrounding work and its impact on Medicare and Medicaid, and also be able to access additional resources related to the Ticket Program, Medicare, and Medicaid. And with that, it is my pleasure to introduce Ray Cebula to start us off with the Ticket to Work Program and support on your journey to work and so much more. Thanks again, Ray. RAY>> Thank you, Sarah. Let’s get right into things. Ticket to Work Program: Support on Your Path to Work. And that’s a good key phrase to remember. Before we get into the nitty-gritty of your return to work, it’s important to know what type of benefits you receive. And there are two disability programs that are administered by the Social Security Administration, those being the Social Security Disability Insurance Program. And those benefits are paid to people who have worked and have paid into the Social Security system. The benefits are based on what you paid in, how long you worked. Then we have the Supplemental Security Income Program, which is a needs-based program that provides benefits to people who have very low entitlement to disability insurance benefits, who may not have a work history or who have a limited work history. Now, both of these programs have different work incentives, and that’s the importance of you knowing what type of benefit you receive. And the more information you could bring to a benefits planner will help them get you on the right path without any interruptions. There’s a new system that will provide you with a lot of self-help. It’s My Social Security account. It’s actually been around for a while, and, you know, I’ve got one. I think everybody should have one. and it’s a personal look at what your Social Security record looks like. It’s at ssa.gov/myaccount, one word. And you’ll get some instructions, some questions, and you’ll respond to them, and you can open an account with Social Security. Right now, I can open my account and find out how much I’ll receive if I am disabled. What type of benefits I’ll receive. What happens if I retire at age 62? What happens if I wait? What does my wage history look like? If I found out that Social Security had zero-zero-zero for last year’s wages, I can file with Social Security to make an adjustment to that. And you want to keep track of all of that. That’s your earnings records. You can get a proof-of-income letter concerning your benefits. You know, there’s a lot of – you know, the estimator tool. And an application to apply for benefits. If I were to apply today, what would my disability insurance benefit look like? And if I like that, and I feel the need to apply for benefits, I can move directly to begin an application for benefits. Incredibly useful tools are there. Good for you to watch. I check it every time. As a matter of fact, Social Security sends me an email and says, time to check your annual earnings. Keep on top of your own benefits and pretty much control them, and be able to use them when you need to. By opening an account. So, we would encourage everybody to do that. And if any of the other people on the host side, don’t have them, well, let’s – you get them, too. Everybody needs one of these accounts. All right, now we have to start the journey. You’ve got all the tools. You know what kind of benefit you have. You can print out the stuff on My Social Security account to bring it to somebody to help you. Only you can make the decision if work is right for you. No one here, no one at the Social Security Administration, is telling you that you have to do this. You’ll find that most of us are going to encourage you to do this because it’s the – it’s the best thing to do for yourself. But that choice is up to you. Our, as planners, as providers, is to provide you with informed choice so you can make the correct decision for yourself. Earning a living through employment is not something everybody can do. It depends very much on the severity of your disability, the limitations imposed upon you by your disability, and work experience. You can make this decision. And what, again, we want to do is give you as much information as possible. we believe very firmly that once you understand the services and the supports that are free, that are available to you to help you on this journey to work, you’re going to find that the rewards of working and a paycheck outweigh the risks. And today’s session is going to be really, really supportive of that statement. Because when we’re talking about health benefits, I hope you work long enough to have to wonder what’s going to happen to your health benefits. There’s really little risk there at all, and you’ll see that. What is the Ticket to Work Program? It is free. It is voluntary. Some of you may have received a Ticket to Work in the mail. That’s just alerting you the program exists. It’s not requiring anything of you. It is hopefully going to get you to meet with somebody to find out some more information. Find out what these services are. What tools we can provide to you. Career development opportunities, wow, for people ages 18 through 64 who receive a disability benefit from either SSDI or SSI and want to work are eligible for this program. So that’s almost everybody. That’s almost everybody who receives a benefit. You know, the Ticket to Work Program is connecting you with free employment services to help you decide if work is right to you. We’re going to give it to you straight. We’re going to tell you, if you work this many hours at this wage, this is going to be the impact on your benefits. And then you’ll be able to make a decision. No one’s playing hide the ball with you. We want you to have as much information as possible. How about preparing for work? There are partners on your work team, your return to work team, who are going to help you prepare for work. Maybe you need – maybe you were a computer operator and had a period of disability where you couldn’t work. You know, that stuff changes daily. And maybe in order to be that programmer, you need a couple of courses in computer technology to update your skills. Well, we can get those for you. How about finding a job? The people on your team know where the jobs are. They can help you put a resumé together. They can explain those gaps that you may think you have on your resumé. But I’ll tell you right now, you weren’t just sitting at home on the couch. You did things. You took care of kids, your children. You took care of kids of a neighbor when they went out. You had hobbies. They can fill that gap. And we’re not going to let you go to get a job and say bye-bye. Not the way we play. We’re going to make sure you succeed at work. So, we may be providing you with on-the-job supports, somebody you can talk to about problems you may have in the workplace, until you are ready to go and work on your own. We want you to succeed. Now, Social Security has more than 20 work incentives that are available to people depending on the type of benefit you get. I told you, SSDI has one set of rules, SSI has another. You know, and these work incentives are going to make it possible for you to work while still receiving benefits. Maybe you’re not sure. But we can plan some time for you to stick your toe into the work world, determine whether or not this is the right step for you, while still receiving benefits. Keeping your health care. Medicaid and Medicare tend to be, in my experience, the biggest barriers to going to work. And I’ve got to tell you, they aren’t barriers. You know, you’re listening to the street. The street is saying you are going to lose your benefits and lose your health care if you go to work. And that’s just not the case. You’re going to have access to individualized supports and service. We don’t want to place you in a job. We want you to be placed in the job that you want. So, this is, really, all about you. You know, we’re not giving you a cookie cutter. Keep some or all of the payments as you transition. That’s the wonderful thing about work incentives. If you’re not sure, if you’re uncomfortable, if you might be a little frightened, we can make this a gradual return to work so that you are comfortable. And that’s a wonderful thing. It really is a great system here. Now, Social Security puts out a Red Book. It’s available in English and Spanish. And it’s a good reference guide so that you look at the employment supports, the work incentives, and the provisions available for either SSDI or SSI. And it is a shorthand, quick glance. But, you know, most people that you start working with on this journey to work will provide you with that. It is also available online. www.ssa.gov/redbook. And you can print that out in Spanish or in English. It will help you find the resources in getting back to work. You know, where do you even start? Fortunately, there are no wrong doors here. You go in the wrong door; the wrong door is going to show you the right door. Information about the work incentives. It will explain what a trial work period is. You know, what your general income exclusion is. What a student earned income exclusion is. Additional information about health care. If you don’t believe me, it’s in writing. And that’s a good place to find it, in a Social Security document in writing. Resources to help transition-age youth. I mentioned that student earned income exclusion. You know, students, transition-age students, need a lot of guidance, and a lot of help managing benefits and returning to work. In fact, it’s really a family effort so we need to talk to the entire family about that and let everybody know what’s going on and what’s going to happen. The Ticket to Work Help Line is a great resource, too. If you’re not sure where to start, if you want to talk to talk to somebody without any obligation, about what might be available for you, call the Help Line. They’re in operations Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time. And I’m going to read that phone number for you, 1-866-968-7842. And for TTY users, 1-866-833-2967. Give them a call. They’ll get you headed in the right direction. All right. So, as I said, health care. You know, very often when I’m working with individuals who are going back to work, they’re not really concerned about the cash payment. What they’re concerned about is what happens when I work enough so that the cash payment goes away? Does my health care remain in place? And the Ticket to Work Act that created a lot of this stuff said people need health insurance to go to work. So, you’re going to find that things have changed and you will be able to keep your health care for a very long time. True or false? If I go to work, I’ll automatically lose Medicare or Medicaid. The street is screaming, yes, yes, yes, you’re going to lose your benefits. I’m here to tell you that that is absolutely false. As long as you receive a benefit payment, cash benefit payment, your Medicare or Medicaid is going to continue. If your benefits stop because you are working and have earned income, you’re going to be able to keep them. Both Medicare and Medicaid. Through work incentives. Through buy-in programs. As your income increases, you may be offered private insurance to supplement or – and these programs will just be your supplement. But as you earn more income, your costs may go up. Not enough to make you want to stay on benefits though. There’s no end to this, guys. There really isn’t. All right. Let’s talk about Medicaid. As I said, all of these programs have different work incentives. Medicaid is generally for somebody who receives SSI. And we need to talk about the SSI and Medicaid programs separately. So that’s why we do this. Medicaid while working, the 1619(b) program, is truly the best thing since sliced bread. And with the Medicaid buy-in programs that are out there in all but five states, that’s the butter on the bread. And these two provisions will protect people for a very long time. A very long time. 1619(b). As an SSI recipient, you know you’re going to be eligible for cash and that going to work is going to impact that cash. Going to work is not going to make it disappear all at once, but when you earn enough to zero out your cash SSI, Medicaid is going to just change categories, and you’re going to be protected by Section 1619(b). And you will be allowed to keep your Medicaid until you hit your state’s individual threshold. Now, SSI pays $794.00 a month and gives you Medicaid. If you are working and protected by 1619(b), you’ll be able to keep your Medicaid until, in some states, $30,000.00. In some states $40,000.00. And in the state of Connecticut, it goes above $60,000.00. So, what’s the risk? If you can go back and earn $40,000.00 a year and still have free Medicaid, you tell me what the risk is. You know, please, tell me. You have to have been eligible for a cash benefit in at least one month before you can qualify for this protection. You continue to meet Social Security’s definition of disability. And you will have medical reviews. Every recipient does to determine if you are still disabled. And the reason why we do that is because science changes, and what was disabling 20 years ago may not be disabling today because of the science changes. You still meet other non-disability SSI criteria. SSI also has limits on unearned income that you can receive and resources that you can keep. So, you may be earning $40,000.00 a year, but you’re limited to the $2,000.00 or $3,000.00 resource limit. Remember that there are potentially protected savings vehicles that you can use to put some of those countable resources into and make them uncountable. That’s going to depend upon your individual situation. And you must need benefits to continue to work. You need those Medicaid benefits. Even if you’re making $50,000.00 in the right state, and you have employer-provided health care coverage, does it meet your medical needs? Medicaid pays for a lot of things that private insurance doesn’t pay. So, you may still need Medicaid along with that private insurance to complete your medical coverage. That’s okay. You just need to continue to work, so you’re going to get it. And have gross earnings below your state’s threshold. You know, every state is a little bit different, so you’ll be working with somebody in your state to give you that information. That threshold is measured – is the measure Social Security uses to decide whether your earnings are high enough to replace SSI and Medicaid. And it is – it’s not just figures we’ve pulled out of our hats. How much does it cost to exhaust SSI cash is a mathematical formula. How much it costs to replace your Medicaid depends on what the state pays annually. On average for people who are in the community receiving Medicaid. So, we’ve got science behind it. These, again, are not just numbers pulled out of a hat. And you can look at the threshold amount by going into the Web Links pod and looking for State Thresholds. They change every year, so you’ve got until January. All right. So more about 1619. If your gross earnings are higher than the threshold amount, the day is not over. Social Security can determine that you are eligible for an individualized threshold. If you have impairment-related work expenses, social services items that you pay for that are related to your disability and necessary to work. so, everything, all those copays. The over-the-counter drugs that you need to take. A lot of prescriptions are now over the counter. If you’re taking a prescription that upsets your stomach, that could be a bottle of Tums or whatever the doctor tells you to buy. Blind work expenses. (Inaudible.) Anything that’s reasonably related to your money-making endeavor. Much broader than (inaudible) and covers a lot of things. Like daycare. A Plan to Achieve Self Support. That is something that allows you to save money. You can put some of your earned income into that Plan to Achieve Self Support. And let’s say you’re working at the mall. Your goal is to become a kindergarten teacher, and you need to go to school to do that. Well, the PASS plan will allow you to put some of your salary from the mall into a plan that is sheltered for resource consideration. And that can be more than that $2,000.00 limit. It’s what you need to go to school. It’s what you need to buy the computer, to buy the books. It could include a car to get you back and forth to work once you’ve gone to school. So, there are lots of things that you can save for, and that resource will not count. Publicly-funded attendant or personal care. Whenever I see those words, I see dollar signs. They are very expensive items. And you can throw in a lot of durable medical equipment to that. They’re just very expensive. Now, I’m going to tell you a story about a friend. He’s passed away, but he was working in the state of New York in a big job. And his individualized threshold, because he had durable medical equipment and a 24-hour personal are attendant, gave him an individual threshold of $110,000.00 a year. He could earn up to $110,000.00 a year and still have Medicaid free under the individualized threshold. Hard for me to understand why anybody would be reluctant to return to work if they that. If they know that. And he was a full-time worker despite his disability. He just needed a lot of support. The buy-in programs. The buy-in programs are also very, very good programs that came to be with the Ticket to Work, so it would be after 2000, but your state would have instituted a Medicaid buy-in program. It is exactly what it says. If you don’t have an individualized threshold and your income goes above your state’s threshold, you’ll lose free Medicaid, but you can buy into that plan. As I said, health insurance from the private sector doesn’t necessarily meet all of your needs. Medicaid is very inclusive and provides a lot of things private insurance doesn’t. So, you still need Medicaid. We’re talking about a premium that’s based on your income and that is really, really inexpensive. Your premium might be $20.00. It might be $50.00. It could be $75.00. That’s not a lot of money a month to get coverage that’s going to continue to meet your medical needs. And by this point, you’re earning enough to be able to pay that just like the rest of us do. You have to be disabled. Again, you have to continue to meet that disability definition. And you would be eligible for SSI if it wasn’t for your earnings. So, if we look at that complex formula, if we take your earned income out of the picture, are you eligible? And for most people, yes, that’s going to be the case if you stop earning income. SSDI beneficiaries can also be eligible for this. But on the SSDI side, remember, it’s not a needs-based program, so we have to look at your income, your resources, and some other criteria before we can determine that. But it’s not a far stretch. It happens more often than you think. Medicaid and the Ticket Program. You know, 1619(b). Take a look in that Web Links pod and you’re going to find all kinds of information on 1619(b) in the 1619(b) link in that web pod. And don’t be thinking 1619(b) is some kind of, you know, legal or fancy number. It’s simply just the next number that was available to Social Security when they were adding new rules and it got tagged 1619(b) by most people that work in this field. The Medicaid buy-in program, go into your Web Link under State-Medicaid, and you’re going to be able to find lots of this stuff. I’m looking right now. It says Medicaid State Thresholds. You want to find out what the threshold is in Wyoming or what it is in California? Take a look. Take a look. Help you plan. Help you make the decision whether you want to talk to somebody about taking a shot at work. All right. We’re going to switch gears and look at the Medicare program. Generally associated with SSDI, so we’re going to have a lot of different work incentives. And even if some of them sound the same, they’re going to be applied differently. Medicare. We have the Extended Period of Medicare Coverage, or EPMC. And Medicare for people with disabilities who work. Both of those are giving me more hope if I were going to be starting to work. What’s an extended period? What’s this program for people who are working and still have disabilities? The Extended Period of Medicare Coverage provides Medicare to beneficiaries whose benefits stop because of work. Because of earned income. Now, after your trial work period, which is your first nine months of working, this period lasts at least 93 months. That’s at least seven years. It’s more than seven years. I don’t want you to worry about what might happen in seven years. I want you to go to work and focus on becoming a worker with a disability. And five years from now, come back to me and we’ll talk about what might happen to your Medicare benefits in two years. Now, Medicare has three significant parts. Part A is hospital insurance. Anything that you require hospital care for, and the after care, which could just be showing up to get those stitches removed, or it could be rehab as well, will be covered by Part A. Part B, Supplemental Medical Insurance. You need to choose to enroll in this. And everybody has to enroll unless they have what’s called credible coverage. And that is alternative health care that is as good or better than Medicare. And then Part B – Part D, I’m sorry, you have to, again, opt into this program. And this is prescription drug coverage. This is a plan where the cost varies incredibly depending on how much you want to pay out of pocket. That’s the simplest rule. The more expensive plans have lower copays. If you want a zero-dollar plan, your copays may be more expensive than they would be otherwise. It has to be tailored to you to meet your medical needs. There are people out there who can help you determine what plan is best. So, what about this extended period of Medicare coverage? Why are you talking about all these plans? Those are the parts of Medicare that we need to protect. You must have Medicare before you start working at what we call the Substantial Gainful Activity or SGA level. Because at that point, your benefits – cash benefits – are at risk. And you cannot have experienced medical improvement. Which basically means you continue to meet the Social Security definition of disability. Now, let’s go ahead, you know, years from now. In five years, you come back to me, and you say, okay, Ray, I’m taking you up on your offer, what’s going to happen now? Well, when the option for free Medicare coverage comes to an end because of work, you can opt in to what’s called Premium HI, Premium Health Insurance. And you can buy Medicare. You cannot be 65 or older. At that point you’re eligible for Medicare because of age. You continue to have the disabling impairment, which means you still meet the Social Security definition of disability. And Medicare stopped – free Medicare stopped because of work. At that point, you can buy into the program. At that point, your earnings are sufficient to make that an allowable expense. Again, tell me what the risk is. The only risk is that you’re going to be a worker with a disability and pay for health care the way all of the other workers pay for health care. But there will be enough money to do that. That’s our job, to make sure that there’s enough money in earnings for you to do that. Now, for this program, for Premium HI or Medicare, for people with disabilities who work, you need to pay attention to enrollment periods. And to make an appointment to enroll, call Social Security. Their 1-800 number is 1-800-772-1213. Or for TTY users, 1-800-325-0778. Now, if the premiums are above your ability to meet them, there is assistance. Of course, it’s going to depend on how much money you actually have. You know, so it’s an individual determination. But you can call Medicare at 1-800-MEDICARE, or 877-486-2045 for TTY users. You’re going to need your Medicare number handy, and you need to tell that represent what state you live in. And we’ll get you directed to the people that make that decision in your state. Lots of people have full assistance or partial assistance to make these benefits payments. All right, Sarah, we’re up for our question-and-answer session. Sarah, you still with me? SARAH>> I’m here. Ray, sorry about that. My microphone got muted somehow. I’m here. RAY>> Okay. That’s okay. I assumed you were. SARAH>> The first question I have for you is, do I need to meet all five criteria to qualify for 1619(b)? RAY>> Absolutely. That’s the criteria that’s set forward. It’s generally not much of an issue, but you do have to meet them all. SARAH>> Okay, Ray. I’m going to move along to the next question if you’re ready. RAY>> Yeah. SARAH>> All right. I am interested in returning to work, but I am unsure of my physical capabilities. If I apply for jobs, do I need to notify Social Security that I am attempting to work so my benefits aren’t interrupted? RAY>> Yes, you do. Remember that at any time, anybody who’s on benefits needs to report a return to work to Social Security on either side, SSDI or SSI. That’s just so that Social Security is aware of continuing eligibility issues and how that earning is going to impact your cash payments. That can happen while you’re testing your ability to work as well. I think if you’re not sure of your capacity, you know, that’s something that is perfectly allowable, and you’re able to explore that. You may – let’s go back to the mall. Get a job in the mall, and that might be a good experience. You might find out you don’t like it, but you know how much you can work. If you go to Lowe’s or Home Depot, that’s a different kind of work. But if you want to work in their garden department because you were gardening a lot, you like house plants, well, let’s do that and try that. That’s going to be physically more demanding or differently demanding. You know, you’re going to be outside a lot. See what your capacity is for that. That way, when it’s time to go for the gusto, you have a really good idea about what you can do and how long you can do it in different environments. And you can make a good choice about where you want to put your efforts. SARAH>> All right. Thank you, Ray. I have another question from the audience. If I get a job and work without participating in the Ticket Program, would I lose my disability benefits? RAY>> Absolutely not. I said the Ticket Program is voluntary. It provides you with extra services, extra assistance, extra direction. If you just go out and get a job on your own, and many, many people do that, all of the work incentives will still apply to your case. You just won’t be using your Ticket. And you will not lose your benefits. You still have a trial work period. You still have (inaudible) and whatever else applies to the particular benefit that you have. It's still a good idea to get some help. Talk to a benefits planner one way or the other so that they can guide you through that process. SARAH>> All right. Thank you, Ray. The next question I have for you is, can I use only one work incentive or can I use a combination of ones that I’m eligible for? RAY>> Oh, use them often and as many as you possibly can. It is most certainly, you know, if you’re an SSI recipient, you’re going to have an earned income exclusion, which is that first $65.00 and divide by two. So, Social Security cares about less than half of what you earn. If you then have impairment-related work expenses, you can deduct those as well. If you have a PASS plan, your contribution to that is going to be a deduction as well. So, yeah, you can – there’s a calculation methodology that takes into consideration every possible work incentive that exists for you. And you can be using several at a time. SARAH>> All right, Ray. Great advice. Thank you. The next question I have for you is, how does SSA decide if my earnings are high enough to replace my SSI and Medicaid benefits? RAY>> All right. That’s a good question. On the SSI world, I’m going to try to figure this out for you while you’re here. I have a ground figure. Times two. Plus – all right. If you today earn $1,653.00 in the month of April, because of the way these calculations are done, and you have no (inaudible), you have no PASS plan. You just don’t have any of those work incentives other than the basic formula, $1,653.00, you will lose your SSI cash. So, you have exchanged $794.00 a month for $1,653.00 a month. Now, if you’re going to lose your Medicare, let’s take my state, New Mexico. $1,653.00, I have no cash benefits. When can I afford to pay for my Medicaid? You have to call the state of Mexico – New Mexico – and find out what New Mexico spends on a recipient with a disability who lives in the community on average by the year. And it looks like that’s going to be about 20 – I’m trying to figure these numbers out while we quickly do this and talk to you. All right. So, it looks like you’re going to exhaust your benefits, and you’ll be making $19,000.00 a year. If Medicaid in New Mexico pays $20,000.00 on average for a Medicaid recipient living in the community, we add those two numbers together, and we have $39,000.00. You can earn $39,000.00 and some change in New Mexico. If you go a dollar over that, Social Security determines that you can replace both with your own funds. Both SSI cash and Medicaid. That only applies to the average person. If we go back to somebody who has personal care attendants, expensive Medicaid services, we could then say, hey, you know, New Mexico, I’m not average. I have expensive care. What did you spend on Ray last year? And if they spent $40,000.00 on me, I go back to the amount of money, the $19,000.00 that it cost to exhaust cash benefits, add $40,000.00, which makes my individualized threshold $59,000.00. So, until I exceed that, I can’t replace my Medicaid. So that’s how it works. It gets you up into the situation where you can replace it. The question, though, is, does Medicaid – this is a second question – does Medicaid provide services to you that are not found in your employer’s insurance plan that they offer? You know, it could still be that you can’t afford to replace Medicaid because some of the Medicaid services, if you were to pay for them out of pocket, are just going to wipe out your income. So, we’re going to consider lots of things about you before we make that exact determination about how much and when that’s going to occur. SARAH>> All right. Thank you, Ray. The next question I have for you is, I had a Ticket to Work years ago. Will I need to get another one? And do Tickets expire? RAY>> I’m going to ask you a question back. I’ll answer it, but did you use that first Ticket that you got? You get one Ticket per period of disability. So, if you have been on benefits for a long period of time and you received the Ticket to Work, if you used that Ticket, it’s possible that it’s no longer available to you. If you didn’t, if you lost it, if you threw it away, that’s all fine. Just call Ticket to Work Help Line. They will let you know that you have a Ticket and point you in the right direction to using it. I forget the second half of that one, Sarah. SARAH>> Do they expire? Do the Tickets expire? RAY>> Oh, thank you. Thank you. Yes, it does expire at some point. But you have to be using it for it to expire. Each Ticket is going to provide you with services. As you get those services, your Ticket is being used. Your Ticket is ultimately going to expire when you’ve achieved your vocational goal and you’re no longer eligible for benefits. When it exactly expires for each individual depends upon the progress that they’re making and how far along their journey they are. SARAH>> All right. Thank you, Ray. And I have one more question for you before we wrap up this question session and move on. Do I have to have a paper copy of my Ticket? RAY>> Absolutely not. You know, when I was practicing law in Boston, and people called up and said, what is this? What is this? I’d say, that’s a Ticket to Work. Do I have to go to work? No. You want to throw the Ticket away, throw it away. If you don’t have the one they received you, you can certainly get another one by calling the Ticket to Work Help Line. You don’t need the paper copy, though. You just need to call the Help Line, make sure you have one, and then go to a provider. And that service provider that’s going to help you on your journey to work will just verify that you have the Ticket, and you’ll be on your way. SARAH>> All right, Ray. Thanks, again, for answering all of those questions. We are going to move forward and stop and turn things back over to you, Ray, and have you discuss the benefits counseling. Thank you. RAY>> Thank you. All right. Benefits counseling. This is a really good service to seek. When you are thinking about work, when you’re about to start a job, you want to know what’s going to happen. A benefits planner can let you know. You know, I always tell people all the time that we want to be in a position of power when it comes to our own lives. When it comes to our own benefits, we want to be in that position as well. If you know what’s going to happen when you earn a certain amount of money, you don’t have to react. You are being proactive. If you don’t know and you just go to work, and you get some surprise notice in the mail that says you’re no longer eligible for cash, you’re reacting to that. And we want to be proactive about everything. And benefits planning lets you do that. Have to be a beneficiary. Now you’ll have free access to this service. And let me tell you, it’s a real good deal. When you – when you get this free, your benefits planner is going to spend hours and hours making a plan for you based on your projected income and your benefits. It's going to include what’s going to happen to your health care, Medicare or Medicaid. If you’re an SSDI recipient, we’re going to tell you what’s going to happen when to your benefits based on what you’re earning. What kind of work incentives are available? There’s the trial work period. An extended period of eligibility. We have lots of work incentives that you need to know about that might extend your ability to work a little bit so that you’re more comfortable, and then you can say, bye-bye. You know, I’m working, it's time to be off of the cash. SSI, SSI reacts very quickly to earnings. It would be nice to know what’s going to happen to your benefits in two months if you earn money in April. You don’t need to be surprised. We don’t want you to be surprised. We want this transition to be shock proof and comfortable. And benefits planning lets you do that. And, you know, a lot of people who are on SSI, or DI, have other benefits. They might have housing assistance. It may be a rent supplement. It may be a subsidized apartment. What’s going to happen to your rent if you go to work? Are there work incentives in the housing program that will allow you to count some of your income, an exempt some of it. We’ll tell you about those, too. Because it’s not just your Social Security benefit. It’s everything. What about SNAP? Or your food stamps? That’s going to react to an increase in earned income. But it’s my job as a planner to make sure that as your SNAP benefits go down, and as your rent goes up, and as your Social Security benefits drop down, you’re earning enough money to make this all happen. Plus a little extra. You know, a benefits planner is not going to plan for you to go to work and have you lose money. That’s not what we’re about. The benefits counseling providers, you know, where are you going to find these folks? They are at Work Incentives Planning and Assistance projects. Those are the WIPA projects. They’re – each individual planner is called a CWIC, Community Work Incentive Coordinator. Those are folks who can provide you assistance if you are actively interviewing for a job, or if you’ve just started a job. There are other planners out there who can help you if you just want to ask a question. If I go to work, what’s going to happen? The state vocational rehabilitation agencies. Lots of those agencies have planners. Not all of them, but some of them do. Lots of those agencies have counselors who have been trained enough to know that at this point in your journey to work, you need benefits counseling, so let’s get you hooked up with somebody. And then there are employment networks. These are private vocational rehabilitation agencies that have agreements with Social Security to provide you with services under the Ticket to Work Act. Many of them have benefits planners in-house. But for those that don’t, if you’re working with them, they know enough to say, okay, it’s time for you to meet with a benefits planner. So, again, three doors, none of them are wrong. You’ll all get the services that you need. Here’s the WIPA. I talked about this probably more than I should have, but I tend to do that. Free benefits counseling. If you are a recipient of SSI or SSDI and still get a cash benefit. They’re going to talk to you about Medicare, Medicaid, all of the other public benefits. They’re all going to be discussed. To help you understand the work incentives. And what is that trial work period, right? You keep saying EPE, Extended Period of Eligibility. What is that? Well, that is what our job is as benefits planners is to explain how you get to that point in your journey and what benefits are available to you. Because you’re in a different period of that journey. How about explaining the potential benefits of employment and dispelling myths, like you’re going to lose everything just because you get a job. They’ll talk to you about that. And what are the benefits of employment? It’s much more than money. It’s much more than money. It’s the ability to make a decision that you are not going to cook dinner tonight because you’re tired from working and you are going to stop and get takeout to bring home. That’s not available to a lot of people who are living, particularly on SSI. It’s the ability to decide, it’s Friday night, I’m going out for dinner. Those are the benefits of work. It’s having a puppy like the one you’ve probably heard barking. The brothers are asleep, but she doesn’t seem to want to go to sleep right now. I can have a puppy, I can have dogs because I work. It’s getting to work with Sarah. If I wasn’t working, I’d never know Sarah. And we’ve been working together for a long time now. There are lots of extra things that come along with the money. And then, help you decide if the services and supports from the Ticket Program are right for you. Benefits planning was created by the Ticket to Work, but you don’t have to use your Ticket to get a benefits plan. So, maybe benefits planning is a good place to explore, and that benefits planner can say, hey, right now seems like the time to get some extra services. And maybe you’re already working. Maybe you need on-the-job support services. Let’s use your Ticket and get those extra services so this job can continue. That’s what a benefits planner is going to do. And they’re not one-stop shopping. Because, you know, if put a plan together for you that gets you through your trial work period, your extended period of eligibility, that magic day when you’re terminated from cash because you are a successful worker. You know, life happens. And you may stop working for any reason. COVID happened and millions of people were out of work because businesses shut down. That’s going to interrupt your plan (inaudible) and the benefits planner to figure out what’s going to happen until we get another job. So, it’s not one-stop shopping. They can follow you through the entire journey. Who do WIPA services provide services to? If you’re working or self-employed, absolutely. If you have a job offer pending, absolutely. If you’re actively interviewing, yep, that’s defined as you’ve interviewed in the last 30 days or you have an interview scheduled in the next two weeks. And then we look at transition-age youth. I erased half of that. Even in the earliest stages considering work. You know, lots of transition-age students, you know, when you have spring vacation, and you have summer vacation, may be offered a paid work experience by the school, okay. What’s going to happen to your benefits during this three-week paid work experience? We can help you and your family get through that to show you what the benefits of work is – are. There are lots of things. And that, again, transition-age assistance, when they’re kids like that, you need the parents’ involvement, and the parents have to be sold on this work effort. And that’s what benefits counselors do. We’ll talk about how family benefits are going to be impacted. And how to make up the difference. You don’t get a free ride in this life. I got a job when I was 16. Birthday present from my father. And on my first payday, which my mother very well knew when that was, she asked me for my paycheck. And all of a sudden, I was given the offer to pay room and board or save that money. And that’s the way everybody, kids, even those with disabilities who are going to work, need to understand that’s what life’s about. So, if mom and dad have fallen short on benefits, Joey’s got to pay some of that salary as room and board to make up for the loss of family benefits. Only fair. State rehab agencies. Big agencies. Every state has one. Some have a separate agency for those who are blind or visually impaired, and I think that brings us up to a total of 83 VR agencies. You’ve got to work with the one in your state. And they’re going to help you regardless of what your goals are. You know, they are there for everybody provided you have a disability. Not just SSI and SSDI recipients. But because you’re receiving Social Security disability benefits you then become a priority for VR services. Vocational rehabilitation. If you were working before you became disabled and had to stop work, can you go back to your old job if we teach you how to do that job differently? If you don’t want to go back to your old job, how can we get you rehabilitated so that you’ll be able to do something in the field you’re interested in? And will that require training? Lots of us have to be retrained every few years. We all need tune-ups now and then. But if you need training to change careers, or that computer operator, it’s been ten years, we need an update of our skillset. We’ll get you training and education to do that through the state VR office. They’ll build a separate plan to return to work which you participate in the building. So that’s also another group effort. You’re not having plans made for you. You are involved in making those plans. And the employment networks. A few over 500 of them now. Employment networks are private or public organizations. They have a relationship with Social Security. And they provide you with free employment services. What do you do in return? When you build your plan, you make timely progress. And Social Security then will reimburse the employment network. All of these services are free to you. We just ask that you progress along with the plan. Okay. Lots of other services here that both ENs and VR agencies provide. They overlap a lot. Career planning or counseling. You don’t want just a job. I want a career. If I wanted to work in Macy’s, I would have told you that. I want to run the men’s clothing department for one of the bigger stores. That’s more of a career. It will take time to counsel you to get into that position, and may have to tell you you’ve got to sell clothes before you can get there. Job search and job placement assistance. Where are the jobs? VR and ENs know who’s hiring in your state and where the jobs are. And they can tell you when to apply, where to apply. State VR agencies may provide specific training programs for that job or they can give you a more general plan so that you are then prepared to enter the workforce. And if you want to be a teaching assistant, you need a two-year degree. That’s going to be provided to you through VR services so that you can obtain that vocational goal. Special programs for veterans and youth in transition. Veterans are a very special group. And veterans with disabilities are going to get services and some special services because they deserve it. They deserve it. And youth in transition. It’s our hope that we can provide services for an SSI child so that that SSI child doesn’t become an SSI adult and has a shot at becoming a worker with a disability. That’s all I ask. Give me a kid for a couple of months, I’ll show you how it works. And assist with job accommodations. Because of a disability, you are entitled to certain reasonable accommodations. But in order to get them, you need to tell your employer that you are disabled even if you didn’t do that during the interviewing process and got the job. How do you have that conversation? What is the average cost for the type of accommodation that you’re looking for? The more information and knowledge you have when you talk to your employer about that, the better that conversation is going to go. Lots of employers think these things are very, very expensive. And on average, they’re about 500 bucks per employee. That’s not too much. And if you walk in and say, well, I need the screen reader for the computer because I do have a vision – visual impairment, and the screen reader that I think will work best for me is $175.00. You’ve calmed down your employer. You’ve provided information as to what’s necessary. And that’s going to be a smooth – smooth discussion. And if you’re uncomfortable talking about that with your employer, maybe discussions with ENs, with state VR, with a benefits planner will help you get more comfortable. Or maybe there’s somebody out there, and we know there is, who can help you have that discussion. And the benefits planners, your ENs, even your VR counselor, and the PABSS agency, which is Protection and Advocacy for Beneficiaries of Social Security, can help you have that discussion. It’s a very important discussion. All right. So where do you find all those people? where do you find them? Again, I’m going to show you a link, or refer you to link in the Web Links pod. TTW Team. Ticket to Work Team. This is a team, and you’ll have as many members as you need from all of the services we’ve discussed. It’s going to refer you to the WIPA projects that serve your area. It’s going to refer you to your state VR agency. You know, what’s the closest office to me? All of the ENs that serve your area. Some of – don’t be surprised if you find some of them are in California. I’m here in New Mexico, but I know there’s an employment network that can provide services from California via distance. And if I need a resumé, if I need somebody to help me fill the gaps that I believe are there, and if I need some interview practice, there’s no reason in the world we can’t do that via computer or via telephone. We’re doing it right now. And I think this Covid experience has given everybody a better understanding of how good distance services can be. So, that might be the place you want to go. How about the workforce ENs? The job – one-stop job centers. Those places are fabulous. If you want to go into one, and I’m sure there are some you can go into now, to do a job search on one of their computers, go ahead. If somebody there can help you with a resumé or you want to prepare your own resumé, go ahead. There’s lots of free services there. Some of them are employment networks as well, as you can tell. In fact, they are all employment networks. And if you need a higher level of individualized services to get this journey started, they are there for you. What I like about those is that you can do a lot on your own. And I really think it’s important for the person who wants to start that journey to work to be ready to stop off and say, let me do a quick search. You know, we’ll have our little meeting, and then I – reserve a computer for me, and I can do a quick job search, what’s available in my area. And remember, Google is your friend. Protection and Advocacy for Beneficiaries of Social Security. I mentioned that a while ago. It is a separate Ticket to Work service that you may need. They are legal advocates, paralegals, attorneys. And they’re there to provide you with assistance any time you run into a barrier to your work. Now, if that is an employer who says, no, I can’t afford that screen reader, I’ll get you a cheaper one, and you really need the expensive one, talk to your PABSS agency and they can talk with your employer. If you get laid off, you’re denied unemployment benefits for some reason, talk to your PABSS agency. If you suffer from a discriminatory episode at work, talk to your PABSS agency. And their number is right there. All right. Find help to achieve your work goals. The second slide. Here I have the Find Help tool. It’s in your Web Links pod, and I can see it, the Find Help tool. It’s going to get – get you to a page that allows you to search by vendor. If I need a PABSS program, I can just hit the PABSS link. If I am starting my journey and I want to know who are the ENs, where are the benefits planners, where is the state agency, and where is PABSS, all I have to do is put in my zip code and everything that’s available in my zip code will come up. I don’t know how you function. I pretty much like to know where everybody is when I start, so I would want that list. You may decide, I just want to talk to a benefits planner and see what this journey might look like and what might happen. Your choice. Again, no wrong door. No wrong way to do this. We will all get you the services that you need as part of your employment team. That direct search, you know, will get – will use your zip code. And I do use that. Every once in a while, people on SSI or SSDI call, and they want to know, where are these services? I don’t know where they are in North Carolina, but I can find them real quick while we’re on the phone by putting in your zip code. You can then narrow the findings. If you come up with seven employment networks, and you do know what they’re going to do. How do I interview seven of them? Will I need to do that? It doesn’t have to be that overwhelming. Look. See what services they offer. If an EN specializes in services for blind workers, and you have a mental impairment, that’s probably one you can just write off, right, and look at some that focus on your disability. Or what other kind of special expertise? Would you rather have services in Spanish? You’re going to find that, too, so you can then narrow the searches and come up with your options. And those fewer options are focused right on the target. Choosing a provider. You’re going to have some interviewing duties here. You’re not just going to call an EN and they’re going to say, sure we can help you, come on down. You need more than that. You need to know what questions to ask. Have you worked with people who have my disability? Have you worked with people who are receiving my benefits? You know, what results have you gotten? How many people have you served who are actually working and off of benefits? Those are great questions to ask. And if they say, no, I’ve never worked with somebody with your disability, you might be looking at a different EN. Find it. Finding an EN in your web pod, choosing an EN in your web pod. I can see both of them right there. Amy. We come to our success story. And Amy’s another success story. She grew up with a developmental disability, knew she wanted to work but didn’t know what her options were. She received services from her state VR agency and later worked with an employment network that continues to help her develop her career and receive benefits counseling. She hit up three different options there. She learned that she was eligible for Medicaid while working, 1619(b), which allowed her to focus on her work goal and not worry about losing her health coverage. That’s a good story. That’s a great story. She’s making a success without having to worry about that health care. All right. Questions. Sarah. SARAH>> All right, Ray. Thank you for sharing that success story with us. The first question that I have for you is, if I enroll in the Ticket Program and I am offered a job, will turning down that job reflect negatively on me? RAY>> No, not at all. I, yeah, it will not. Again, it’s your choice. And that may be the point in time where you decide maybe working isn’t for me. Maybe you’ve been offered a job and are wondering, why? How did I get that job? That interview was horrible. I didn’t like him, he didn’t like me. It may just be the wrong fit for you. So, no, we’re going to write that up to experience and move on to the next interview. SARAH>> All right. Thank you, Ray. The next question I have is, how do I know which work incentives I am eligible for? RAY>> How do you know? You can certainly go into that web link and find the Red Book, and that will explain it to you. You may want to make an appointment with a benefits counselor and see. Again, be ready to tell them what benefit you have so that they’ll be focused on the right program. And you will find out how they work and when they kick into play. SARAH>> Okay. The next question I have for you, Ray, is, are there work incentives for people starting their own business? RAY>> Absolutely. There are work incentives for that. You know, that trial work period that we talked about. You know, there’s a special definition of trial work for self-employed people. Because you know, self-employed people tend not to make a whole lot of money right away. It takes a while. But we can look at the number of hours you’ve worked to see if you are actually engaging in work that would meet the trial work definition. And big incentive, you know, when you get your paycheck, or when you make money as a business, we have to subtract all of your business expenses. If you paid rent for the month of April, and your business brought in $10,000.00, well, the rent comes off the top. What about the electricity? What about the telephone expense? What about the computer that you just bought? All of that comes off the top just like it does the IRS. And then when we get to what’s called net earnings from self-employment, that’s what your business or you earned. Now we’re going to apply all of the regular work incentives and see if there are other deductions, like impairment-related work expenses, that we can take to reduce your income. So, there are a lot of similar and extra work incentives for self-employed people. SARAH>> All right. Thank you, Ray. The next question I have for you is, is it possible to have employer-sponsored insurance, Medicare, and Medicaid? RAY>> Absolutely. And wouldn’t that just be the gold standard. If you are eligible for employer-paid health care, yeah, take it. Medicaid – let’s go to Medicare first. Medicaid – Medicare may pay for things that your private health care does not pay for. And if Medicare doesn’t pay for them, then we get to Medicaid. Medicaid will generally pick up the rest. And particularly when you’re talking about individuals with disabilities, there are services, personal care attendants, are not found in private insurance or Medicare, but they are found in Medicaid. So, keeping all three of those is really having all of your bases covered. And it’s certainly possible. It’s an order of payments preference. Private insurance first, Medicare second, Medicaid will take up whatever is left. SARAH>> All right, Ray, thank you for that response. Unfortunately, we are out of time for questions for today’s webinar. And I want to thank the audience for sending in all of your questions. We hope that we provided you with answers about your questions concerning the Ticket to Work Program. And, again, many thanks to Ray for being with us today and sharing his knowledge of the Ticket to Work Program. Thanks, Ray, have a great day. RAY>> You, too, Sarah, always good to be here. SARAH>> You as well. Thanks. Social Security’s Ticket to Work Program has a number of service providers and other resources ready to help you get started. To get a list of providers in your area, or to get answers to questions that you may have about the Ticket Program and other work incentives, you can contact the Ticket to Work Help Line at 1-866-968-7842. Or for TTY, 1-866-833-2967. Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time. Or you can always visit the Ticket to Work website at choosework.ssa.gov. You can also find us on social media or subscribe to blog and email updates by visiting choosework.ssa.gov/contact/index.html. This link appears in the Web Links pod under Ticket to Work Contact Information. To get advice and encouragement and read success stories from the people who have had success with help from the Ticket to Work Program, you can receive text messages from the Ticket Program. Simply text TICKET – T – I – C – K – E – T – to 47 47 47. Standard messaging rates may apply, and you may opt out at any time. Please join us for the next WISE webinar, Working from Home with Ticket to Work, which will be held on Wednesday, May 26, 2021 from 3:00 to 4:30 p.m. Eastern Time. Registration is open, and we look forward to having you attend. To register online, go to choosework.ssa.gov/WISE, or you can call 1-866-968-7842, or for TTY, 1-866-833-2967. Your feedback is very important to us, and it helps us plan for future webinars. Please provide your feedback and tell us what you think about today’s webinar by taking our survey. To take the survey, you can follow the link that will pop up after the webinar or visit the Ticket to Work website to complete the survey. The survey can also be found in the Web Links pod. I want to thank you again for attending today to learn about the Ticket to Work Program. Please take this opportunity to reach out to any of the resources we discussed today and take the next step on your career path. This concludes today’s webinar. Have a wonderful evening. Thank you.