Social Security, Medicare, KanCare and Work Incentives� Maddie Bowens Working Healthy Sr. Manager May 2023

Work Incentives

Social Security, Medicare, KanCare and Work Incentives

• Persons with disabilities can work, earn more money, be self sufficient and maintain health insurance.
• You do not have to live in poverty to protect your health insurance.
• This presentation will provide insight into some of the basic work incentives to assist people to test their ability to work.

Protect and improve the health and environment of all Kansans

Social Security Work Incentives

Social Security Disability Benefits

Social Security, Medicare, KanCare and Work Incentives

Social Security Disability Insurance (SSDI)

Disability insurance for individuals who become too disabled to work

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• Cash benefit based on individual’s employment history and contributions to FICA or SECA
• Medicare after a 24- month waiting period
• Medicaid

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Childhood Disability Benefits (CDB) The adult child meets adult disability standards between 18 and 22.

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• Cash benefit based on the parent’s employment history and contributions to FICA or SECA. Parent/s are either deceased, disabled or retired.
• Medicare after a 24- month waiting period.
• Medicaid

must be at least 50 years old and not receiving any other auxiliary benefits from the deceased spouses’ contributions.

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Social Security Disability Benefits

Social Security, Medicare, KanCare and Work Incentives

Disabled Widow/er Benefit (DWB) Disabled surviving spouse must be at least 50 years old and not receiving any other auxiliary benefits from the deceased spouses’ contributions.

Cash benefit based on the spouses’ contributions (work history and earnings).

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Supplemental Security Income (SSI)

Supplemental Security Income (SSI)

• Benefit is not related to employment history
• Designed to supplement low income for individuals who are
• disabled
• legally blind
• Aged (65) years or older
• Automatically eligible for Medicaid

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Our vision is 'healthy Kansans living in safe and sustainable environments'. The state belongs to all of us - "Kansas Don't Spoil It"

Ticket to Work

• Employment program for people with disabilities who want to go to work.
• The ticket program is a part of the ticket to work and work incentive improvement act of 1999.
• Goal of the ticket to work is to increase opportunities and choices for social security disability beneficiaries:
• To obtain employment;
• To access Vocational Rehabilitation; and
• To access other support services from the public and private providers,
• employers and other organizations.

SSI Work Incentives

General Income Exclusion (GIE)

• The first $20 of income is excluded.
• It is applied to unearned income first, or it can be applied to earned income if there is no unearned income.

Earned Income Exclusion (EIE)

• First $65 of earned income in a month plus one-half of the remainder.
• Applied to gross wages received in a month.
• Subtracted from net earnings from self-employment; averaged throughout the 12 month calendar year.

Effect of Earned Income on SSI�(see SSI/Earned Income example)

Gross earned income $685

Minus GIE - $20

Minus EIE - $65

Subtotal $600

Minus one-half -$300

Countable income $300

• 2022 Federal Benefit Rate of $841* minus $300 countable income equals $541 SSI benefit
• Total income: $685 plus $541 equals $1,226 before taxes

* this amount may change each year

Blind Work Expenses (BWE) �

• Applies to SSI benefits only.
• Deducted from remaining earnings after the one-half disregard.
• Must meet SSA definition of blind/visual impairment.

Impairment Related Work Expenses (IRWE) – SSI�

• Same rules apply to SSDI benefits as SSI regarding what is allowed.
• Amount is deducted from earnings before the one-half disregard.
• Reduction occurs in month wages are received.
• IRWE can be used for both SSDI & SSI.

SSI has other cash work incentives.�

• PASS – Plan for Achieving Self Support
• PESS – Property Essential for Self-sufficiency
• SEIE –Student Earned Income Exclusion

SSDI Work Incentives

Title II & Medicare

• Medicare is health insurance for Title II beneficiaries.
• Part A-Hospital;
• Part B-Medical (physician, out-patient);
• Part C-Medicare Advantage Plans (HMO or PPO), replaces A & B and cannot allow a separate Part D plan (Rx coverage must be included in the Advantage plan if coverage is desired);
• Part D-Prescription Drug Plan.

Trial Work Period (TWP)�

• The TWP is a 9 month period in which Social Security allows you to earn any amount and receive SSDI cash benefits.
• For 2022, TWP months are counted if gross earnings are $970 or more (this amount can change and past years may be different) or if one works more than 80 hours in self-employment.
• TWP months do not have to be consecutive.
• TWP is completed when you have worked 9 months in a rolling 60 month period.
• Once TWP is completed, Social Security will make a decision as to whether work is substantial.

Impairment Related Work Expense (IRWE)�Applicable after the TWP

• Expense enables the person to work.
• Paid by the beneficiary and not reimbursed by any other source.
• Expense must be reasonable as determined by Social Security.
• Expense is paid for in the same month the person was working.
• Amount of IRWE is deducted from gross earnings when determining if work is substantial (IRWE does not increase the SSDI cash benefit).

Extended Period of Eligibility (EPE)

• The EPE begins the month following the 9th and final TWP month and continues for 36 consecutive months.
• At any time after the TWP, the first month in which SGA is achieved may be considered the cessation month and is followed by 2 grace months (the 3-month grace period).
• Benefits may continue to be paid beyond the EPE if earnings are less than SGA and you continue to meet Social Security disability criteria.
• If SGA is earned after the EPE, benefits may be terminated.

Expedited Reinstatement

• Allows for reinstatement within 60-months from the last month of entitlement if benefits ceased due to SGA; and
• Must be unable to perform SGA because of the same medical condition;
• Will receive provisional benefits for up to 6 months while a new decision of disability is being made;
• If approved, will receive benefits for any month in which SGA was not achieved subject to retroactivity of 12 months (no earlier than January 2002);
• Entitled to new trial work period after 24 months of paid benefits (may not be consecutive months).

Extended Medicare Coverage�Applicable after the TWP

• Continued eligibility for Medicare for at least 93 months after the TWP ends.
• Must meet SSA disability criteria for Medicare coverage to continue.
• Medicare may extend beyond 93 months as long as there is entitlement to cash benefits.

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ADULT DISABLED KANCARE

SSI & KanCare

• In Kansas, an application for SSI/KanCare is required (apply through Kancare Clearinghouse).
• SSI recipients are eligible for KanCare without a spenddown, client obligation, or premium.

1619(A)

• 1619(a)-allows SSI recipients to receive cash benefits when paid earnings per month plus any other income combined is less than the SSI break even point (BEP).
• This Year’s BEP for Federal Benefit Rate (FBR) single is $1,767.00

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Section 1619(B)�

• Continued KanCare eligibility when the recipient’s wages alone stop SSI check.
• Must have been eligible for SSI for at least one month with 1619a.
• Must need KanCare coverage to continue working.
• Must continue to meet SSI resource limit.
• Meet earnings threshold limit:
• Kansas threshold is $37,223 for 2022 (this amount may change each year) or an individualized threshold as determined by SSA.

Working Healthy Program

Working Healthy is KanCare Coverage:

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Allows people with disabilities to return to or increase their work effort without losing critical KanCare Coverage.

Working Healthy encourages people to work, increase their income and accumulate assets in order to reduce long term reliance on public supports.

Protect and improve the health and environment of all Kansans

Program Highlights

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Working Healthy offers the following to working persons with disabilities:

• Earn more income without loss of medical coverage
• Accumulate assets
• Elimination of spenddown
• KanCare coverage is the same as in the current KanCare program
• Help with Medicare expenses
• In some instances, employer premiums may be paid
• Personal assistance services under WORK
• Medically Improved provision
• Benefits planning and assistance available.

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Help with Medicare

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• Part B premium paid by KanCare
• May enroll in certain Part D plans with no premium (partial premium coverage in remaining Part D plans)
• $0 Part D deductible
• No Part D gap in coverage (donut hole)
• Low co-pays on covered Part D prescriptions

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Eligibility Criteria

• 16-64 years of age.
• Meet the Social Security definition of disability.
• Verified earned income which is subject to FICA/SECA taxes.
• $65.01 minimum income after IRWE, BWE, and income producing

costs are deducted (State rules are different to Federal exemptions)

• Earnings at or above the federal minimum wage (unless self-employed)
• Cannot be on an HCBS Waiver
• Cannot be a SSI cash recipient
• Kansas resident.

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Premiums

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• Some people may be required to pay a monthly Premium for

KanCare coverage.

• Premium amounts are based on the household’s countable

income and are payable monthly.

• Premium amounts will be reviewed by the Clearinghouse

Eligibility Team every 6 months.

• Enrollees are expected to remain current with premium payments.
• WH may end if behind by 2 months or more.
• Premium billing is administered by Gainwell Technologies
• Bills will be mailed monthly with the payment due by the end of the

month.

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Working Healthy – in addition:

Medically Improved Provision

A person who is currently on Working Healthy may remain on Working Healthy even after SSA determines they are medically improved.

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Role of the Benefits Specialists

• Benefits Planning
• Collect data on individual’s current benefits status
• Provide critical analysis of work, earning, and resources in these benefits
• Provide options to the individual and their support network if appropriate about the impact of employment or increased employment on benefits
• Work with the Clearinghouse to establish medical coverage and other benefits
• Compare and contrast WH with other available programs

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Employment Plans

The participant must work with a WH Benefits Specialist to establish an Employment Plan to remain Working Healthy eligible.

Participants may remain enrolled in WH for up to 4 months beginning with the month employment criteria is not met.

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Benefits Specialists

KC Region Vacant. Wichita Region Vacant, North Central Region Vacant.

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Danielle Mowery: Southwest Region danielle.mowery@ks.gov

Shelli Nyambane southeast Region shelli.nyambane@ks.gov

Billie Crawshaw: Northwest Region:

Billie.Crawshaw@ks.gov

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Earl Williams: Northeast Region: earl.williams@ks.gov

Wichita Region: Vacant

Social Security, Medicare, KanCare and Work Incentives

• To Learn More About Working Healthy, WORK or STEPS or to see updated information, Visit Our Website: https://www.kancare.ks.gov

Or Contact:

• Nancy Scott: Director
• nancy.scott@ks.gov
• Madeleine Bowens: WH Sr. Manager madeleine.bowens@ks.gov
• Sherri Marney: WORK Program Manager
• sherri.marney@ks.gov
• Erin Sanders-Hahs: STEPS Program Manager
• Erin.SandersHahs@ks.gov

Contents of this presentation was provided by VCU

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Social Security, Medicare, KanCare and Work Incentives�

Abbreviations

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• SSDI – Social Security Disability Insurance
• SSI – Supplemental Security Income
• CDB – Childhood Disability Benefit
• DWB – Disabled Widow(er)’s Benefit
• FBR – Federal Benefit Rate
• BEP – Break Even Point
• GIE – General Income Exclusion
• TTW – Ticket to Work
• SGA – Substantial Gainful Activity
• TWP – Trial Work Period
• EPE – Extended Period of Eligibility
• TWP – Trial Work Period

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• EPE – Extended Period of Eligibility
• EPMC – Extended Period of Medicare Coverage
• IRWE – Impairment Related Work Expense
• BWE – Blind Work Expenses
• EIE – Earned Income Exclusion
• SSA – Social Security Administration

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Protect and improve the health and environment of all Kansans

Web Site

More information:

Ticket to Work

https://choosework.ssa.gov/ or call 1-866-968-7842

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Apply for KanCare

https://www.kancare.ks.gov/consumers/apply-for-kancare or call 1-800-792-4884

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Thank you/Questions