SSI & SSDI: Applications of Work Incentive Provisions, Other Rules

Case Study

On analysis sheets please provide your name, address, phone number and email.

Make sure to attach all Computation, Trial Work Period, Extended Period of Eligibility and Extended Medicare worksheets used in your responses.  Remember, content and writing style count and you should respond to questions as though responding to a beneficiary.

[Please assume that Sandy’s SSDI and SSI rates do not change as the years change. The SSI rates in question for each year will be the FBR for 2015.  In addition please use the 2015 TWP, SGA, and SEIE rates throughout the entire case study.  Use the POMS to find the appropriate numbers!  DO NOT USE STATE SUPPLEMENTS!]

Scenario #1

Sandy is 38-years old and lives with her mother.  Sandy does not contribute to household expenses.  During her early and mid-20s, Sandy worked as a clerk.  At age 30, Sandy had an emotional breakdown and was hospitalized for several months.  During the next four years, she attempted to work several times but each time she had a relapse and was forced to stop working.  Finally, at age 34 she stopped work altogether and applied for Social Security Disability Insurance (SSDI) benefits.  Her claim was denied at both the initial level and at reconsideration.  She then sought an attorney and her claim was then approved when she appeared before an Administrative Law Judge (ALJ).

Sandy has now been collecting SSDI benefits since her claim was approved by the ALJ.  Her monthly check is $635 and she qualifies for Medicaid because her monthly countable income is less than $1000, the one-person income limit for Medicaid under her state’s “medically needy program.”  If it was higher she would be required to pay a Medicaid “spend down.” 

1.           Sandy has called you and wants to know if she qualifies for SSI.  She claims that a friend gets a similar amount of SSDI per month and qualifies for a small SSI check.  Is Sandy eligible for SSI?

Scenario #2

Let’s change the facts a little.  In June 2015, Sandy told you she was thinking of moving into her own apartment.  She knew that money would be tight but she had been offered a pretty good deal.  She wanted to know if either her SSDI benefits would increase upon moving out or if she would now qualify for an SSI supplement.

2.           Please answer Sandy’s questions.

              a.           Will her SSDI benefits increase? Please explain.

              b.           Will she now qualify for an SSI supplement?  If so, how much?

3.           Sandy’s mother recently received a $20,000 inheritance and gave one half of it to Sandy.

              a.           Will this $10,000 gift affect Sandy’s SSDI eligibility?  Please explain.

              b.           If Sandy is receiving SSI, will the $10,000 gift affect her SSI eligibility?  If so, how?

Scenario #3

In January 2015, Sandy is offered work with a bulk mailing service run by a private rehabilitation agency, Disability Rehab, Inc.  Sandy has not worked since obtaining SSDI.  This is unskilled work and Sandy will have support from a job coach.  She will work 100 hours per month and make $8.75 per hour, a total of $875 gross per month.

Sandy calls you.  She is excited about getting out of her apartment and working again, but is also nervous about this opportunity.  She has heard stories about people losing all their benefits when they go to work; about the trial work period; and about being able to work and keep half her benefits.  She also has heard something about the “16 something or other - c” program but has no idea what that is about.  Sandy has become agitated in response to all of these issues.  She is also obviously confused and is in need of your support.

4.           How will this work affect her SSDI?

              a.           Will she have a trial work period (TWP)?  If so, how will this work affect her TWP?

              b.           What about the extended period of eligibility (EPE)?  What is her status with regard to the EPE?

              c.           Will her wages affect the amount of SSDI she gets each month? Please explain.

5.           How will this work affect Sandy’s SSI cash benefit? Please explain.

6.           Is she protected by any special work incentive that allows her to keep her Medicaid benefits?

              Please explain.

Scenario #4

Sandy continues working throughout 2015, making $875 per month at Disability Rehab.  Based on her performance, in January 2016 she is placed at a commercial business, Bulk Mailers, Inc., that does similar work.

Throughout the first nine months of 2016, Sandy works at Bulk Mailers, Inc. and earns $1190 gross per month, working 100 hours per month at $11.90 per hour.  During the first three months at this job (January – March 2016), she receives three hours of job coaching services per week.  Disability Rehab supplies the job coach services at a cost to ABC of $20 per hour (covering salary, fringe benefits, and overhead).  Disability Rehab had explained to Sandy that it would only provide job coach services for three months as they expected her to learn her job in that period.  Since she is still having problems, Sandy decides to hire a private job coach at $20 an hour for 3 additional months (April – June 2016).  Starting in July 2016, Sandy works without any job coach services.  In September 2016, Bulk Mailers tells her it is about to hit its busy season and will give Sandy more hours.  She will earn $1584 gross during October, and expects to earn the same in November and December 2016.

Sandy has reported all of this information to the Social Security Administration (SSA) in a timely fashion.  Through September 2016, she has continued to receive SSDI benefits of $635 per month, with no SSI.  She calls you in late September 2016 because she has heard nothing from SSA and is very nervous about all of this.  Recently, a friend told her about another friend who, like Sandy, had worked for two years with no word from SSA.  He wound up having his benefits terminated and incurring a $15,000 overpayment.

7.           Please explain how would you deal with Sandy’s concerns?

8.           Sandy wants to know if she was entitled to the SSDI benefits she received during all of 2015 and the first nine months of 2016.  Please go over the entire period for her based on what you know about the TWP and EPE rules.

              a.           Does Sandy have any impairment related work expenses (IRWEs) and/or subsidy and/or a special condition?  Please explain. How does that fit into your analysis?

              b.           Please describe any special work incentive that may allow Sandy to keep her Medicaid benefits?

9.           Sandy has not received SSI benefits since shortly after she started the work at Disability Rehab in January 2016.

a.           Assume that Sandy gets no SSDI check in July 2015.  Will she now be eligible for an SSI check?  If so, how much will she get in SSI benefits?

Scenario #5

On January 2, 2017, Sandy is called by her boss at Bulk Mailers, Inc.  It seems that the company has a major problem with its computers and other processing equipment.  The company will be subcontracting out most of its work until the problem is fixed.  Sandy is to be laid off and will not be able to return to work until June 1st.  She will receive no paychecks during the five-month period, January through May 2017.

Sandy calls you and is all upset.  She stopped getting SSDI checks in December after you insisted that she let you call all her latest wage information into SSA.  She now is without an SSDI check or a paycheck.  Worse yet, she was depending on her paycheck to pay her rent.  What is she to do?

10.         Can she get her SSDI checks back?  If yes, under what theory?  What will she need to do?

11.         Sandy asks you again about SSI.  Is there any way that she will now qualify for SSI? Please explain.

12.         What about Medicaid benefits.  Will she be eligible for Medicaid?  Under what theory?  Please explain.

13.         If Sandy cannot pay her rent during January 2017, and considering your local, state and community resources, is there any place she can go for help? Please explain.

14.         You sense that Sandy may be heading toward a worsening or recurring episode of her mental illness symptoms.  You, however, are not a mental health counselor.  What can you do or recommend? Please explain.

15.         Is there any other benefit out there for which Sandy may be eligible?

Scenario #6

It is now the first week of June 2017.  Sandy has gone back to work at Bulk Mailers.  She will be earning $952 gross per month and continue at that rate of pay at least through the summer working 80 hours per month at her old pay rate of $11.90 per hour.

Sandy now calls you again.  She wants to know about her potential eligibility for SSDI, SSI, and Medicaid.  She is less certain now about the security of the job and wants to be sure she is not left “high and dry” if the job should suddenly end.

16.         Please explain what will happen with Sandy’s SSDI upon her return to work?

17.         Will she be eligible for SSI?

18.         What about Medicaid?

19.         Please explain what happens to her benefits if the paychecks suddenly end again?

Scenario #7

Sandy continues to earn $952 gross per month throughout 2017.  Her wages are expected to increase to $1,350 gross per month in January 2018 and remain at that level throughout 2018.

20.         Please explain what will happen to Sandy’s SSDI during the remainder of 2017.

21.         What will happen to her SSDI in 2018?

22.         What can you tell Sandy about her future eligibility for expedited reinstatement of benefits?  Will she ever qualify for a new trial work period or extended period of eligibility?  If so, explain how Sandy might qualify for a new trial work period or extended period of eligibility.

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