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                                             Winter 2003-4

    During the past year, I have received numerous questions about the Expedited Reinstatement of

Benefits regulations.  This is a relatively new provision applicable to Social Security beneficiaries

and SSI recipients. I believe it is an extremely valuable work incentive.  For years, I encountered

people who were fearful of earning too much money and terminating from benefits, because it

took them a considerable amount of time to qualify the first time.  They were afraid it would be

more difficult to re-qualify if they worked, had significant income, terminated from benefits due to

income, and then their impairment forced them to leave employment.

    A provision in the Ticket to Work and Work Incentives Improvement Act of 1999 allows a

beneficiary to request an Expedited Reinstatement  of benefits within five years of their Termination

Month.  This new work incentive went into effect January 1, 2001 and applies to any beneficiary

who terminated from benefits  because significant earned income, after January 1996. 

    While the rules are similar in both program, I will break the explanation into two parts to avoid

confusing people.

    To qualify for the Expedited Reinstatement (EXR) of benefits the person must terminate from

benefits because of countable income (wages) above Substantial Gainful Activity (SGA) level

(countable income of $810 or more per month in 2004).  For the following 5 years, after the

Termination Month, the person can request an EXR if s/he is unable to continue to perform SGA

due to the medical condition that originally qualified him/her for benefits or a condition related to

the original impairment.  The medical condition either required the person to:

1. leave employment;

2. reduce work hours;

3. incur Impairment-related Work Expenses; or

4. receive subsidy or special work conditions.

    SSA will issue a provisional cash benefit for up to six months, beginning the month after the

request for an EXR is filed by the person.  The amount of the cash benefit will include the previous

award amount plus any cost-of-living increases and adjustments due to additional payments to the

trust fund (FICA from wages).  The person will also qualify for Medicare during this provisional

period.

    SSA will forward the case to the state Disability Determination Services (DDS).  It is the

responsibility of the DDS to review the case for possible medical improvement since the initial

period of disability.  Again, it must be pointed out - the person is requesting an EXR on the original

impairment(s) or a condition directly related to the original impairments.  If another impairment has

caused the loss of employment or reduction of countable income below SGA, the person must file

a new application for benefits. 

    NOTE: The law requires SSA to expedite the provisional payments, but the law did not require

    the DDS to be as expedious.  I strongly recommend that anyone requesting the EXR do their

    homework before filing the request.  Bring current medical reports documenting the deterioration

    of the medical condition and/or documentation of the need to use subsidy or Impairment-related

    Work Expenses.

If the medical condition has been found to have not improved, the person is given a 24-month initial

reinstatement period (IRP) of cash benefits.  This IRP can be renewed, if necessary.  At the

completion of the IRP, the beneficiary begins a NEW Trial Work Period and Extended Period of

Eligibility!  This cycle can be repeated multiple times provided the beneficiary continues to meet

basic eligibility requirements.

                                                       What is the bottom line? 

There has never been a better protection of benefit entitlement.  In addition, twenty-six states now

offer Medicaid to many individuals with disability who work and meet basic eligibility requirements.

    This new work incentive applies to any SSI recipient who terminated from benefits because annual

earned income exceeded the SGA amount and the applicable state threshold amount, after January

1996. 

    To qualify for the Expedited Reinstatement (EXR) of benefits the person must terminate from

benefits  because of countable earned income above SGA.  For 5 years following the Termination

Month, the person can request an EXR if s/he is unable to continue to perform SGA due to the

medical condition that originally qualified him/her for benefits or a condition related to the original

mpairment.  The medical condition either required the person to:

1. leave employment;

2. reduce work hours (countable earned income below SGA); or

3. incur Impairment-related Work Expenses.

    SSA will issue a provisional cash benefit for up to six months, beginning the month after the request

for EXR is filed by the person.  The amount of the cash benefit will reduced by countable unearned

income and countable earned income available to the recipient.  The person will not receive the state

supplement (if applicable) to the SSI cash benefit.  The person will also qualify for Medicaid during

this provisional six month period.

    SSA will forward the case to the state Disability Determination Services (DDS).  It is the

responsibility of the DDS to review the case for possible medical improvement since the initial period

of disability.  Again, it must be pointed out - the person is requesting an EXR on the original

impairment(s) or a condition directly related to the original impairments.  If another impairment has

caused the loss of mployment or reduction of countable income below SGA, the person must file a

new application for benefits. 

    NOTE: The law requires SSA to expedite the provisional payments, but the law did not require

    the DDS to be as expedious.  I strongly recommend anyone requesting the EXR do their homework

    before filing the request.  Bring current medical reports documenting the deterioration of the medical

    condition and/or documentation of the need to use Impairment-related Work Expenses.

    If the medical condition has not improved, the person is given a 24-month initial reinstatement

period (IRP) of cash benefits.  This IRP can be renewed, if necessary.  Once the provisional period

has elapsed and the IRP begins,  the recipient can receive cash benefits under 1611 status, Section

1619(a) status, or Section 1619(b) status.  This cycle can be repeated multiple times provided the

recipient continues to meet basic eligibility requirements.

                                                  What is the bottom line?   

    Maximus has announced a simplified outcome payment request process entitled: Certification

Payment Request Process.  This is a significant improvement over the previous method, but it

contains a major hazard for Employment Networks (EN).

    Previously, Employment Networks or State Vocational Rehabilitation agencies electing the EN

method of payment for a ticket holder had to produce proof of wages when requesting payment

from SSA.  It was expected, this proof of wages would become extremely difficult to accomplish

over a five-year period or longer.  The Certification Payment Request Process allows the EN or

State VR agency to request payment after the beneficiary has worked for three continuous months

at specified amounts of income, without proof of wages.

    In the outcome only payment system, the EN can use the process after the beneficiary has

achieved three continuous months of earnings high enough to stop the cash benefit and the EN has

been paid for those three months.  After this criteria has been met the EN can submit a

Certification Payment Request every three months, if the person continues to work and achieve

earning high enough to preclude payment of cash benefits.

    Within the outcome-milestone payment system, the EN can use the process after 1) the

beneficiary has achieved milestones, (gross earnings over Substantial Gainful Activity level;  2) the

EN has been paid for some or all milestones; and  3) the beneficiary has achieved three continuous

months of Substantial Gainful Activity (milestones) followed immediately by earnings high enough

to stop the payment of cash benefits (outcome payment).   After this critera has been met the EN

can submit a Certification Payment Request every three months, if the person continues to work

and achieve earnings high enough to preclude payment of cash benefits.

    The hazard: While SSA will honor the request for payment, the Employment Network must

realize SSA will later verify the person’s countable income.  During this later review, if it is found

the beneficiary was eligible for a cash benefit in any month for which the EN received an outcome

payment, the EN must refund the payment to SSA.  For example: The person’s monthly wages

were $1,200 thus the cash benefit stopped and the EN received outcome payments for the

months this was achieved.  Later during a work review, SSA determined the person had

unclaimed Impairment-related Work Expenses or Subsidy during the period of work.  SSA

determines the countable income was $700 during the period of work.  The criteria for an

Outcome payment was not met and the EN will have to return the appropriate payments..

    A team of agencies and organizations have organized a one day workshop on Social Security,

SSI, Medicaid, and Medicare benefits for professionals of the mental health community.  The

team, made up of the RI Division of Behavioral Healthcare Services, RI Council of Community

Health Organizations, Sherlock Center on Disabilities, the New England RCCEP, and others

pulled together the resources to conduct this workshop. 

    Over 50 professionals serving individuals with mental illness are expected to attend.  The workshop

will be held on November 24^th at the Amica Mutual Insurance Co. on Amica Way in Lincoln, RI

(off Route 146).  Amica will provide the training facility, refreshments, and lunch as a community

service. If you are interested in attending this workshop contact Susan Turner, Training Director,

RI Council of Community Mental Health Organizations, T: (401) 273-0900 or e-mail:

sturner@riccmho.org. We sincerely appreciate the efforts of Ann Boyd, Vocational Rehabilitation

Program Manager for East Bay Mental Health Center, for spearheading the organization of this

workshop.

    The SSA has proposed changing rules for Section 301 to expand access to this work incentive for

title II beneficiaries and SSI recipients.

    Background: When a beneficiary has been found by the SSA to have medically improved, the

person is terminated from benefits (regardless if they are working or not).  Section 301 Continuation

of Benefit Payments... is a work incentive that permits SSA to continue the cash benefit to a

beneficiary, who medically improves, while s/he is participating in an approved vocational

rehabilitation program.   Currently, Section 301 applies to participants of State Vocational

Rehabilitation programs, participants of SSA research and demonstration programs, and other

organizations approved by SSA (in the old days: Alternate Participants).  To qualify for this work

incentive, the person must be enrolled and engaged in a vocational program prior to the finding of

medical improvement, and the continued participation in the program will (probably) result in the

person being able to be self-sufficient at the conclusion of the program.  If approved, the cash

benefit would stop when the person completes the vocational program or terminates participation

in the program.

Proposed: SSA would like to expand this protection to a larger variety of service systems, in

particular, school-to-work transition programs.  Children receiving SSI must re-qualify for SSI at

years of age.  The SSA is using adult medical criteria to determine eligibility for SSI at this step. 

Many children do not re-qualify for SSI because their medical condition is not severe enough to

meet this critera.  SSA has proposes the application of Section 301 in these situations, if the

student has an IEP (Individualized Education Plan), under 22 years of age, and is engaged in

preparing for adulthood (employment) according to the IEP.  Under Section 301 (proposed),

the medically-improved student would continue to SSI until completion of the school program

or attaining 22 years of age, whichever occurs first.  (Problem: in some school districts,

“mainstreamed” students with a disability do not have an IEP.)

SSA has also proposed expanding access to Section 301 to: “ an appropriate program of

vocational rehabilitation services, employment services, or other support services,” which means

one of the following:

1. A program carried out under an individualized plan for employment with a State vocational

    rehabilitation agency operating under a State plan approved under title I of the Rehabilitation

    Act of 1973, as amended;

2. A program which is carried out by an organization administering a Vocational Rehabilitation

    Services Project for American Indians with Disabilities authorized under section 121 of part C

    of title I of the Rehabilitation Act of 1973, as amended (29 U.S.C. 750 et seq.);

3. A program of vocational rehabilitation services, employment services, or other support services

    carried out under a similar individualized employment plan with another provider of services

    approved by us (my insert - SSA); or

4. An individualized education program (IEP) developed under policies and procedures approved

    by the Secretary of Education for assistance to States for the education of children with disabilities

    under the Individuals with Disabilities Education Act (IDEA), as amended (20 U.S.C.

    1400 et seq.).”

    While it is not clearly identified, there is a reference to including such programs as Dept. of Labor

One Stop Centers, WIA programs,  Job Corps, Vista, etc.  in the fourth provision “... another

provider of services approved by SSA.”  I know many people will ask.. “does this include people

in our facility-based program?”  Unfortunately, NO.  The provision states approval of Section 301

is for a specified period of time and a determination has been made that the person will ”probably”

be self-sufficient at the conclusion of the program.

    If you would like to review the proposed rule changes go to the Federal Register, August 1, 2003

(Volume 68, Number 148), Page 45180-45190.  Access this at the following address: http://www.ssa.gov/regulations/ssa-policy-comments.htm   select “Proposed Rule Changes Closed to

Public Comment” in the left column, once there, then select “0960-AF86 - Continuation of Benefit

Payments to Certain Individuals Who Are Participating in a Program of Vocational Rehabilitation

Services, Employment Services, or Other Support Services.”  (At the bottom of the list, last time

I looked.)

    The Luzerne-Wyoming Counties MH/MR Board, Wilkes-Barre, PA will be conducting a

workshop for parents and provider agencies.  The workshop will address the issues raised by parents

and care-givers for individuals who are entitled to title II benefits and/or eligible for SSI.  The Board

has recognized a significant number of questions about the impact of employment (wages) on eligibility

for the Home and Community-based Waiver Program services, share-of-cost Medical Assistance,

the Medical Assistance for Working Disabled program, personal service planning, and related issues. 

    This is an increasing concern to parents throughout the U.S. Typically, they relay upon support staff

to know the answers to very difficult questions.  We have created a unique workshop for this

audience; it blends their specific questions into federal and state program structures and rules.  Mike

will conduct this workshop on November 21^st in the Wilkes-Barre, PA area.  Contact Gina Galli,

email: for additional information about attending this workshop.

    Is it possible to have to many benefit advisers?  Not many places have this question to think about

or answer.  Through the continuing efforts of the Delaware Department of Vocational Rehabilitation,

benefit advisement is available throughout the state.  Funding has been made available through the

SSA (BPOA), the US Department of Education (demonstration grant), the US Department of

Labor (Navigator program), and additional state resources to offer a wealth of benefit counseling

services.  The SSA’s public affairs department has been supporting this service development and

expansion with a committee organized by Delaware Dept. of Vocational Rehabilitation.  The goal

is to further expand this service by qualifying professionals within community organizations to

provide benefit advisement. 

    In December, the Delaware Dept. of Vocational Rehabilitation’s planning committee, with the

support of SSA and state agencies, will be conducting a two-day workshop in Dover to accomplish

this goal.  Mike Walling will lead to training portion of the workshop.  If you interested in additional

information about the workshop on December 2^nd and 3^rd or information about Delaware’s project,

contact Michael McGarrity, Project Coordinator, DE Dept. of Vocational Rehabilitation at

(302) 761-8275/ E-mail: MmcGarrity@dvr.state.de.us.

    Frequently, I am asked questions about how federal and government employment effects entitlement

to benefits in the SSA program.  This is always a difficult topic to address because there are so

many rules and these rules may be particular to a specific employment situation.

    SSA has constructed a web site to address questions specific to government employees and

others who have not participated in the Social Security program (federal taxes were not taken

out of wages).  I would recommend you visit this website for answers.  The address is:

http://www.ssa.gov/slge/.

    Through the efforts of Connie Meyer of the Liberty Centre Clubhouse, Mike will be conducting a

workshop sponsored by the Business and Industry Department of  Northeast Community College,

in Norfolk, NE.  The training program will be a basic workshop with time set aside for Q&A

about the Ticket to Work program and Nebraska’s Working Disabled Medicaid program.  If you

are interested in attending this workshop, scheduled for October 21^st,  contact  Joe Ferguson,

Director of Business & Industry, Northeast Community College,  (402) 371-2020.

    Many of you have attended our basic workshop on SSA benefits, work incentives, Medicaid,

and Medicare.  While this basic workshop (let’s call it SSA 101) remains popular for training new

employees and a refresher for others, many customers have asked for an advanced workshop.

    So, in 2004, we are rolling out “SSA 401, Beyond the Basics of Social Security, SSI,

Medicaid, and Medicare.”  This new one-day workshop will cover such topics as concurrent

beneficiaries, SSI deeming process, use of multiple work incentives, and enable audiences to

apply material to case examples.  It will be combination of presentation of new information and

hands-on practice with the case examples.

    If you are interested in hosting this new workshop, let us know.  E-mail us at wallinginc@aol.com .

Also, we offer two other workshops, which are only provided upon request.  “Children’s Benefits

and Medicaid,” and  “What Parents / Care Givers need to know about SSA Benefits and

Medical Benefits.”   The “Childrens’ Benefits and Medicaid” workshop includes eligibility

requirements, deeming of parents’ income, and the issues (and solutions)  parents and professionals

face in the school-to-work transition period. 

    The “What Parents / Care Givers need to know about SSA Benefits and Medical Benefits”

workshop focuses on the issues most parents and care-givers have regarding the maintenance of

benefits (particularly Medicaid) and employment.  Generally, we divide this workshop in two parts,

the morning focuses on SSI and Medicaid and the afternoon presentation is on Social Security and

Medicare.  This schedule allows parents/ care-givers to attend the session appropriate for their

family member.

(We picked this up at Maximus’ web page.  You may want to check it out.)

    The Beaumont Foundation of America (http://www.bmtfoundation.com/bfa/us/public/)  grants

Toshiba branded equipment to support digital inclusion for underserved individuals. The

Foundation will grant $350 million in all 50 states and the District of Columbia. The Foundation

has three distinct grant programs:

        a.      Community Grants of technology equipment to community-based organizations;

        b.      Education Grants of technology equipment for schools; and

        c.       Individual Grants to technology equipment directly to individuals.

    In 2003, the Foundation awarded grants in 21 states and the District of Columbia (Group A). In

2004, the Foundation will award grants in the remaining 29 states (Group B). Additional grants will

be available in subsequent years.

    An opportunity exists for schools and community based organizations that serve low-income

individuals, as well as low-income individuals themselves, to apply to the Beaumont Foundation

of America for Toshiba branded computer hardware to assist these sectors in accessing technology.

This Foundation must distribute $350 million dollars worth of this equipment over the next five

years. The Foundation will award grants in 21 states and the District of Columbia in 2004, and

the remaining 29 states in following years. The application process, as well as other information,

is located on the attached website address. For individuals interested in this equipment, they

simply apply via telephone and submit proof of their disability.

    Many people have called asking for more details on hosting workshop on Social Security and

medical benefits, which is presented by Michael Walling.  To some people think the offer sounds

too simple and there must be a catch.   

    By serving as the host organization (or agency) for a workshop, the organization has ten free seats

at the workshop.   This certainly reduces staff training costs, particularly when your program is on

a tight budget.

    We ask the host organization to provide meeting space, for approximately 40 people, in a classroom

setting.  The host organization is responsible for providing light refreshments (coffee, soda, snack

foods).  We also ask the host organization to distribute an advertisement of the workshop to local

contacts, as they have a better mailing list of contacts in the local area.

    The host organization’s distribution of the advertisement is an important role in suburban and rural

areas. This usually assures a minimum registration of people to conduct the workshop.  We supply the

master copy of the ad by e-mail and/or mail.

    Michael Walling and Associates, Inc. will provide the trainer, the training materials, and audio-visual

equipment.  Travel and lodging costs are covered by our company.  In addition, we take care of

registration matters and the confirmation of registrations.

    Host organizations have used a variety of free meeting space when their own facility was inadequate

to accommodate the workshop.  The meeting site must be accessible to individuals with disability.

    We maintain a list of interested organizations and contact them approximately 3 months prior to the

week Michael will be in their area. Contact us if you would like to host a workshop during 2004. 

You can reach us by phone: (610) 696-1551, fax (610) 932-0428, or by e-mail:

wallinginc@aol.com.

If you would like to receive future editions of our newsletter directly, simply send us an e-mail request. 

We will add you to the distribution list.  Many organizations do not allow staff to receive attachments

to e-mails, thus we will fax the newsletter and announcements of upcoming workshops upon request. 

E-mail your request to: wallinginc@aol.com.

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