Revised 6-02
SOCIAL SECURITY ADMINISTRATION/DEPARTMENT
OF VOCATIONAL REHABILITATION
PROGRAM
AUTHORITY
Social Security Act
For the purpose of this manual, use of the terms must
or shall reflect requirements of Federal law or regulation or state
administrative regulation and must be adhered to strictly.
The Department of Vocational Rehabilitation has been
presented a challenge to provide a more effective rehabilitation program to
Social Security Disability Insurance and Supplemental Security Income (SSDI/SSI)
beneficiaries and recipients. As part of this initiative, the Disability
Determination Services, Department for Social Insurance refers individuals
found eligible for disability benefits to the Department. Some SSDI/SSI
beneficiaries or recipients are self-referred, or may be referred by other
sources. The Department helps these eligible consumers develop an Individual
Plan for Employment to assist them in returning to work.
Costs incurred by the Department to help these eligible
individuals return to employment may be recovered by the Department. Under the
authority of the 1981 Amendments to the Social Security Act, the Social
Security Administration is authorized to reimburse the Department of
Vocational Rehabilitation for cost of services provided on a case by case
basis. Only when Vocational Rehabilitation services have resulted in a
beneficiary or recipient performing a "Substantial Gainful Activity"
(SGA) for a continuous period of nine months are these costs recovered.
THE VR ROLE IN REFERRAL OF ALLOWED SSDI/SSI RECIPIENTS
Social Security Allowed Referrals
All Disability Determination Services’ SSI/SSDI
referrals must be contacted by assigned DVR Counselors. Once a referral has been
received an appointment is to be scheduled to discuss services and take an
application if requested. If the letter is returned by the Postal System as
address unknown, at least one attempt should be made by telephone to contact the
referred individual. A completed Referral Response Form and the SSA-831-C3
should be returned to the SSI/SSDI Program Coordinator’s office within 60
days. Individuals who do not apply for or are not currently being served by DVR
are then released to a statewide pool of alternate providers. Other SSA approved
vendors are then able to contact these individuals for assistance in returning
to work.
When referrals are received of current or recent DVR
consumers it is not necessary to schedule an appointment. The counselor should
simply complete the appropriate area of the referral response form and return it
with the SSA-831-C3 form to the SSI/SSDI Program Coordinator’s office.
Confidentiality of SSI/SSDI Information
In some cases, it is possible that the Department
counselor may receive SSI/SSDI entitlement, non-entitlement, or termination
information prior to an applicant’s receipt of an official notice.
Therefore, the counselor should be careful to avoid premature disclosure of
this information to the individual.
SSDI/SSI Beneficiary Status
The counselor should verify each individual applicant’s
Social Security Benefit status. The SSI/SSDI beneficiary block should be
marked appropriately on all Department forms. The documentation may be a copy
of the SSA-831/SSA-833, copy of the award letter, or a progress note
documenting a call to the local Social Security District Office. Frequently,
the individual receives survivor’s or some other type of Social Security
benefits, and the counselor incorrectly marks the status as
"allowed". The individual may be receiving benefits as a Disabled
Adult Child or Disabled Widow or surviving divorced widow on a wage earner’s
(W/E) number. It is NOT appropriate to mark the beneficiary block as
allowed in this instance. The SSDI/SSI status refers ONLY to the individual
who is considered disabled and receives benefits.
Medical Re-Examination Date/Diary Date
Many individuals are qualified for Social Security
Disability Insurance benefits or Supplemental Security Income by reason of
impairments that are expected to improve substantially in the future. Such
claims are scheduled (the Diary Date) for medical re-examination when
appropriate. This information is found in Item 17 on the SSA-831 and item 23
of the SSA-883 or SSA-832.
Use Of Medicare/Medicaid And Other Medical Insurance
All SSDI beneficiaries who have received benefits for
two years (or longer) are eligible for Medicare benefits. SSI recipients are
eligible for Medicaid immediately upon entitlement to SSI payment.
Medicare/Medicaid and other medical insurance shall be utilized in the same
manner as any other available comparable benefit.
Social Security District Office and DVR Coordination
The importance of having close coordination and working
relationships with local Social Security District offices cannot be
overemphasized. Department consumers should be referred to the local Social
Security District Office for any assistance in connection with their
disability claims. They also need to report events such as recovery from
impairments, return to work, termination of work, etc. that may have a bearing
on their claims. Contact with the local Social Security District Office should
be made when Vocational Rehabilitation staff needs information that is not
available from the individual or DDS. The medical information is not available
from the local Social Security District Office.
There are Work Incentive liaisons established in Social
Security District Offices to facilitate good cooperation and working
relationships with DVR. Get to know your Work Incentive Liaison. This person
is an invaluable resource to you in your casework.
GUIDE TO SOCIAL SECURITY DISABILITY AND SSI WORK
INCENTIVES
Most people want to work. It is important for disability
beneficiaries to understand that they can still receive benefits while they
try to work. The Social Security Administration work incentives make it
possible for people with disabilities receiving Social Security Disability
Income (SSDI) or Supplemental Security Income (SSI) to work and still receive
monthly cash payments plus Medicare or Medicaid. Some incentives are different
for SSDI and SSI beneficiaries. For additional materials on work incentives,
refer to your SSA/VR 2002 Red Book on Employment Support. You can also access
up to date information from the following Social Security site as follows:
http://www.ssa.gov
http://www.ssa.gov/work/ResourcesToolkit/workincentives.html
Another resource for helping beneficiaries with work
incentives is Benefits Plus. Benefits Plus counselors will work with
beneficiaries individually to explain these incentives and how they relate to
a specific individual. This program can be contacted at 888-813-8497 (voice)
or 888-813-8652 (TTY). Beneficiaries may also feel more secure in verifying
this information with their local Social Security office.
Substantial Gainful Activity (SGA):
SGA is the performance of significant duties over a
reasonable period of time in work for remuneration. "Significant
duties" implies not only that the duties are useful in accomplishment of
a job or the operations of a business, but also that they have a degree of
economic value. Generally, work that results in substantial earnings would
establish ability to engage in SGA. The SSA earnings criteria for determining
SGA for beneficiaries of Social Security Disability Insurance Benefits and for
recipients of Supplemental Security Income follow. Earnings which
average more than $780 a month are deemed to demonstrate the ability to engage
in SGA in the absence of evidence to the contrary.
Social Security Disability Income (SSDI) Work Incentives
Trial Work Period – A
9-month period, not necessarily consecutive, during which a Social Security
beneficiary’s earnings will not affect his or her benefit. The 9 months of
work must occur within a 60-month period. Any month in which $560 is earned
counts as one month of the total nine months in the trial work period.
If a self-employed person has earnings that are equal to
or less than the dollar amount for this Trial Work Period, it could be
considered that a month of Trial Work has been performed if the self-employed
person works more than 80 hours a month in his or her business.
Extended Period of Eligibility
– For at least 3 years after a successful trial work period, a Social
Security beneficiary may receive a disability check for any month that his or
her earnings are below the substantial gainful activity level. In 2002, these
SGA levels are $780.
Continuation of Medicare
– If Social Security disability payments stop because a person has earnings
at or above the substantial gainful activity level, but the person is still
considered to have an eligible disability, Medicare will continue after the
trial work period. Effective October 2000, premium-free Medicare hospital
insurance can continue for at least 93 months (7 years, 9 months) after the
end of the trial work period.
Impairment-Related Work Expenses
– Certain expenses for things an individual with a disability needs because
of his/her impairment in order to work may be deducted when counting earnings
to determine if the person is performing substantial gainful activity.
Recovery During Vocational Rehabilitation
– If a person recovers while participating in a vocational rehabilitation
program that is likely to lead to becoming self-supporting, benefits may
continue until the program ends. These are known as 501 cases. Contact the SSI/SSDI
Coordinator for help with these situations.
Supplemental Security Income (SSI) Work Incentives
Continuation of SSI – SSI
recipients who work may continue to receive payments until countable income
exceeds SSI limits.
Continuation of Medicaid Eligibility
– Medicaid may continue for SSI recipients who are no longer eligible for
cash payment due to their employment. This individual must have been eligible
for SSI for one month, still be disabled, and need Medicaid to work. See the
Red Book for additional criteria.
Earned Income Exclusion
– When an SSI beneficiary returns to work the first $65 of earnings in a
month plus one-half of the remainder is not counted against their benefits.
The process for calculating income is found in the Red Book.
Plan For Achieving Self-Support
– An SSI recipient may set aside income and resources for up to 48 months
toward an approved plan for achieving self-support (PASS).
Impairment-Related Work Expenses
– Certain expenses for things a person with a disability needs because of
his/her impairment in order to work may be deducted when counting earnings to
determine if a person is eligible and to figure the payment amount.
Recovery During Vocational Rehabilitation
– If a person recovers while participating in a vocational rehabilitation
program that is likely to lead to becoming self-supporting, benefits may
continue until the program ends.
Students with
Disabilities – Tuition, books, and other expenses related to getting an
education may not be counted as income for recipients who attend college or
another training program. Students have an earned income exclusion of $1,320
per month with a maximum yearly exclusion of $5,340. The student must be under
age 22, not married or head of household, and regularly attending school.
PRESUMPTIVE ELIGIBILITY FOR SOCIAL SECURITY REFERRALS
With the Reauthorization of the Rehabilitation Act,
there is a presumptive eligibility of SSI/SSDI recipients. A consumer who
signs the DVR-2 "signifies my intent to work after completion of
Vocational Rehabilitation Services." Any applicant who receives SSI/SDI
would be presumed to be eligible (refer to eligibility section for details).
It is necessary to verify that the individual receives these benefits (refer
to SSDI/SSI Beneficiary Status Section for procedures).
The recipients are also presumed to have a disability
that is significant provided that the individual intends to achieve an
employment outcome consistent with the unique strengths, resources,
priorities, concerns, abilities, capabilities, interests, and informed choice
of the individual. Only by clear and convincing evidence that the individual
cannot benefit from services and after a period of trial work can this
presumption be overcome (refer to Trial Work Experience in this Manual).
A waiver is not an option for presumptive eligibility
applicants. If adequate information is available to determine eligibility, it
is not necessary to wait to accept a case on presumptive eligibility. However,
it is still necessary to verify eligibility for benefits and the disability on
which these benefits are based.
Presumptive Eligibility does not presume these
individuals meet the most significant disability category.
Casework documentation, including self-report, substantiates the appropriate
priority category based upon functional limitations.
THE VR ROLE IN THE REFUSAL PROCESS
Overview Of The Refusal Process
The refusal process begins with the referral of a
beneficiary for VR services. The Department for Disability Determination (DDD)
as well as Social Security Field Offices (SSAFO) refer possible candidates for
rehabilitation to the counselor. The process then becomes dependent on the
counselor’s evaluation of each referred individual. The counselor determines
if the individual can benefit from VR services, or if a Trial Work Experience
is needed. When offering an individual services, the counselor should
encourage the individual to participate by helping the individual to overcome
any obstacles. This includes information about the suspension policy as well
as work incentives. A refusal should be reported only after such efforts have
failed.
Once a refusal has been reported, the Social Security
Regional Office (SSARO) then assumes overall responsibility for the refusal
process. The SSARO coordinates the development of the refusal case,
determines if good cause exists, and initiates any suspension actions. The SSA
Field Office supports the SSARO’s efforts by obtaining and developing
any evidence requested.
THE VR ROLE IN REPORTING FAILURE OF AN SSDI/SSI
BENEFICIARY TO COOPERATE WITH VOCATIONAL REHABILITATION
The Department has a responsibility under the law to
notify SSA when a beneficiary or recipient’s lack of cooperation with the
Department constitutes a "refusal" of services or whether the
beneficiary or recipient has "good cause" for such a refusal. It is
the counselor’s discretion to determine when or if such a report will be
made. The Department need not, and should not, make a judgement as to whether
the beneficiary/recipient’s failure to cooperate constitutes refusal of
Department services, even if it appears obvious that such is the case. The
Department need only report to SSA the efforts undertaken to gain the
beneficiary/recipient’s cooperation and the response or lack of response on
the part of the beneficiary/recipient. This "Failure to Cooperate"
report is done on the SSA Form SSA-1408U4.
Types of Refusal
A VR refusal issue can arise at any point in the VR
process beginning from the time the counselor first attempts to contact the
person through the person’s refusal to undertake job placement after
completing VR services. Different issues are involved at different stages of
this process; thus, two types of refusal should reported:
Failure to Respond Refusal
The referred person fails to respond to the counselor’s
significant attempt at contact. Significant attempt is more than just a single
routine attempt at contact for which the counselor gets no response. It is
more than one letter or telephone call. It may include several letters,
telephone calls, and attempts at personal contact. It should include an
attempt to contact the person at the address to which benefit checks are being
sent. (The counselor may want to contact the local SSAFO to determine the
address to which payments are being made.) It is assumed that the counselor
will make a significant attempt at contact if the counselor has interest in
the person and has reason to believe the person may benefit from VR services.
Failure to Participate Refusal
There are two types of situations in which this type of
refusal may occur.
- The consumer has applied for vocational
rehabilitation services, signed the DVR-2 application implying willingness
to return to work, but the person either refuses to participate in the
development of an Individualized Plan for Employment (IPE) or to sign the
IPE.
- The counselor has determined that VR services could
contribute to the person’s return to work. The person has agreed to
services under an IPE, but then fails to participate or continue
participation in VR services or undertake job placement if this is part of
their IPE.
NOTE: It is not a refusal to participate when the
consumer chooses a vocational objective that is below SGA.
Both types of refusal may result in suspension of
benefits. Some people may initially be reported as "failure to
respond" refusal and, after subsequent contact by the counselor, become a
"failure to participate" refusal.
The counselor’s role is critical because of the
responsibility for starting the process by reporting VR refusal. The goal of
the refusal process is to encourage participation in VR programs, not to
suspend benefits. To help accomplish this goal, the counselor should make
every effort to contact referred people believed to be able to benefit from VR
services and to work with beneficiaries to the fullest extent possible to
overcome any obstacles preventing participation in VR services and their
successful job placement. A refusal should be reported only if the counselor
has been unsuccessful in these efforts and believes that good cause does not
exist.
If the counselor has a consumer who is not cooperating
with VR, the counselor should first report this situation to the local Social
Security Office for assistance in getting the consumer to cooperate. If, after
30 days, the consumer refuses to cooperate with VR, the SSA-1408U4
"Failure to Cooperate" report is to be completed and submitted to
the SSA/DVR Coordinator.
SOCIAL SECURITY REIMBURSEMENT PROGRAM
The Social Security Administration will reimburse the
Department for administrative and direct costs incurred helping an SSDI/SSI
recipient return to work. Generally, the closing counselor will be sent a
letter from the State Coordinator asking for the case to review and submit a
claim to SSA for these expenses. In some instances, the closing counselor
should notify the State Coordinator if the consumer has been at SGA for nine
months. SSA will only reimburse if the Department’s claim is filed no later
than twelve months after the consumer has worked nine months at SGA.
Therefore, it is very important to track a consumer’s earnings. SSA does not
base the reimbursement on the consumer’s closure date with DVR. It is based
solely on the date the individual has reached nine out of twelve months of
continuous SGA and benefits are discontinued or significantly reduced.
NOTE: Helen Martin, the Department’s SSI/SSDI VR
Program State Coordinator sends letters requesting cases for review. Send the
requested cases immediately. The reimbursement review and request must be sent
to Social Security Administration within a strict timeframe. The Department
will lose these reimbursements if not submitted within this established
timeframe. There are NO EXCEPTIONS.
TICKET TO WORK AND WORK INCENTIVES IMPROVEMENT ACT
To assist individuals with disabilities in their efforts
to achieve self-sufficiency and social and economic independence, Former
President Clinton signed into law the Ticket to Work and Work Incentives
Improvement Act of 1999 (Public Law 107-170) on December 17, 1999.
The Ticket to Work Incentives Improvement Act has four
purposes:
