One of Puna Kamali’i Flowers, Inc.’s top priorities is the promotion of a successful Hawaii economy and infrastructure so businesses of all sizes can flourish and provide job opportunities for everyone.

 

Free Assistance to Ticket Holders

Puna Kamali’i Flowers, Inc. has a contract with the Social Security Administration to provide free work related services to qualified beneficiaries of SSI and/or SSDI through the Ticket to Work program.

If you are between the ages of 18 and 64, receive SSI and/or SSDI, and would like to try working, Employment Network Hawaii can help.  We are an authorized Employment Network (EN) contracted by the Social Security Administration to provide work related services such as assistance with resume writing, job searching, training and retention services at no cost to you!

Didn’t receive a “TICKET” in the mail? Don’t worry, just give Marc Uebelhardt a call, he’s our Ticket to Work Employment Specialist. He can help with that and any other questions you may have.

Call Toll Free: 1-855-930-6200

E-mail: benefits@enhawaii.com

Substantial Gainful Activity (SGA)

Substantial Gainful Activity (SGA) is used to describe a level of work activity and earnings. The performance of significant physical and/or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit, regardless of the legality of the work. SSA evaluates the work activity of persons claiming or receiving disability benefits under Social Security Disability Insurance (SSDI), and/or claiming benefits because of a disability (other than blindness) under Supplemental Security Income (SSI). Under both programs, SSA uses earnings guidelines to evaluate work activity to decide whether the work activity is substantial gainful activity and whether the individual is considered disabled under the law. means the performance of significant physical and/or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit, regardless of the legality of the work.

Generally, if you are employed and have “countable earnings” over $980 per month in 2009 ($940 in 2008), you are considered to be engaging in Substantial Gainful Activity (SGA). If you are blind, the SGA level is $1,640 in 2009 ($1,570 in 2008). These figures are automatically adjusted each year. SGA levels for other years may be found in the table below.

If you are self-employed, the SSA does not consider your income alone when determining if you are engaging in SGA, since your actual income may not be the same as the value of your work activity. See Self-Employment Income and SGA for details about how SSA evaluates Self-Employment Income for purposes of determining whether or not you are engaging in Substantial Gainful Activity.

Effective January 2001, SSA will ordinarily consider an employee whose earnings are equal to or less than the SGA amount not to be engaging in SGA. SSA will go beyond looking at earnings only when circumstances indicate that an employee may actually be engaging in SGA or might be in a position to defer or suppress earnings — for example, an individual working for a small corporation owned by a relative or by the individual. If evidence shows the individual is in a position to defer or suppress his/her earnings, than the work activity is comparable to an individual who is self-employed.

The effects of engaging in SGA are very different in the two programs. See SGA – SSI for more information on how SGA affects SSI (Title XVI) recipients; and see SGA – SSDI (Title II) for information on how engaging in SGA affects SSDI (Title II) beneficiaries and their dependents.

The table below shows SGA levels for earlier periods:

Effective Date SGA Blind SGA
January 2009 $980 $1,640
January 2008 940 1,570
January 2007 900 1,500
January 2006 860 1,450
January 2005 830 1,380
January 2004 810 1,350
January 2003 800 1,330
January 2002 780 1,300
January 2001 740 1,240
January 2000 700 1,170
July 1999 700 1,110
January 1999 500 1,110
January 1998 500 1,050

NOTE: For Title II beneficiaries, SSA counts the gross monthly income earned in the calendar month, rather than what was received, based on pay dates.

Subsidies and Special Conditions

Subsidy and special condition are SSA’s names for support an individual receives on the job that may result in the individual receiving more pay than the actual value of the services being performed. Subsidy is support provided by the employer. Special conditions are generally provided by someone other than the employer, for example a vocation rehabilitation agency.

SSA considers the existence of subsidy and special conditions when making an SGA decision. Only earning that represent the real value of the work being performed is used to determine if the work is at the SGA level.

SGA Determination Process

In making SGA determinations, the SSA claims representative will contact Title II beneficiaries. In some cases, the review will be handled by mail or telephone, but in most cases it will be conducted in the local SSA office. The claims representative needs information from the individual’s employer and/or may refer the case for a medical determination to determine whether the individual continues to have a disabling condition. The claims representative will request information from the individual and their employer regarding extra support and supervision supplied, and special accommodations and arrangements made, to enable individuals to obtain and maintain employment. This form is called the Work Activity Report and is available online or available at the local social security office. Communication should occur, with all parties submitting information to ensure accurate presentation of employment situations.

Trial Work Period (TWP)

The TWP allows you to test your ability to work for at least 9 months. During your TWP, you will receive full SSDI benefits regardless of how high your earnings might be as long as your work activity has been reported and you have a disabling impairment.

Your TWP starts the first month you are eligible for SSDI benefits or the month in which you file for benefits, whichever is later.

The TWP continues until you accumulate 9 months (not necessarily consecutive) in which you perform what we call “services” within a rolling 60-month period. We use this “services” rule only to count TWP months.

In 2009, we consider your work to be “services” if your gross earnings are more than $700 a month, or if you work more than 80 hours in self-employment in a month.

When your TWP is complete, you become eligible for other employment supports.

Extended Period of Eligibility (EPE)

SSI is a monthly cash benefit that is available from the Social Security Administration to help low income children and adults with disabilities.

The amount of SSI cash benefits depend on the type (i.e. earned, unearned, or in-kind support) and the amount of income, support, or resources available to the individual.

SSI recipients can go to work and retain some, if not all of their benefit through the use of “Work Incentives”. Some of the work incentives available to SSI recipients are:

General Income Exclusion (GIE) SSA excludes the first $20 of income from any source.

Student Earned Income Exclusion (SEIE) Allows a person under age 22, not married, not head of household, and attending school on a regular basis to exclude up to $1640/month or up to $6600 for the year 2009. *This amount changes every year.

Earned Income Exclusion (EIE) This incentive allows most of the person’s income, including wages earned at a sheltered workshop or activity center to be excluded when determining the amount of SSI cash benefits they will recieve.  The SSA does not count the first $65 of earnings in a month plus one-half of the remainder. This means that for every two dollars a person earns, SSA excludes one dollar.

Impairment-Related Work Expenses (IRWE) Expenses an SSI recipient with a disability has related to his/her disability, which are essential to work are deducted from earnings before the earnings are divided by two.

Blind Work Expenses (BWE) SSA will not count any earned income that you use to meet expenses that are needed to earn that income in deciding your SSI eligibility and your payment amount. To qualify you must be eligible for SSI based on blindness.

Plan for Achieving Self-Support (PASS) Allows SSI recipient with a disability to set aside income and/or resources for a specified period of time for an employment goal.

Property Essential for Self-Support (PESS) Allows a person to exclude certain resources which are essential to the person’s means of self-support. The value of tools or equipment which a person needs for work is totally excluded when determining your continuing eligiblity for SSI.

Special SSI Payments for People Who Work You can receive SSI cash payments even when your earned income (gross wages and/or net earnings from self-employment) is at the SGA level ($980 in 2009) and up to $1433/month. Your eligibility for SSI will continue for as long as you meet the basic eligibility requirements and the income and resource tests. SSA will continue to figure your SSI payment amount in the same way as before.

It is important to note that even though you are eligible for these or other work incentives, the SSA may not automatically apply them to your case. It is a good idea to let your Social Security case worker know of any changes that may affect your benefits and if you feel that you qualify for certain incentives. For more information, call our Ticket to Work/Benefits Specialist Maelyn at 982-8322.

SSDI

To be eligible for SSDI, individuals must have insured status as former workers, or be eligible on the insured status of a specific relative like a parent or spouse.

To be eligible for SSDI benefits an individual must:

  • Be determined medically disabled by SSA rules;
  • Earn under the Substantial Gainful Activity (SGA—defined as $900 in 2006 or, if blind, $1,500 in 2006) or not be working; and
  • Have insured status either as a former worker, or disabled widow/widower of a spouse who is a former worker. Minor children of former workers and their non-disabled parent may receive benefits on the former worker’s record.

You must also meet the following income and asset limits:

Income

  • Limited to SGA of $900 in 2006 (or, if blind, $1,500)

Asset Limit

  • No asset limit

Substantial Gainful Activity

Substantial Gainful Activity (SGA) is measured against countable income. Impairment – Related Work Expenses can be used to reduce an individual’s countable income.

Earned Income Threshholds Defining SSDI Eligibility
2006 2007
Substantial Gainful Activity (Non-Blind) $860/month $900/month
Substantial Gainful Activity (Blind) $1,450/month $1,500/month
Trial Work Period Month $620/month $640/month

To be eligible for SSDI, individuals must have insured status as former workers, or be eligible on the insured status of a specific relative like a parent or spouse. To establish insured status for benefits, individuals need 20 quarters of coverage (payment of Social Security taxes—FICA) in the 10 years before their disability started (those disabled before the age of 31 need less work to qualify).

  • In addition to meeting our definition of disability, you must have worked long enough–and recently enough–under Social Security to qualify for disability benefits.
  • Social Security work credits are based on your total yearly wages or self-employment income. You can earn up to four credits each year.
  • The amount needed for a credit changes from year to year. In 2007, for example, you earn one credit for each $1,000 of wages or self-employment income. When you’ve earned $4,000, you’ve earned your four credits for the year.
  • The number of work credits you need to qualify for disability benefits depends on your age when you become disabled.
  • Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.

These rules are complex and the practitioner should always confirm their findings with SSA.

Grace Period

If Social Security decides to terminate an individuals SSDI benefits, it pays his/her SSDI benefits for the month the disability ceased, due either to medical improvement or your work at the SGA level, plus the next 2 months. This is called the “grace period.” Then, Social Security stops paying benefits.

It should be noted that Cessation and the Grace Period often occur during the EPE, but might not necessarily, depending on the beneficiary’s earnings.

Be careful when assisting individuals in determining Medicare cessation/termination.

IMPORTANT: Remember that whatever your age is, an individual must have earned the required number of work credits within a certain period ending with the time you become disabled. A Social Security Statement shows whether an individual meet the work requirement at the time it was prepared. If you stop working under Social Security after the date of the Statement, you may not continue to meet the disability work requirement in the future.

Impairment Related Work Expense & PASS

Two additional work incentives allow you to deduct additional money beyond the exclusions mentioned above, under specific circumstances. They are only briefly described here, and are complicated, so you will need to speak to your local Social Security Representative or an advocate for complete details.

(a) Impairment Related Work Expenses (IRWE). This allows you to deduct from your earnings any disability-related expenses that are necessary to maintaining your job. This might include personal care assistance at work, job coaching services, or special transportation expenses. You cannot use this incentive if you are reimbursed for the expense by another source such as Medicaid.

(b) Plan for Achieving Self Support (PASS). Under the PASS incentive you can save for or set aside SSI or other income for work goals. The range of possible uses is broad and may include education, vocational training, job coaching services, purchase of adaptive equipment, or health club membership to help with work stamina. The plan must be in writing and approved by the Social Security Administration. There is no limit to how long a PASS plan can be in effect, but plans are reviewed every 12 months.

1069a and 1619b

Under Section 1619, a person who is eligible for continued Medicaid coverage under 1619(b) can begin receiving SSI cash payments without reapplying at any time earnings drop below the break-even point (the point at which after deducting your earned income you would receive an SSI payment).

This means that even if your SSI check drops to $0 because of your earnings, you can restart it at any time if you lose your job or your income decreases.  At one time, SSI recipients who worked were bound by the same concept of SGA that affects working SSDI recipients. This meant that earnings over the SGA amount (currently $900 per month in 2007) usually resulted in loss of benefits. This is no longer the case. As long as working SSI recipients continue to meet all general SSI requirements (disability, resources, other countable income, etc.), SSI eligibility will generally continue unless there is medical improvement.

Section 1619(a) is the part of the Social Security Act that authorizes continued SSI eligibility even when a working SSI recipient grossed over $900 per month in 2007. This provision allows you to try working in supported or competitive employment, or self-employment without fear that your benefits will be stopped as a result of earnings. Within twelve months of the time an SSI recipient grosses over $900 per month and continues to receive benefits due to 1619(a), there may be a medical review to confirm that no medical improvement has taken place.

Section 1619(a) benefits can continue until you turn 65, or medically improve or fail to meet any SSI eligibility criteria, or until your earnings decrease to less than $900 per month. When your earnings are less than $900 per month, you receive regular SSI benefits.

Of course, as your wages increase, your SSI checks will gradually reduce to $0 due per month. Even at this point, however, SSI eligibility is not lost under Section 1619(b). It is just that you have no checks because of the amount of your earnings. The threshold amount when this occurs is $1,326.

1619b – Retention of Medicaid (SSI only)


Medicaid While Working (1619(b) eligibility) only applies to working individuals. Once an individual has reached the earned income limit of $1,326, which zeroes out his/her SSI cash benefit, he/she may be able to retain Medicaid coverage. In Hawaii, an individual can have income of $2,355 per month ($28,260 per year) and still retain Medicaid coverage.
The disabled individual must meet all of the following:

  • Continue to have a disabling condition
  • Need Medicaid in order to work
  • Be unable to afford equivalent medical coverage without assistance
  • Meet all non-disability requirements for SSI payments, other than earnings

When working SSI recipients are not due an SSI check because of the amount of their gross earnings, they do not lose their SSI eligibility and they do not lose their Medicaid. The reason for this is a provision of the Social Security Act known as Section 1619(b).

Section 1619(b) particularly benefits two groups of working SSI recipients:

  1. Persons whose only benefit is SSI and whose earnings in any one or more months exceed “breakeven” amounts and therefore are too great to permit the issuing of any SSI check.
  2. Persons who receive both SSI and SSDI (concurrent recipients), and whose SSDI check is the greater of the two, while their SSI check is relatively small.

In all cases, in order to be eligible for extended Medicaid under 1619(b), an individual must meet all of the following criteria:

  • Be under 65
  • Be blind or have another “severe impairment”
  • Have been eligible to receive either a “regular” or Section 1619(a) SSI cash benefit in the prior month, and you would have continued to receive an SSI check if your earnings had been lower (SSI check is not due when you have earned income beyond the 1619 (a) break-even point);
  • Need Medicaid to work
  • Be unable to afford medical care without assistance.

The 2007 state threshold for Section 1619(b) is $28,260 per year or $2,355 per month

Be careful when assisting individuals in determining Medicare cessation/termination.
These rules are complex and the practitioner should always confirm their findings with SSA.

Student Earned Income

This allows a person who is under age 22 and regularly attending school to exclude up to $1,340 of earned income per month:

The maximum annual exclusion is $5,410 (2003 figures). These amounts are adjusted annually for inflation. The person must be taking classes at a college or university for at least 8 hours per week, or at a high school for at least 12 hours per week. This exclusion is applied before the general income and earned income exclusions mentioned above.

BLIND WORK EXPENSE

Expenses can include transportation to and from work, federal and state income taxes, union dues, or translation of materials into Braille.

If a person is on SSI and is blind, expenses needed to earn income that are paid for by the individual (not necessarily related to the disability) can be excluded from the income determination for SSI purposes. Examples of these expenses can include transportation to and from work, federal and state income taxes, union dues, or translation of materials into Braille.

Blindness


“Blindness” for Social Security purposes means either:

  • Central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; or
  • A limitation in the fields of vision so that the widest diameter of the visual field subtends an angle of 20 degrees or less (tunnel vision).

Strategies for Managing your Work Incentives

Always report changes in earnings to your local office. Otherwise, you risk being overpaid or underpaid in your monthly check, and could owe them a refund.

Remember to make all SSA required reports in writing and keep copies of whatever they provide.

  1. Confirm your participation in Section 1619a & 1619b, the incentives which allow continued eligibility for SSI and Medicaid. These should be automatic, but are not always. Don’t worry! If they mess it up (you’ll know if a Medicaid claim is rejected), it can be fixed. Ask for help.
  2. Locate an advocate who is familiar with SSI and the work incentive programs. Employment programs usually have at least one person with expertise in this area. In particular, a PASS or IRWE must be approved by Social Security. You may find it helpful to get assistance in developing a PASS or IRWE.
  3. Contact or visit your local Social Security Office and get to know the staff there by name. Recognize that not all Social Security staff understand these programs. Always be willing to ask questions or seek other advice.

For Further Information

Further information about SSI and work incentives is contained in the publication Red Book On Work Incentives, a Summary Guide to Social Security and Supplemental Income Work Incentives for People with Disabilities.

You can get a copy free from your local office, or by calling the Social Security Administration’s toll free number: (800) 772-1213.

Call the Social Security Administration at their toll free number to ask questions or request additional information on any SSI or work incentive topic between 7:00am to 7:00pm on any business day.

The following websites may also be helpful:
Social Security Administration: www.ssa.gov
Work Incentives Transition Network (WITN): www.vcu.edu/rrtcweb/witn.ssi.htm
Center for Psychiatric Rehabilitation: www.bu.edu/sarpsych
Program on Employment and Disability, Cornell University: www.ilr.cornell.edu/ped