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Special Issue on Employment Policy
University of Michigan Model SCI Care System

Fall 2003

In This Issue:

Social Security Disability Benefit Basics

Does It Cost Too Much to Work?

The PASS Program

Important Laws Affecting Employment

Ticket to Work and Work Incentives
Improvement Act of 1999



Many changes in the law during the last few years have made it easier for persons with a disability such as SCI to return to work," states Rick Baisden, Vocational Counselor at the Ann Arbor Center for Independent Living. Baisden said that sweeping civil rights legislation such as The Rehabilitation Act of 1973 and the Americans with Disability Act (ADA) of 1990 have received most of the publicity, but many other, lesser known laws and regulations can also be important for those wishing to return to work. "It's often difficult for people to understand these laws and how they can benefit from them." Baisden cited the Plan for Achieving Self-Support (PASS) and Trial Work Period (TWP) as examples of programs that have been around for a long time but are underutilized by persons with a disability who want to enter the workforce. Recently, the Ticket to Work and Work Incentives Improvement Act of 1999 (TW/WIIA) was enacted by the Federal Government. It can also help people with disabilities enter the workforce.
This Special Issue of SCI ACCESS provides basic information about the numerous laws that can help people with SCI to successfully return to work.

Social Security Disability Benefit Basicis: SSDI and SSI
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two programs of the U.S. Government's Social Security Administration that provide cash benefits to people with disabilities.

Social Security Disability Insurance (SSDI)
People with disabilities such SCI may qualify for SSDI six months after their injuries, depending upon their work history. While the formula used to determine eligibility for SSDI is complex, basically it depends on how long you have worked at jobs for which Social Security taxes (also called FICA) were withheld and how much you earned before the time of your injury. SSDI payments are based on a worker's FICA taxed earnings over the ten-year period, before they became disabled. Payments are increased every year based on inflation. For information about SSDI call: 1-800-772-1213.
If you have access to the internet, check out the website: (In the column entitled, "Benefits," click on "disability".) Another good site is:

Medicare is the federal program that provides health care benefits to people who qualify for SSDI. You will be enrolled in Medicare automatically after you have been receiving SSDI benefits for two ears, as long as you are age 21 or older. For more information about Medicare, call 1-800-633-4227 or check out the website:

Will I lose my SSDI benefits immediately if I start working?
No, Social Security has a created a Trial Work Period (TWP). This allows people to work for up to nine months during a five-year period without losing their SSDI benefits. There is no limit to what your earnings can be during these trial months. After that, for every month when you earn above the SGA you will lose your cash SSDI benefits. However, after your TWP, for every month within your three-year Extended Period of Eligibility (EPE) that you earn less than SGA, you will still be eligible for SSDI cash benefits.

Will my disability status be reviewed?
Some beneficiaries have asked, "If I return to work, won't they immediately review my status and assume I am no longer disabled?" The Social Security Administration periodically reviews a person's disability status. However, the new law states that SSA will not conduct a review to see if a person's medical condition has improved while they are using a Ticket To Work. (Scroll down for more information on Ticket to Work.)

What about the $800 Substantial Gainful Activity?
If you earn less than $800.00 or are self-employed and work less than 80 hours in a month, you can work and receive your SSDI benefits indefinitely. After your trial work period, you will lose your cash benefits for any month you earn over $800.00 or work more than 80 self-employed hours.

Supplemental Security Income (SSI)
SSI gives cash assistance to people with disabilities who have limited financial resources. Eligibility for SSI depends on income and financial resources. Income includes money from wages, Social Security benefits, pensions, stocks, bonds and non-cash items you receive such as food, clothing or shelter. If you're married, your spouse's income is also included. Your financial resources are limited to $2,000 if single and $3,000 if married. This does not include the value of your car or home. To learn more about SSI, call 800-772-1213 or go to

Are the rules for SSI the same as those for SSDI?
No. If you receive SSI you can only earn up to $85.00 before your benefits will be lowered. Above that, your SSI payments will be reduced by $1.00 for every $2.00 you earn. You may still be eligible to receive Medicaid, the health insurance program for people with limited financial resources, even if you no longer receive money from SSI. Starting January 1, 2004, you can earn up to $22,450 per year and still be eligible for Medicaid without paying premiums. If you earn over that amount, you can pay for your premiums on a sliding scale beginning at $50 a month. (Scroll down for information about the Medicaid buy-in.)

Does it cost too much to work?
When people with spinal cord injuries return to work, their expenses for attendant care, transportation, and other impairment-related work expenses may increase. Social Security will allow you to deduct the cost you pay for a large number of goods and services that make it easier for you to work. These include certain attendant care costs, vehicle and home modifications, and medical supplies. This amount is subtracted from your gross earnings to determine if you have exceeded the SGA threshold of $800 per month (See article in this newsletter, "How does working affect SSI and SSDI").

For example, John pays $400 per month for attendant care services to help prepare for work. He spends another $400 per month for several months to pay for the cost of modifications to his car. John can earn up to $1580.00 per month ($800 + $400 + $400) before his SSDI benefits are affected.

How does Working Affect SSDI and SSI?
You can earn up to $800 a month and continue to receive SSDI benefits. Earnings of $800 or more are called Substantial Gainful Activity (SGA). This $800 amount is increased annually for inflation.
If you receive SSI you can earn up to $85 a month without your SSI payment being affected. After that, your SSI income is reduced by an amount that depends on how much you earn.

What Happens to Your Medicare if You Work?
Recent changes in Medicare regulations created by the Ticket to Work and Work Incentives Improvement Act allow you to keep your Medicare coverage for at least 8 ½ years after returning to work as long as you continue to be disabled.
Note: Working people with disabilities who received Social Security Disability Insurance (SSDI) or Medicare in the last three years can get these benefits restarted if they are no longer able to work because of their medical condition without filing a new application with the Social Security Administration.

The following timeline shows what might happen:

Some useful terms to know…..
Trial Work Period (TWP) A period of nine months (not necessarily consecutive) during which your Social Security benefits will not be affected by employment earnings. (The nine months of work must occur within five years. If 9 months are not used in a 5-year period, your TWP renews.)

Substantial Gainful Activity (SGA) SGA is defined as work "that involves doing significant physical or mental activities and is the kind of work usually done for pay or profit. "Significant activities" are useful in the operation of a business and have a specific economic value.
Extended Period of Eligibility For at least three years after a successful trial work period, a Social Security beneficiary who is disabled may receive a disability benefit for any month that his/her earnings are below the substantial gainful activity level of $800 per month

Don't "PASS" Up this Opportunity
Plan for Achieving Self-Support (PASS) is a work incentive for people who receive SSI and SSDI. PASS is designed to help people with disabilities enter the work force. It is provided through the Social Security Administration.

PASS lets people with disabilities set aside money and/or things they own to pay for things they need to achieve self-sufficiency through specific work or self-employment goals. Funds can be used to achieve these goals without their counting against SSI income and asset limits. Qualified expenses include things such as education, training, and assistive technology.

(If you do not already receive SSI, you will need to apply for SSI when you apply for your PASS.)

In order to take part in the PASS program, you must develop a plan for how the funds set aside will be spent. PASS plans must be submitted and approved by the Social Security Administration before they start. Plans normally last 3 to 5 years. For more information, go to or call the SSA at

An Individual Who Made Use of PASS
Carole is a 45 year-old woman who sustained a spinal cord injury five years ago. She was formerly a secretary but now does not work. Carole recently used PASS to help her achieve a dream of becoming a computer programmer. Here's how PASS is working for her:
Carole submitted a PASS to SSA to assist her in obtaining programmer training. The PASS included a timeline and detailed budget, all of which were approved by Social Security. Carole now has $4000 in savings, money that would normally exclude her from receiving monthly SSI benefits. Carole plans to use this $4000 to help pay for tuition and books and some personal attendant expenses. Because this money is used to help Carole achieve the work goals detailed in her PASS, it will not be used in calculating Carole's SSI benefit amount. Because of her PASS, Carole's monthly SSI benefit will actually increase while she is attending classes.


The Rehabilitation Act of 1973
The Rehabilitation Act was the first piece of Federal legislation focused on protecting the rights of individuals with disabilities. It includes a variety of provisions focused on rights and advocacy.

The Americans with Disability Act (ADA)
The ADA, enacted in 1990, is the major Federal civil rights law that applies to individuals with disabilities. The ADA protects you from discrimination in employment practices. You have a right to request a reasonable accommodation in both the hiring process and on the job.

Specifically, you cannot be discriminated against because of your disability if you can perform the essential functions of the job with reasonable accommodation.

A reasonable accommodation is any change or adjustment to a job, the work environment or the way things are usually done that would allow you to apply for a job, perform job functions, or enjoy equal access to benefits available to other people in the workplace. Many things that can help people with a SCI successfully work are protected under the ADA. Some of the most common accommodations include physical changes such as installing a ramp, providing equipment, such as voice recognition software or modifying a workspace or an adjusted work schedule or time off for someone who needs treatment for a disability. For more information, call 800-514-0301 (voice) 800-514-0383 (TTY) or go to the Web site:

Ticket to Work and Work Incentives Improvement Act of 1999 (TW/WIIA)
The Ticket to Work and Work Incentives Improvement Act of 1999 is an important law that makes it easier for people with SCI to become employed in a number of ways. For example, recent changes in Medicare created by the TWWIIA allow you to keep your Medicare coverage for at least 8 ½ years after you return to work. Other parts of TW/WIIA focus on support.
Starting in 2001, people receiving SSDI and SSI in some states were issued a "ticket". With these "tickets", people could obtain free vocational rehabilitation services from private or state vocational rehabilitation agencies, as well as other organizations approved by the Social Security Administration. The organizations that provide services through the Ticket to Work program are called Employment Networks (ENs). Michigan joined the Ticket Program in October 2002.

MAXIMUS is a private organization that helps the SSA manage the Ticket Program, overseeing the approval of ENs and providing information to beneficiaries about the Ticket to Work Program.

For information about the program details and Employment Networks, call MAXIMUS at
1-800-866-968-7842 (1-866-YOURTICKET) or TTY (1-866-833-2967) (1-866-TDD 2 WORK).
On the web, go to: and

Important: Participation in the Ticket to Work program is voluntary. If you choose not to participate, your decision will have no effect on your Social Security benefits.

If I get a job through the Ticket Program, will my disability status be reviewed?
Periodically, the Social Security Administration reviews everyone's disability status to see if they are still disabled. However, the new law states that work activity will not trigger a medical review to see if a person's condition has improved while they are using a Ticket To Work.

Michigan To Implement Medicaid Buy-in January 1, 2004

We are happy to report that Michigan will join 27 other states which have reduced the financial burdens of returning to work by allowing persons with disabilities to work and still keep their Medicaid benefits.
Under the new law, which goes into effect on January 1, 2004,

People with disabilities who earn up to $22,450 a year can continue to receive Medicaid without paying premiums.

People who earn over $22,450 will pay a premium for Medicaid on a sliding scale, beginning at $50 a month. Anyone earning more than $75,000 a year will pay the full Medicaid premium, estimated to be $6,000 to $10,000 annually.

The asset limit will increase from $2,000 to $75,000. People also will be allowed to set up individual retirement accounts.

To see the entire bill, go to and enter Senate Bill 22 or House Bill 4270. You may also link to an analysis of the bill on this page.

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