E-Newsletter Archives and Articles
Welcome to the North Carolina Evidence Based Practices e-Newsletter. In this issue:
* Letter From the Director
* Together Facing the Challenge: A Therapeutic Foster Care Resource Toolkit
* Supported Employment: SSA Work Incentives & Employment
* New Brochures Online
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Letter from the Director
Hello!
It has been a while since our last e-newsletter for the NC Evidence Based Practices Center. We have decided to start publishing the e-newsletter on a quarterly basis rather than a monthly basis. This will allow for more in depth information about EBPs and their development across the state of North Carolina.
We have had several developments in the last several months with the NCEBP Center. As stated in our February newsletter, we received a grant extension from the Duke Endowment over the next three years!
As part of the plan for the next three years, we have begun training on the Children’s Toolkit: Therapeutic Foster Care. We are working with Barbara Burns and Maureen Murray of Duke University to provide training across the state to providers of these services. See the attached article by Todd Collier describing these trainings as well as future training dates.
Speaking of Todd Collier, he is another development we have had at the NCEBP Center. Todd joined us here in June of this year, as Director of Mental Health CE and EBP Program Coordinator. He has relocated from Kentucky and loves it here in North Carolina. Todd has worked in residential and therapeutic foster care agencies, and is also up to speed on the TFC toolkit. Todd will assist Maureen as a co-facilitator and a trainer on the toolkit. In addition, Todd has recently been trained as an Integrated Dual Disorders Treatment Trainer. He can come directly to agencies and provide on site training in IDDT.
Other activities of the NCEBP Center for the next three years will include a focus on developing the substance abuse workforce in North Carolina, and increasing the Spanish language competency of mental health providers across the state.
We have already started developing the substance abuse workforce effort by collaborating with partners in Guilford County, Duke University, and Greensboro AHEC to develop the Guilford Academy of Substance Abuse Recovery Advocates. This group of 15 participants received in depth training in certain areas of substance abuse to allow them to be “champions” in their community to intervene with substance abusers in Guilford County. This group has the opportunity to meet substance abusers in the community and to offer assistance, basic interventions, and referrals to treatment. This is a unique group of individuals who work collaboratively with their own agency to help substance abusers. The participants worked in a variety of settings including the court system, the public library, the health department, the police department and local clergy. We will be focusing a newsletter article on this effort in our next edition.
Finally, as we approach the holiday season we are reminded of the gratitude we have for those working in this field to help those less fortunate than ourselves.
John Bigger,
Project Director
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Together Facing the Challenge: A Therapeutic Foster Care Resource Toolkit
The TFC Toolkit began its dissemination on September 10, 2007 at Moses Cone Hospital in Greensboro, NC. Maureen Murray conducted the training for an audience that exceeded initial capacity numbers and were representative of ten different agencies. The two days of training was filled with audience participation coinciding along with multiple instructional venues, set by Maureen herself. The overall training atmosphere was highly conducive to learning the new material and resulted in positive reviews from the participants. The third day of TFC training is set for November 16, 2007, also in Greensboro.
The two days of Therapeutic Foster Care training in Greensboro were followed with biweekly consultation calls. Consultation calls were conducted by Maureen Murray and set up to provide the participants with feedback/collaboration, a method to check on plans of implementation, and monitor progress with the utilization of the toolkit within their own agencies.
Looking ahead, Together Facing the Challenge training will be hosted next year by Coastal AHEC in March at their Wilmington location. The training will take place at Cape Fear Hospital in Wilmington March 25-26, with a third day set for May 28. Participants have already been signed up for the aforementioned training date due to an overwhelming response to the initial session in Greensboro.
The NC EBP Center is currently looking at the fall agenda for the TFC toolkit and will be considering a training site toward the western portion of the state.
For more information about training and consultation, please contact Todd Collier, Project Coordinator, at todd.collier@ncebpcenter.org or by phone at 910-678-7306.
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SSA Work Incentives and Employment
Social Security Administration (SSA) Work Incentives and Employment for Persons with Severe Mental Illness (SMI)
By Kirk Williams, M.Ed.
When I first started working as an employment specialist in supported employment, the local psychosocial clubhouse invited me to attend a presentation by the new manager of the local social security office. After introductions, the SSA manager walked up to the podium and asked the clubhouse members “How many of you want to work?” All 25 members present raised their hand. Then she said, “How many of you are afraid to go to work because of fear of loss of social security benefits?” Again, all 25 raised their hands.
The ability of the employment specialist (ES) to casually rough out case benefit scenarios during the assessment and job development phase of support employment plays a significant role in each supported employee’s (and the support of their close others) decision to pursue employment. Further, the ES is in a unique position to assist the individual with SSA issues and correspondences during employment and towards independence from benefits.
SSA work incentives work and are generous. As an ES, simply referring an individual to the SSA office or other resources could seem like another bureaucratic obstacle and thwart the individual’s decision to pursue employment. They will need your assistance throughout the process so learn how it works and remain current.
The following information is not a standard part of the national Evidence Based Supported Employment training package. It was added to the training package in this state because of its significance to beneficiaries and because employment specialists and supported employment programs need this information to assist the beneficiaries to make solid decisions as they test employment and its many potential benefits. The sections include: Basic Information, Case Scenarios, Other SSA Considerations, and Social Security Resources.
Basic Information (See the Case Scenarios sections for the application of these terms)
SSA- Two major programs
- SSDI- Social Security Disability Insurance
- Financed with Social Security taxes paid by workers
- Medicare is a SSDI benefit (Hospital and Medical Insurance)
- SSI- Supplemental Security Income
- Financed by general revenues
- For those with disabilities who have limited income and resources
- Medicaid is a SSI benefit (Health insurance for low income)
- SSI Federal Payment Standard
- $623 individuals and $934 couple
- SSI Resources Limits
- $2000 individuals and $3000 couples
- Substantial Gainful Activity (SGA)
- $900/mo. SSDI’s earning threshold where your work is considered substantial and benefits are closely examined
- Trial Work Period (TWP)- $640/mo
- Incentive period for SSDI beneficiaries who work
- Allows 9 months of SSDI benefits regardless of earnings
- Includes a three month grace period for essentially 12 trail work months
- Extended Period of Eligibility (EPE)
- Automatic start of your benefit payments within a 36 month period after SGA if you stop working
- Continuation of Medicare Coverage
- 93 consecutive months of insurance after last month of TWP
- Impairment Related Work Expenses (SSDI and SSI)
- A deduction from earned income of costs of items and services you need in order to work
- Example: Transportation costs, attendant care of and related to work, work related equipment
- Plan to Achieve Self-Support (PASS)
- Allows you to set aside income for a specific work goal (say to buy a used car, self-employment, additional work related training)
- Set aside income reduces the countable earned income when SSA figures your SSI payment
- ***Continued Medicaid Eligibility- Sect 1619b (Important to know this exists)
- Medicaid can continue even if earnings are too high for a SSI cash payment
- Must need Medicaid in order to work
- Must have gross earned income insufficient to replace SSI, Medicaid, and publicly funded attendant care.
Case Scenarios
Case 1- SSI and Modest Earned Income
SSI benefit $623.00 (monthly cash payment)
Estimated monthly earned income:
$15 hr/week x $6.25/hr x 4.33 weeks/month = $406.00
Earned income (gross) $406.00
Earned income exclusion $ -65.00
Unearned income exclusion $-20.00
Countable Earned Income for SSA $321.00
$321.00 divided by 2 = $160.00 (SSA wants 50 cents on the dollar of “countable earned income”). This is the amount the SSI check will be reduced.
$623.00 (Original SSI check)
-$160.00 (reduction for working)
$463.00 New SSI Check amount
New Income Gain and Benefit Changes From Going to Work
Earnings $406.00/mo + $463.00/mo=$869.00
Total $869.00 was $623.00/mo
Net gain $250.00
No impact on Medicaid
After roughing this out at his favorite coffee house, the ES should look at Homer and say, “so what would you do with an extra $250.00 in your pocket each month with no loss of the Medicaid benefits from working 15 hours per week? (These financial gains are often minor compared to countering loneliness through the gain of friendships and related social benefits often associated with work.)
Case 2-SSI and Moderate Earned Income
SSI Benefit $623.00/mo
Estimated Monthly Earned Income $1400.00/mo
Income Exclusions -$85.00 (combined earned and unearned exclusions)
Countable Income $1315.00/mo
Reduction in cash benefit $1315/2= $657.00
SSI Cash Benefit $623.00-$657.00=$0
Cash payment would cease but this does not mean you would lose the Medicaid benefits. Medicaid benefits would cease unless you request consideration for 1619b Medicaid Waiver. If you need Medicaid in order to work and your income does not exceed the benefit of Medicaid and SSI, then you would qualify for the waiver. The ES and the individual would need to see SSA directly to discuss qualifying for the waiver. Most qualify.
New Take Home Amount!
SSI- $0 (was $623)
Work- $1400
Net Gain of about $775with no loss of the benefit, assuming the waiver is applicable
Also note that transportation expenses (must be approved by local SSA office) and other impairment related work expenses may be subtracted from the gross earnings to reduce the true countable income and hence increase the SSI cash benefit.
Case 3 SSDI and Modest Income
SSDI (cash payment) = $425.00/mo
Estimated Earned Income= $350.00/mo
$350 < Trial work period (TWP) threshold of $640.00/mo
No trial work months effected
$350 < Substantial Gainful Activity (SGA) threshold of $900.00/mo
No impact to cash or Medicare benefits
New Take Home Amount
SSDI $425 + Earnings $350 = $775 was $425
A net gain of $350 with no loss of benefits
Case 4 SSDI and Moderate Income
SSDI benefits only
SSDI amount = $425.00/mo
Earnings $950.00/mo
$950 > TWP threshold of $640.
Trial work months would start at first check
Individual could have unlimited income during this 9 month period with no impact to benefits
$950 > SGA of $900.
Work is substantial. Benefits would cease after TWP (9 months) and 3-month grace period
Extended Period of Eligibility (EPE) would begin immediately after benefits cease and continue for 36 months. Any month the individual did not work or if they lost the job during this 36-month period, benefits would return and you would not have to reapply
Adjusted Income
First 12 months $425 + $950 = $1375 (was $425).
Net gain of $950/mo x 12 mo=$11,400
Post 12 months = $950. Net gain of $525.
Extended Medicare for 93 months after TWP ends
Where are the financial and benefit risks?
Case 5 SSI/SSDI Concurrent with Modest Income
SSI Income $135
SSDI Income $468
Estimated Earned Income $600
Calculations
$600
-$85 (exclusions)
$515
Reduction in SSI (income needs benefit first to go)
$515/ 2 = $258
SSI $135 - $258 = $0 (zeroed out)
SSI cash payment would cease
Contact SSA regarding qualification of 1619b Medicaid waiver
Impact of SSDI
$600 < $640, does not meet trial work threshold
$600 < $900, work is not substantial (SGA)
Bottom Line Gain
Earned income $600 + SSDI income $468 = $1068. She was at $623 (unearned), a $445 monthly earning increase.
Case 6 SSI/SSDI Concurrent with Moderate Income
SSI Income $135
SSDI Income $488
Earned Income $1200
Calculations
$1200
-$85 (exclusions)
$1115
Reduction in SSI (income needs based benefit first to go)
$1115/2=$558
SSI $135 - $558 = $0 (zeroed out)
SSI cash payment would cease
Contact SSA regarding qualification of 1619b Medicaid waiver
Impact on SSDI
$1200 >$640, begin using trial work months
$1200 > $900, work is substantial (SGA)
Bottom Line Gain
12 months of earnings at $1200 + $488 = $1688
$1688/mo x 12 mo = $20,256
Loss of SSDI cash benefit of $488 after 12th month so work is sole source of income of $1200
$1200-$623= $577 net gain
Employer may provide benefits
Continued Medicare for 93 months.
Employer benefits are used first.
Other SSA Considerations
State Medicaid
***Individuals who receive state Medicaid may have earning limitations***
- $817 in earned and unearned income for individuals requires a $242 deductible for medical costs
- There are Medicare Savings Programs that assist with this deductible
Contact the local Department of Social Services (DSS) representative of the supported employee and schedule an appointment to examine work and state Medicaid earning considerations. Also, go to www.dhhs.state.nc.us/dma/ for more information.
Housing
Rent in HUD and other supported housing may have small increases due to work though there are typically clear financial gains from working. See the local housing manager for a review of the sliding rent scale based on income.
Food stamps and other income-based benefits may be impacted slightly
The SSA Office Experience
Your experience at the SSA office can be a unique one. Often there is an armed security person. You pick a number for services and waits can be long (you will learn the best times to go). When called, you speak to the assistant through a hole in the glass partition. Front desk staff may not know all of the details of work incentives for people with disabilities. They may also be overworked and underpaid. Be prepared to request a specialist at the SSA office if the front desk staff cannot assist you. Do not allow them to brush you off. Be gently assertive and ask for another staff person or a supervisor. Usually someone there knows the answer to your question or case. Ask for the specialist who deals with the particular issue you resolving. The person you are supporting must be present to access their information. They should participate in the process, and to learn about their own benefits.
Income Taxes
Most all entry-level part time employees are eligible to receive all of their income taxes paid in (due to limited earnings) by simply completing their 1040EZ income tax form. Supported employment programs should consider assisting supported individuals in completing their tax forms. It only takes about 15 minutes per person to complete and typical reimbursements are around $500.00. Refer the people you support to local volunteer organizations that assist people with taxes if you are unable to set this up within your own program.
Social Security Resources
Resources www.socialsecurity.gov
www.workworld.com (now fee-based in NC)
Can input work variables and see impact on benefits
Must know current benefit situation
Social Security Red Book 2006
A summary guide to employment support for individuals with disabilities
Available from local SSA Office
Available on-line
Available to order a hardcopy on-line
BPAO - Benefit Planning, Assistance and Outreach Program for free access to SSA benefits planning and related. Also known locally as the MEANS Grant.
Raleigh 919-855-3587
Fayetteville 910-485-4439
Charlotte 704-878-4230
Asheville 828-648-9678
Rocky Mount 866-605-7765
Greensboro 336-272-9602
New Bern 252-636-6007
Wilmington 910-794-9488
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Brochures Online
Please check our website for updated brochures. The Winter/Spring Evidence Based Practices brochure will be up soon. See http://www.NC EBPcenter.org/brochures.htm for brochures on Evidence Based Practices, Person Centered Thinking, Person Centered Planning, Crisis Response, and Community Support Services training programs.
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Archive:
February 2007
December 2006
November 2006
October 2006
September 2006
July 2006
June 2006
May 2006
March 2006
February 2006
January 2006
December 2005
November 2005
To receive the NC EBP Center's monthly e-Newsletter by email, please contact Kate Smith.
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