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Wisconsin Disability Benefits Network Newsletter For Your Benefits

Vol. 7, Issue 31, July, 2009

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For Your Benefit – Introduction

The Wisconsin Disability Benefits Network (WDBN) is a statewide system that provides direct assistance to benefits counseling practitioners and seeks ways to reach out to and better serve people with disabilities, their supporters, and professional service providers in Wisconsin. This newsletter provides current program news, important notices and updates, and upcoming training and educational opportunities. Check out past editions of this newsletter!

2009 WDBN Calendar

| Printable version of the calendar (pdf) | Bookmark Online Calendar

What's New


Ben Spec's Blog: Your Benefits Related Questions Answered!

Ask Ben SpecBen Spec, a long-time contributor to this newsletter, recently launched a blog to answer benefits related questions from wherever he happens to be in the world! We are excited to have access to Ben's expertise and he frequently checks in to find out what's new in Wisconsin or to consult with WDBN staff. If you haven't had the opportunity to visit the site or ask ben a question, you may want to check it out.

Speaking of the WDBN, Stephanie Drum created a presentation on how to track what is happening on Ben's blog using a variety of subscription methods. Find out how you can stay up to date on the latest questions and responses from Ben.

Projections of No COLA Increase for 2010

The Congressional Budget Office and the Obama Administration are projecting that there will be no Cost Of Living Adjustment (COLA) in Social Security benefits this year, because the cost of living has not and is not going up, according to a Robert Pear article in the New York Times. In fact, the head of the Congressional Budget Office says there may be no COLA until 2013.

Spousal Impoverishment Income Allowance

The amount for the Community Spouse Income Allowance and the Spousal Impoverishment Family Member Income Allowance will changed effective July 1, 2009. The Shelter base Amount also changed. The new amounts are: Minimum Allocation - $2,328.33, Family Member Income Allowance - $607.08, Shelter Base Amount - $728.50. See Operations Memo 09-40. Download an updated Quick Check Sheet (doc).


Updates to Note


BadgerCare Plus Update

On June 15, 2009, DHS began taking applications for Childless Adult Coverage through the BadgerCare Plus Core Benefit, and coverage will start in the second half of July. An article in the July 14 Milwaukee Journal Sentinel reports that about 24,575 people had applied for coverage through the program for adults without dependent children through Monday, July 13 - roughly the population of the City of Stevens Point - suggesting that enrollment may happen faster than anticipated. State officials had projected enrollment will eventually reach about 40,000.

A recent policy brief from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured provides some background information on the characteristics and insurance coverage of low-income adults. Among the key findings:

In summary, individuals and married couples who meet the following criteria may be eligible for the new Core Plan for Childless Adults:

Complete an application online at www.access.wi.gov or via phone with the Enrollment Services Center at 1-800-291-2002. You can also download a copy of some Questions and Answers (WORD) put together by DRW from a meeting with Clare Smith.

More information is available in Chapter 43 of the BadgerCare Plus manual and on the DHS website. Additional details are outlined in Operations Memo 09-30.

Changes to FoodShare Handbook (FSH)

A FoodShare unit member may receive a deduction for child care expenses paid while the member works, looks for work or attends school. FSH 1.1.4 Local agencies shall encourage households to complete the FoodShare application process even if a household member's application or benefits for another program has been denied or terminated. FSH 2.1.1.4 These changes took effect May 1, 2009.

Thanks DRW for sharing an Updated FoodShare Worksheet. It includes the change in maximum FoodShare monthly allotment from $176 to $200 for a household of one. It also includes the change in the minimum monthly allotment from $14 to $16. The worksheet is an easy way to calculate the amount of monthly FoodShare allotment your clients should receive. The information currently on the worksheet is an example only. Plug in your client's information at all points indicated in red lettering.

Cool Resources


Benefit Program Resources

Are you a benefits specialist looking for policy information regarding Wisconsin Benefits? Perhaps you already use some of the handbooks such as the Medicaid Eligibility Handbook (MEH), and maybe you have even dabbled a little in the BadgerCare+ Handbook. There are others that may be helpful resources to you also. Here is a list of some of the handbooks that might be helpful to ben specs:

For a full list of handbooks offered by the State of Wisconsin, visit: http://dhs.wisconsin.gov/em/index.htm. Here you can also find the directory of local Income and Maintenance offices in your area. Add these links to your bookmarks for easy access!

Local SSA Offices

Download a handy list of all Local SSA Offices Serving Wisconsin (excel), grouped geographically.  Note that some counties are served by more than one office; the claimant’s address will determine which of several counties will handle an inquiry or application.

Disability Statistics Online

The US Department of Labor has initiated the process of releasing monthly employment/labor statistics regarding people with disabilities. This is an historical undertaking and will for the first time give the public reliable information regarding the employment/unemployment rate of people with disabilities. Information on this initiative is available on the DOL website.

Celebrate the 19th Anniversary of the Americans with Disabilities Act (ADA) July 26, 2009

The DBTAC – Network of ADA Centers is pleased to announce the release of the 2009 Americans with Disabilities (ADA) Anniversary Tool Kit. Together with our Affiliate Networks and Partners, we have accomplished significant results toward voluntary ADA compliance. The Tool Kit captures our collective achievements and offers informative materials designed to help you plan and publicize your ADA activities during the ADA Anniversary and throughout the year. The Tool Kit includes:

Download the 2009 ADA Anniversary Tool Kit.

GovBenefits.gov

GovBenefits.gov is a partnership of Federal agencies with a shared vision to provide improved, personalized access to government assistance programs. The mission is to:

GovBenefits.gov will help answer the question: Are there government benefit programs available to help? The online screening tool is free, easy-to-use, and completely confidential. It does not require a name, phone number, Social Security number, or any other identifying information. An individual answers a series of questions and then GovBenefits.gov returns a list of government benefit programs they may be eligible to receive, along with information about how to apply. Visit GovBenefits.gov for more information.

Pfizer Launches Free Medicines Program for Newly Unemployed Americans

Pfizer, Inc. announced today that it will launch an innovative program to help eligible unemployed Americans and their families who have lost their health insurance maintain access to their Pfizer medicines for free. The inspiration for the new program, called MAINTAIN™ (Medicines Assistance for Those who Are in Need), was generated by Pfizer employees who were witnessing friends, family, and neighbors struggle to make ends meet after losing their jobs. All of Pfizer’s patient assistance programs, including the new program, can be reached by calling a single phone number (1-866-706-2400) or by visiting www.PfizerHelpfulAnswers.com.

Arranging Accessible Business Meetings for People with Disabilities

April 2009: A publication by the U.S. Department of Justice Civil Rights Division Disability Rights Section provides helpful information on how to evaluate the accessibility of a meeting site for people with disabilities including resources and tips on room set-up, presentation of meeting content, parking, and providing auxiliary aids and services. Download it at http://www.ada.gov/business/accessiblemtg.htm.

Benefits News Roundup

Benefits News Roundup

Expedited Reinstatement (EXR)

For people who have had their Social Security benefits stopped because they successfully returned to work but later have to stop working due to their disability, Social Security has an accelerated way that they can restart their benefits. Under the Expedited Reinstatement (EXR) work incentive provision, Social Security can reinstate a beneficiary’s disability payments without a new application.

For this provision to apply, the disability benefits must have ended due to the beneficiary’s Substantial Gainful Activity (SGA) within the previous five (5) years; and the beneficiary must no longer be able to work at the SGA level due to a medical impairment(s) that is the same as or related to the original impairment(s). The EXR request period may be extended if the individual establishes good cause for late filing of the request.

When a person requests EXR, the state Disability Determination Bureau (DDB) must review the case and make a medical decision using the medical improvement review standards (MIRS), those used in medical Continuing Disability Reviews (CDR’s). But while the medical decision is being made, a beneficiary can receive provisional payments.

SSA pays provisional payments for up to six (6) months while the medical determination is being made as long as the beneficiary is entitled otherwise. The amount of the provisional payments is the same as the last benefit amount paid to the beneficiary with any subsequent Cost of Living Adjustments (COLA’s) included; Medicare may also be available. A Disability Insurance Beneficiary’s (DIB) auxiliaries (spouse or children) do not receive provisional payments.

If a beneficiary is reinstated under the EXR provisions and then performs SGA in any of the first 24 months after reinstatement, he/she will not be entitled to benefits for that month (although Medicare coverage will continue.) These 24 months are the Initial Reinstatement Period (IRP). After the 24 month IRP of benefits (the months do not have to be consecutive), the beneficiary gets a new Trial Work Period (TWP) and Extended Period of Eligibility (EPE). Even if a beneficiary’s payments are suspended due to SGA during the IRP, benefits will not be terminated as long as the beneficiary is still disabled.

A beneficiary whose benefits ended due to SGA may instead of filing for EXR file a new application for disability benefits. If a person reapplies within 60 months of when last receiving a cash payment, he/she does not have a five (5) month waiting period for the benefits to begin. Another advantage to reapplication is that the EXR’s 24 month Initial Reinstatement Period (IRP) does not apply so a new TWP and EPE are available sooner. However, unlike under EXR, provisional cash payments are not available while the DDB is making its disability decision and the reapplication is pending. POMS DI 13050.005.

Extended Period of Eligibility (EPE)

The Extended Period of Eligibility (EPE) is the 36 month period immediately following the completion of a Social Security Disability Insurance (SSDI) beneficiary’s 9 month Trial Work Period (TWP). During the EPE the Social Security Administration (SSA) will pay SSDI benefits for any month the beneficiary does not work above the Substantial Gainful Activity (SGA) level ($980 per month in 2009) even if benefits have been stopped due to SGA after the end of the TWP. (Note that the EPE applies to only SSDI and not Supplemental Security Income, SSI).

The EPE is a safety net feature for beneficiaries who use all their TWP months, have their SSDI benefits stop due to SGA, but then stop working above the SGA level within three years after the end of their TWP.

Beneficiaries or their representatives are responsible for reporting earnings and work to SSA so payments can be made correctly and timely. The reason a beneficiary’s work earnings drop below SGA is not relevant; that is, reduced work does not have to be due to the beneficiary’s disabling condition.

The EPE continues for 36 consecutive months regardless of the beneficiary’s work status, that is, working, not working, or working above the SGA level. However, a beneficiary must still be disabled throughout the EPE to be eligible for SSDI; medical recovery will result in benefit cessation during the EPE.

The EPE ends the 37th consecutive month after the end of the TWP. If a beneficiary is eligible for a benefit for the 37th month, benefits will continue indefinitely until he/she works a month above the SGA level, medically recovers, or otherwise becomes ineligible due to non-disability factors.

Once past the 37th month, if the beneficiary works above the SGA level, his/her benefits end. If his/her work above the SGA level stops after that, he/she may be able to use the Expedited Reinstatement (EXR) process or can file a new application to begin benefits again. POMS DI 13010.210

SMI Premiums and Overpayment Withholding

Normally for Social Security Disability Insurance (SSDI) beneficiaries who are paying their own Medicare Supplemental Medical Insurance (SMI) premiums, the amount of the premium is withheld directly from the beneficiary’s monthly benefit before payment is made.

When a beneficiary also has an overpayment that will be withheld from his/her monthly benefits, the Medicare SMI premiums owed are deducted before any full or partial adjustment is made to the benefit to recover the overpayment. Payment of the premium is given priority over recovery of the overpayment in order to prevent loss of SMI coverage during a period in which a beneficiary is either receiving no income or only a portion of his/her usual income from benefits or earnings.

If a beneficiary’s payments are suspended for whatever reason, he/she is billed directly for premiums on a quarterly basis and is expected to pay the premiums by direct remittance. POMS HI 01001.020

Social Security Benefits and Worker's Compensation

Worker’s Compensation (WC) provides partial replacement of income and medical payments to employees who cannot work due to work related injury, accident, illness, or disease. WC is a form of insurance that is paid for in advance by employers and to disabled workers through private insurance carriers. The Wisconsin Department of Workforce Development administers WC which not only partially replaces lost wages and covers medical expenses but also can pay certain rehabilitation costs. More about worker's compensation.

Income compensation is normally about two-thirds of the worker’s pay (with a specified maximum amount for weekly payments), medical coverage is all reasonable and necessary medical expenses, and rehabilitation is vocational/retraining costs. Download a copy of the Worker’s Compensation -- Maximum Wage and Rate Chart (pdf).

A disabled worker may collect Social Security Disability Insurance (SSDI) benefits and WC at the same time although the receipt of SSDI cash benefits can reduce the amount of WC benefits in Wisconsin, which is called WC reverse offset. Essentially, the state reduces WC benefits so that the total benefits paid (WC and SSDI) do not exceed 80% of the employee’s average earnings before disability onset. In doing this computation, the state excludes from the countable WC attorney fees and costs.

A person receiving WC is required to notify his/her Employer's Worker's Compensation Insurance Company if receiving both Worker's Compensation benefits and Social Security Disability payments.

In certain other states it is the Social Security Administration (SSA) that reduces the SSDI when WC is received so that the combined amount of workers' compensation and Social Security disability benefits does not exceed 80 percent of the worker's average earnings before disability onset.

For Supplemental Security Income (SSI) payments, any WC benefits that a person receives are unearned income and offset against SSI payments dollar for dollar after a $20 general income disregard.

Representative Payee

At some point an SSDI or SSI beneficiary who has a representative payee may want to apply to receive the benefits him/herself.

In determining whether or not a beneficiary should have a representative payee, SSA’s goal is to ensure the physical, mental, and emotional well-being of a beneficiary in a way that both preserves a person’s dignity and protects basic rights. If a beneficiary is legally incompetent or under age 15, Social Security law and regulations require that the beneficiary have a representative payee. Otherwise, SSA’s decision to appoint a representative payee is based on a beneficiary’s capability. The SSA policy is that an adult beneficiary who is legally competent is capable of managing or directing someone else to manage his/her benefits unless there are indicators or evidence to the contrary. Source: POMS GN 00502.001

When a beneficiary who has had a representative payee applies to be his/her own payee, an SSA employee will talk to the beneficiary and re-evaluate the situation by obtaining current evidence of capability. This may be a signed statement from a physician or other medical professional indicating the beneficiary's present capability. SSA may use lay evidence which can include SSA’s own observations or statements from people (such as relatives, close friends, neighbors, or landlords) who are in a position to know of the beneficiary's ability to manage or direct the management of funds. If the beneficiary has been legally incompetent, a certified copy of the court order restoring the beneficiary's rights is needed.

Then SSA decides if the beneficiary is able to manage or direct the management of benefits in his/her best interests. Any decision SSA makes about capability or the selection of a representative payee can be appealed by the beneficiary. Source: POMS GN 00502.000 for details.

Retired and Disabled

Dear Mr. Spec,
I'm 67 and receive regular Social Security retirement benefits. I have been working full time but recently became disabled to the point where I no longer can work. Can I receive Social Security disability benefits in addition to or more than what I get for retirement?

Otto
Moquah, WI

Dear Otto,
Someone in your situation cannot receive Social Security disability benefits in addition to or instead of retirement benefits. Once a person is over the full retirement age (now 66), he or she cannot be eligible for Disability Insurance Benefits (DIB.) A person can only receive DIB if younger than the full retirement age and no longer able to do substantial work because of a disabling condition.

For those receiving DIB when turning full retirement age, the payments become retirement benefits. The benefit amount is the same as before, but the rules regarding work, Substantial Gainful Activity (SGA), and medical reviews no longer apply since the payments are technically no longer disability benefits. Similarly, Widow(er) Disability Benefits (WDB) essentially become Widow(er) Benefits when the widow(er) turns full retirement age.

One way to look at DIB or WDB payments is as a form of early retirement benefits intended to tide a person over until reaching full retirement age when those payments automatically become retirement benefits.

Note, however, that Childhood Disability Benefits (often called Disabled Adult Child or DAC benefits) are different. Those who are entitled to DAC benefits continue to receive them past full retirement age as long as they remain disabled. It is unlikely a Childhood Disability Beneficiary would ever medically recover after full retirement age, but the disability rules regarding work, SGA, and work incentives still apply.

Ben (Ask Ben a question: askben@eri-wi.org | Visit Ben's Blog

Training and Educational Opportunities:


Wisconsin Aging and Disability Resource Center Conference 2009

Date: September 21-22
Where: Stevens Point Holiday Inn & Convention Center
Mark your calendar for the Wisconsin Aging and Disability Resource Center Conference 2009 from the Office for Resource Center Development. We look forward to seeing you and stay tuned for more information.

Puzzled By Brain Injury? Enhance your skills to improve the lives of those you work with.

Dates & Locations:

  1. October 8, 2009 in Eau Claire at Chippewa Valley Technical College.
  2. October 26, 2009 in LaCrosse at Western Technical College.
  3. November 5, 2009 in Appleton at  Fox Valley Technical College.
  4. November 10, 2009 in Madison at Madison Area Technical College (Truax Campus).
  5. November 13, 2009 in Milwaukee at Milwaukee Area Technical College (Oak Creek Campus).

Presenters:
Wisconsin based and Nationally Certified Brain Injury Specialist Trainers (CBIST)

This training utilizes a national curriculum recommended by the Academy for the Certification of Brain Injury Specialists (ACBIS) for entry-level staff and experienced professionals. A sampling of the topics included in the training manual are:

Following a day long training, a written exam will follow (optional) to earn a nationally recognized credential- Certified Brain Injury Specialist (CBIS).

For More Training Information Contact Myrt Sieger, TBI Training Coordinator at:
608-442-0317 or email her at siegerfam@gmail.com.

For More Registration Information Contact Brenda Jackson, Administrative Assistant at:
262-790-9660 or email her at admin@biaw.org.

Registration Information Coming Early August! Register early as each session is limited to 30 attendees.

Systematic Instruction

Dates & Locations:

  1. October 20-21, 2009 in LaCrosse.
  2. December 7-8, 2009 in Waukesha.
  3. December 9-10, 2009 in Fond du Lac.

Sponsored By: WI Pathways to Independence, WI Division of Vocational Rehabilitation, Western Wisconsin Cares, Waukesha Training Center, and Creative Care Options.

Hotel Accommodation provided free of charge for those traveling to attend on the following days:
October 20, December 7, and December 9.

This two day training course will provide an overview of systematic instruction procedures based on Marc Gold's timeless Try Another Way approach. The information provides job coaches with the perspectives necessary to understand the teaching of essential job tasks in integrated community workplaces. Topics covered will include a brief retrospective on the evolution of supports in community work sites and a discussion of a "road map" strategy called the Seven Phase Sequence that helps explain how to start and how to proceed with training and supports that are built on the natural features and natural supports uniquely present in each workplace.

The course will also provide overview discussion of the tools of systematic instruction that includes a range of organizational strategies. Training strategies will also be discussed that reference the use of formats for presenting information, demonstration, verbal assists, gestural and modeling cues and physical assists. The role of natural motivation in lieu of reinforcement will also be discussed.

Space is Limited.  Register Early. 
Registration Deadline: Thirty(30) days before the training date you select.
Priority given to those placed on waiting list in 2008 and those directly involved in job coaching.

For More Information Contact Lisa Mills at:
608-225-4326 or email her at lisa.mills@dhs.wisconsin.gov.

Ongoing Training:

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