Medical Cessation Protection

In Benefits Articles, Blog, Financial Resources, Ticket to Work Articles by John Benbow

An important work incentive for people who are receiving Social Security disability payments and participating in work rehabilitation programs can be a protection against benefits stopping due to a medical Continuing Disability Review (CDR).

The Social Security Administration (SSA) is required to conduct periodic medical reviews of all Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability beneficiaries to ensure they remain disabled and entitled to benefits. If SSA finds that a beneficiary is no longer disabled due to medical improvement, payments normally stop. However, under certain conditions, a disabled beneficiary’s payments will not stop despite a scheduled medical CDR and potential cessation decision.

Such protection may come about in two ways.

1. Ticket to Work

Ticket to Work is a free and voluntary program that offers SSDI and SSI disability beneficiaries choices for obtaining vocational rehabilitation, employment, and other support services needed to get and keep a job.

SSA will not initiate a medical CDR for a beneficiary who is using a Ticket and making timely progress toward a goal of self-sufficiency. This provision allows Ticket holders to continue their return to work efforts without even having a medical CDR.

For a disability beneficiary to have protection against a medical CDR under Ticket to Work, his or her Ticket must be “in use.” This means that the Ticket holder has assigned the Ticket to an Employment Network (EN) and is receiving employment support services. After the Program Manager (Maximus) has received a signed Individual Work Plan (IWP), the Ticket holder must make timely progress toward the vocational goal of achieving self-sufficiency as set out in the plan.

Maximus reviews Ticket holders’ cases to check if the timely progress requirement is being met. If a Ticket holder submits no evidence, or if the evidence submitted shows that the ticket holder did not meet the guidelines, the beneficiary is subject to a medical CDR, even though the ticket remains assigned to an EN or a state Vocational Rehabilitation (VR) agency.

2. Section 301

Section 301 allows the continuation of payments after a medical cessation for an SSDI or SSI beneficiary who is participating in an approved vocational rehabilitation program. The difference between the Ticket and 302 is that rather than providing that no medical CDR be initiated (as is the case with the Ticker), 301 is used after a beneficiary is found no longer disabled.

Section 301 applies when a Social Security disability beneficiary has a medical CDR, is found no longer disabled, and is participating in an approved program of Vocational Rehabilitation or similar services. This cessation protection continues until the program ends, the beneficiary stops participating, or SSA decides that the beneficiary’s continued participation in the program will not increase the likelihood of permanent removal from the disability benefit rolls.

Approved programs may include a VR IWP, a Plan to Achieve Self Support (PASS), or other support services using an individualized written employment plan. An Individualized Education Program (IEP) for transition age youth (18 through 21) may qualify as an approved program; SSA normally assumes that participation in an IEP will decrease the likelihood of ongoing benefit dependence. When SSA contacts a beneficiary to obtain information needed for a medical CDR, one of the questions asked is about the beneficiary’s participation in any vocational rehabilitation program.

As indicated earlier, a beneficiary with a Ticket assigned but not “in use” is not protected from having a medical CDR. However, if such a beneficiary undergoes a medical CDR, is found no longer disabled, and continues to receive approved services, the protection from benefit cessation under Section 301 can still apply.

The critical factor for Section 301 eligibility is that the beneficiary’s continued participation in the program must increase the likelihood of independence from disability benefits. After a medical CDR cessation determination is made by the state Disability Determination Bureau (DDB), SSA’s Office of Disability Operations (ODO) reviews the program and the person’s participation to see if Section 301 can apply. Both the DDB cessation determination and the ODO 301 decision can be appealed.

About the Author

John Benbow

John brings extensive experience in understanding and navigating complex benefits systems. John worked for 27 years for the Social Security Administration (SSA) serving in several different positions in offices throughout Wisconsin. At ERI, John’s expertise includes providing training, presenting, writing, developing curriculum, researching program and policy issues, and lending technical support to benefits. More about John...