Addressing Concerns Related to Losing Social Security and Health Care Benefits Virginia Commonwealth University (page 4 of 5) Page 4 of 5

1. The item or service must be needed to help the individual work. 
2. The individual must need the item or service because of a disability or any other impairment that is being treated by a doctor. 
3. Individuals must pay for these support items and services out of their own pocket and cannot be reimbursed for them from anyone else (i.e. State Rehabilitative Services).
4. The cost of the service or item must be reasonable.  This means that the individual is paying the same for the item or service as anyone else in the community. 
5. Individuals must get the expenses approved by Social Security.

There are several other things for people to remember about this work incentive.  It is available to individuals who receive both SSI and SSDI.  Also, individuals must keep copies of their receipts for their work support items and services.  These receipts must be submitted to SSA in a timely manner.  Individuals can contact their local SSA office to find out how often they should submit this information.

Question:  One person that I know really wants to go to work.  But, she has a lot of medical expenses including mental health counseling once a week.  What should she do?

Answer: An individual’s counseling and some medical expenses may be considered Impairment Related Work Expenses (IRWE) as outlined in the previous answer.  Often in order for a person to go to work and stay employed, he or she will need counseling and medications.  These supports must meet the IRWE criteria mentioned above.  This individual will need to contact SSA and explain how these supports meet the IRWE criteria.  If Social Security does approve the counseling and medical expenses, then the individual will need to keep receipts for the expenses and submit these receipts to SSA in a timely fashion.

Question:  What happens if a person goes to work and then loses his or her job?  I have heard that it is really difficult to get back on the "benefits roll."  Several individuals that I know are afraid they won't get a check if this happens, and they have decided to stay in our facility-based program.

Answer: Losing a job is a natural part of the working world.  It happens to almost everyone at some point in his or her life.  Often people are concerned about going to work, because they have spent so much time trying to get onto Social Security benefits that they fear work will automatically mean they will lose their benefits. However, Social Security has a number of “safety nets” built into both the SSI and SSDI systems. 

For individuals who receive either SSI or SSDI and lose their job, as long as they are still eligible for benefits, all they need to do is contact Social Security.  They should notify SSA that they have lost their job and are requesting reinstatement of their benefits. SSA will verify their benefits information and resume the SSI or SSDI benefits.

In the event that an individual’s benefits have been terminated, there is a protection called Expedited Reinstatement (EXR).  Expedited Reinstatement is available to individuals who received either SSI or SSDI and had their benefits stopped by SSA due to their work or earnings.  Individuals are able to request that their benefits start again without having to complete a new application. While SSA determines whether an individual can get benefits again, SSA will give the person provisional (temporary) benefits for up to 6 months.  Individuals are eligible for Expedited Reinstatement if they are an SSDI or SSI beneficiary who:

• Stopped receiving benefits because of earnings from work,
• Are unable to work or cannot work at what SSA says is a substantial level,
• Are disabled because of an impairment(s) that is the same as or related to the impairment(s) that allowed them to get benefits earlier, and
• Make the request within 5 years from the month their benefits ended.

Question:  I know that a person can't have more than $2,000 and still qualify for benefits.  I hear a lot about individuals with disabilities starting their own businesses.  How is that possible?

Answer: The $2,000 resource limit is only applicable to individuals who receive SSI.  Social Security has two programs that help SSI recipients start businesses without having to worry about the resource limit:  Plan to Achieve Self-Support (PASS) and Property Essential to Self Support (PESS).

A PASS allows individuals to use their own income and/or things they own to reach a work goal.  For example, an individual can set aside money to go back to school, or to get specialized training for a job or to start a business.  An individual’s goal should be a job that allows him or her to earn enough to reduce or eliminate the need for benefits provided under the SSDI and SSI programs.

Social Security does not count some resources that individuals need to be self-supporting when they decide if an individual is eligible for SSI. These items are called Property Essential to Self-Support (PESS).  Examples of PESS would be property such as tools or equipment that an individual uses for work. Or, if the individual has a business, inventory would be considered property essential to self-support.

There are no resource limits for individuals who receive SSDI.  Individuals who receive SSDI and want to start a business are able to save money without fear that it will affect their benefits.

Question:  Should our program have someone on staff that is an "expert" in benefits counseling to help consumers decide how they can pursue competitive employment vs. staying in the facility-based program?

From Virginia Commonwealth University Rehabilitation Research and Training Center on Workplace Supports and Job Retention, Region III CRP-RCEP, Rehabilitation Services Administration. Used with permission. www.crp-rcep.org.

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