Larry's Success Story
Larry receives a monthly Social Security Disability Insurance (SSDI) check. He began receiving this check about five years ago when he was diagnosed with a severe mental illness. After receiving SSDI for 24 months, he became eligible for Medicare (this is a health insurance available to Social Security beneficiaries). He also applied for Medicaid and was approved because of his disability. With his Medicaid, he paid a monthly spend-down each month. Through a spend-down he had to pay for some of his medical expenses each month, and then Medicaid would pay the rest. At times, it was hard for Larry to meet the spend-down and keep up with his other bills.
Larry tried to work several times, but had difficulty keeping a job for more than two to three months at a time because of his disability. Even though he was not able to keep his jobs, he was using one important work incentive timeframe associated with his Social Security Disability Insurance (SSDI) check. This work incentive is called the Trial Work Period. While he was working at previous jobs, he used all nine months of his Trial Work Period. Larry received a letter from the Social Security Administration to let him know he had used his Trial Work Period, and was entering into another work incentive timeframe called the 36-month Extended Period of Eligibility. After reading the letter, he was confused. It was difficult to understand what these work incentive timelines meant. He thought he was being cut off of his Social Security Disability Insurance benefits all together. Because of this, he was wondered if he should try to work.
In the summer of 2004, Larry did begin looking for work again. He saw a Help Wanted sign at a factory not far from his home, so he stopped in and filled out an application. He was thrilled when he was hired to work. Today, Larry works on the first shift, at least 40 hours per week. His gross monthly earnings are over $1,500 which is above Substantial Gainful Activity (SGA). He is still in his 36 month Extended Period of Eligibility timeframe. If Larry earns more than SGA in any months during the Extended Period of Eligibility, he is not entitled to his SSDI check for that month. If his gross monthly earnings are less than SGA he is eligible for his benefit check for that month. The Extended Period of Eligibility provides Larry with a safety net in trying to work full-time without totally losing eligibility for his benefits. Larry talked to his Social Security Claims Representative and an Indiana Works Benefits Counselor to help him understand the Extended Period of Eligibility and what will happen to his benefits check. They informed him about another work incentive available to him during the Extended Period of Eligibility called Impairment-Related Work Expenses (IRWE). With an IRWE, he can deduct the costs of certain work related expenses from the amount that he earns, and it will keep his earnings counted by Social Security under SGA. Larry, his Indiana Works Benefits Counselor and the Social Security Claims representative were able to identify IRWE expenses that he had. Because his doctor told him he must refrain from driving due to his disability, and because there was no other public transportation that he could access, he needed to hire someone to drive him to and from work. Paying for a driver to help him get to and from work qualified as an IRWE. Through the IRWE work incentive, he was able to try to work full-time, earn more money, keep his SSDI longer as he tried to become self-sufficient, and stay healthy.
Because Larry also had Medicaid, and had a spend-down to keep this Medicaid coverage, he was worried about what his work income would do to his Medicaid. When he called his Division of Family Resource caseworker to let her know that he had started the job at the factory, he dreaded finding out how much his spend-down would increase. But, his Medicaid caseworker had good news for him. He was eligible for a Medicaid program for working employees with disabilities, called M.E.D. Works. With M.E.D .Works, monthly premiums take the place of a spend-down. Larry now pays a monthly premium for his Medicaid health insurance that is much less than the spend-down that he previously endured. He not only has his earnings from his job, he also has more money because he doesn’t have to worry about paying for some of his medical expenses out of his own pocket each month to meet the spend-down.
Larry enjoys his job and the self-sufficiency of earning an income that offers him and his family a higher standard of living. Because of work, he is feeling better too. Over time Larry hopes to save enough money to buy a car, and when his doctor releases him from driving restrictions, he hopes to drive himself to work. He is proud of his efforts at his job, and proud that he has been able to keep his job for so long. With the help of Social Security work incentives and M.E.D. Works, he says; “I am well enough to work and I want to work. Getting a paycheck every week makes me feel really good.”
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