Pat>> -Thanks, Jayme. I want to thank everyone for joining today, the topic being Medicare and Medicaid and the path to employment. As Jayme said, my name is Pat Van Nelson. I'm a member of the Ticket to Work team, and I'll be the moderator today. On behalf of Social Security and the Ticket Program, thank you for joining us to learn about the Ticket Program, Social Security's Work Incentives, and the impact that choosing to work may have on your Medicaid and Medicare benefits. We'll also talk about many people and organizations that you can call upon to help you as you start or expand your path to financial independence through work. Each of us has our own path. Today, our hope is that we can provide you with information that will help you on yours. So let's get started. We want you to get the most out of today's presentation, so we have a few tips for using this webinar platform. First, there's the audio. You can manage your audio using the audio option at the top of your screen. 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As today's moderator, I have the pleasure of introducing my colleague, Derek Shields. Those of you who have attended previous webinars may recognize Derek as your regular moderator. However, today he's going to be our presenter. During the webinar, Derek will cover the Ticket to Work program, Work Incentives, the impact that choosing work may have on Medicare and Medicaid, and importantly also benefits counseling and service providers. I hope what you take away from this session is a better understanding of your benefits, how the Ticket program can help you if you decide to work, and put to rest those myths about Medicare and Medicaid and become familiar with the resources available. I'll be back with you during the Q&A session, so remember to put your questions in the Q&A pod. It's now my pleasure to turn the microphone over to Derek. Derek>> Pat, thank you so much. I appreciate the introduction and the warm welcome, and it's great to be back with everybody this month to talk once again about the Ticket to Work program and support on your path to work. As Pat just said, hopefully to bust some myths and to take what can be some complicated information and help simplify it a little bit to help you make some decisions that would be right for you. Let's get started today with the Ticket program and supporting your path to work. All of our sessions talk about it because we really want you to have the support that you need to work and become independent of your benefits if that's the choice you make. To do that, we're going to start off by looking at the two Social Security Disability Benefits programs. There's two, and I'm going to refer to them throughout, especially when we talk about Medicare and Medicaid because there's some important differences. I'm going to start out by talking about Social Security Disability Insurance, or SSDI. That's the first one there. Please note the name, Disability Insurance. This is an insurance program that people actually payinto while working. If you've worked in the past and you've had those taxes withheld called FICA taxes, you've actually been putting funds in there to be available in your future. This amount of benefits is going to depend on really how long you've worked and how much you've earned. There is a maximum amount that you can contribute, and it's important to note that everybody's benefit is different. Each person works a different amount. Each person is going to have a different amount of Social Security Disability Insurance available to them. It's also important to note that you have to have a bit of a history developed, sometimes up to 10 years to be insured. That can vary, but with SSDI, recall that it is insurance. When you have worked in the past, then you've paid into that program. With SSDI, we don't care about things like resources. We don't care about things like unearned income that you may have. It's the insurance program. If you've worked in the past, you've contributed to it. Then if you qualify, which we'll look at, you can access it. That's SSDI. The other benefit program is Supplemental Security Income. That's SSI. Notice it doesn't say insurance. There's one way to differentiate there. You have the insurance program, and then you have the other one, not insurance. SSI is a needs-based program, and it's provided also by Social Security to people who have not worked enough to be insured. People haven't worked enough potentially to fund that disability insurance that I just talked about, or perhaps they don't have a work history at all. It's very, very different from SSDI. It's also going to look to see about those resources. Do you have low resource amounts? Do you have low or no income amounts? Social Security administers this program as well and pays monthly benefits to people with limited income and resources. That's why they're looking at those amounts for people who are blind or have a qualifying disability. It happens to also be available for some other people. You can qualify for SSI if you're 65 or older, and you can also qualify for SSI as a child with a disability or an individual, a child who is blind. There are some other groups there, but for our purposes today, we're really looking at this for the working age population. Now, directly related to our session today, SSDI, the insurance program, comes with Medicare. If somebody is eligible for Medicaid in their state, they would need to apply separately through your state agency, your state Medicaid agency. On the contrast, SSI automatically is paid to recipients of SSI. You won't have to apply for that to receive it. In most states, Medicaid comes with the SSI program. The Medicaid program also has resource limitations and income limitations, just like we talked about with SSI. This is where it can be a little bit more complicated. So in 46 states, to include District of Columbia, this can happen automatically, but in four states, you also need to apply separately for Medicaid. Once you're in, you have a good long time to work yourself off of the benefits, and it's a real long time, and we're going to examine that a little bit further today to help bust some of those myths. I just wanted to get you through these two programs as our baseline of information. So I'm going to say it again because it's important. SSDI coming with Medicare, SSI coming with Medicaid. It's a real key to following what you need to know as we get into the next layer of information. Okay, so now that we've covered the benefits programs, I'm going to jump to a great resource that you should be aware of to figure out, well, what benefit may I have? What may I already be on? There's something called a My Social Security account, and you can look to your Social Security account, and these accounts have to be set up through the Social Security website. They're going to ask you for some personal information to make sure it's you, and then you could access your information online, but when you do get access to that My Social Security account, you're also going to get access to your work history, and it's going to tell you things like are you eligible for the SSDI program, how much will you receive in disability insurance, and it will tell you how much your family members will receive if you have dependents as well. So I looked at mine yesterday, making a habit before I do a session like this just to check in, see what's going on in my account. So I logged in to my SSA account and read the statement, and it had projected disability benefits to include that SSDI, and it also had my projected survivor benefits. I also saw my eligibility status for benefits. So if you haven't done that yet, I would encourage you to do so. On the SSI side, it's going to clarify that benefits are SSI and how much those benefits are if you're already participating. So all that information is really good to have when you get into the benefits planning stage, and that's one of our big objectives today is to talk about benefits counseling. We'll get into that in a little bit. If you don't have an account, I recommend that you go check that out. Now you can find a link in the web links pod to that. You can do an internet search, or you can also go to ssa.gov/myaccount. There's a lot of great information in there for you to explore.I encourage you to do that. Okay, starting the journey. You know, this is a pretty important slide, and really because it gets to the core of this that only you can decide if work is the right choice for you. I'm going to give you a lot of information. Pat and I are going to, you know, break for a couple or three Q&A sessions actually to take your questions, and we're going to tell you what may occur should you go to work. And you hopefully will make that informed decision as to whether work is the right choice for you, or whether now is the right time to begin work. At the end of the day, what we want to know is you have a large employment team here to support you to help guide the process by giving you all the information, and these will be projections that we could all come up with, your employment team, and some of them are going to talk about the impact of work on healthcare. And as you think about this today, as I talk about it, and you form your questions, just recall this choice is yours, and only you can decide if work is the right choice for you. Speaking of choosing work, so why choose work? You know, this is your choice. We have a saying, work works, and it sounds pretty straightforward because it is. You know, work really does help people.It gets people out of poverty. It also gives people the ability to make a choice and to make choices for themselves. When you think about that, you have more choice if you're working and earning more than your benefits are providing, and at the end of it, you could have some excess money, and in that case, work can really be great. You can look forward to some excess money on the weekend to do the things that you enjoy. In the work, just the act of working and collecting a paycheck can really make that possible for you. So earning a living through employment is not something that everybody can do, and we know that, and that's why the benefits exist, and we also know that the Social Security disability standard can be very tough, but this just might be the right choice for you. And once you understand those different services and supports that are available through the Ticket program at no cost, you know, many people often decide that the rewards of this will outweigh the risks. And again, today, we're going to debunk some of the myths so you can be more clear about what the risks are and how you can work and sustain your health care benefits for a very long period of time. All right, so as I said, we cover the Ticket to Work program in every session, and it's an important area for us to ensure that you're aware. The Ticket to Work program is free and voluntary. Notice we bold voluntary here just to reinforce this is your choice. You do not have to participate, but if you do, you also should know that you don't need that Ticket to make use of the Work Incentives that the Social Security administration provides. When you do decide to access the services, or we'll call use the Ticket, kind of in air quotes there, you do get a lot of services that other folks wouldn't pay for, and these are the services involving career development. We're really looking at people for career development at people ages 18 to 64 who receive a disability benefit from Social Security and importantly want to work. That's the real requirement there. So if you want to work, then you can have access to free voluntary services or free and voluntary programming to support you. Remember, 18 to 64, and that's receiving the Social Security disability benefits that I just covered. SSDI, SSI, or potentially both. If that sounds like you, you're on the benefit, one or the other, or both, and you want to work, and you're 18 to 64, then we have some great career development offerings for your consideration, and we're going to cover those today. When you connect with the free employment services, what does that really mean? The Ticket program has those services out there for you to decide if work is right for you. As you make the commitment, and if you're second-guessing yourself, well, know that there's professionals out there that are part of the employment team that can help you consider, well, is work right, and is the timing right for me, and what will happen if I begin to work, both to my income, but also potentially to my health care? The next one there, preparing for work. After you make the decision and you have your employment team, the Ticket program has individuals that can support you in preparation. Sometimes it's easier to decide, but then actually to get everything in line and to make a plan that takes you from where you are to where you want to be, that can be challenging. Somebody might need educational preparation. Somebody else might need to have rehabilitation preparation. It can be done, and the Ticket program is designed to both customize for you, but also help you see the project schedule that's ahead of you, how you're going to reach the place you want to be, and that's working and earning more than your benefits are providing. Well, to do that, of course, you have to find a job, and we're going to talk today about the employment networks that are experts in that. They're part of your employment team, if you choose, and they have relationships with employers. They do this locally, but also nationally, and they really know their territories. They know where the employers are, the types of jobs the employers have, and they can help you prepare. Maybe it's preparing the resume. Maybe it's preparing for the interview, but they really get you to the point where you have the tools and the confidence to go into the relationship with that employer. Now, they're going to say, hey, go over to this employer. We've been working with them for a while. They are seeking candidates with some of your skill sets. We believe you're ready to meet them. It seems like a good match. And then, you know, the Ticket program can help you succeed at work, and, of course, this is the most important part. We envision ourselves working, but we also envision success at work, and, you know, the Employment Networks can help there. They can provide some of that on-the-job support with you. They can help with discussions between you and the employers, perhaps around things like reasonable accommodations, and they can really bring all these services there to you in a way that really helps you move from deciding what's right to not only finding the job but succeeding at work, too. So the Ticket program also has Work Incentives with it, you know, so there's a lot of them, and, you know, we're going to cover a few today. As I said, you're going to get to these Work Incentives through your employment team, and layering this all to get on top of these Work Incentives is a great thing that the employment team can help do. Social Security has a total of more than 20 Work Incentives, and some of them apply to SSDI, that's the insurance program, and some of them apply to SSI as a Supplemental Security Income. And some of them sound really similar, and some of them are very different, so you have to have some assistance in navigating them. But Work Incentives make it really possible for you to work while still receiving the benefits, and the details of these we're going to discuss in more detail through my presentation, but probably through some of the questions you have, because these are designed really to help you succeed. If you're not sure, though, about Work Incentives or the Ticket program, well, you know, you might get contacted, and this could tell you if you qualify, but if you're not sure if you qualify, we also have some folks you can reach out to to get that answer, and we'll give you that information in just a little bit. Clearly, you're going to keep your Medicare and Medicaid for a long time, and that's the key here. I told you that at the beginning, we're debunking myths, and we're going to do it with specific numbers for how many years you can keep this, and you're going to have access to those individualized services and supports along the way, this is all customized for you. So just remember that this is important. You can keep your Medicare and Medicaid, you're going to have access to the customized services, and you can keep some or all of those benefit payments as you transition into work. Really important things to keep in mind. All right. Now, as we talk about all this, you're probably going to say, well, how do I access this information afterwards? Because there's a lot of details here. We recommend looking at the Work Incentives through a few different ways, but Social Security's Red Book has a great general reference to all the Work Incentives, but really a reference guide about employment-related supports available for all people who receive SSDI and/or SSI, and it comes with information that's helpful for individuals that are looking to transition to work, but also educators, advocates, rehab professionals, and the whole employment team that's out there as well. It also has some other information in it, including resources for finding or returning to work. So if you haven't checked out the Red Book, I encourage you to do that. There's a link in the deck. We have it in the web links pod, and if you're on the internet, you can literally search Social Security's Red Book, and it'll be one of your first hits. I also recommend each year, for this year, 2023, there's a What's New page, and that will really call out things that change every year, like things like Trial Work Period or Substantial Gainful Activity. So if you want to see updates, you can go into that section as well. The Red Book is available, the entire Red Book, in English and Spanish, so I encourage you to check that out too. We do include in there, if you're focused on transition age youth, you can check out some resources that are designed as well. All right, now I mentioned before, if you're interested in a Ticket program, but you're not exactly sure where to start, well, we have a helpline available for you. Social Security's Ticket to Work program offers this helpline to support you on determining just exactly where and how to start this journey. I encourage you to reach out to the Ticket to Work helpline to talk to a representative if you are unsure of where to start, or if you're deciding it's time to start, and you need to contact a member of the employment team. So the helpline is open Monday through Friday from 8 a.m. to 8 p.m. Eastern Time, and you can reach them at 1-866-968-7842, or if you're a TTY user, you can reach them at 1-866-833-2967. So if you're interested, I encourage you to reach out to the helpline, and they can answer your question. So with that, I'm going to advance us to our first question break, and ask Pat to return. Pat>> Thanks, Derek. We've gotten quite a few questions. The first one is kind of a softball question, because I think you mentioned it in your presentation, but somebody wanted to make sure, do they need to pay anything to participate in the Ticket to Work program? Derek>> Thanks, Pat. This is Derek. Yeah, I appreciate the softball for the first one, but the answer is no. There is no cost to participate. The program is free. Remember, the word voluntary was bolded. That's an important point. You have to be receiving benefits, and you know, between 18 to 64 years of age. So those are the real requirements, but it is free, and you know, that's a great thing, because you can get access to so many support services. Pat>> Okay, it's Pat again. Would you go over the difference between Medicaid and Medicare one more time? Derek>> Well, I will, but I'm going to go into the details of it in the next section, but let's just give a description there. So when you hear it, Medicaid is a federal and state health insurance program administered through the states. So if that's confusing, the federal money coming down to Medicaid, but that's a health insurance program administered by the states to qualifying individuals with limited income. So when we talk about Medicaid, we also talk about SSI. And then on Medicare, that's a federal health insurance program for individuals who've received SSDI for over 24 months, and they can be really at any age. It's also available for people over age 65, but that's regardless of disability status. And remember, I said before, Medicare, attach that to the insurance program. So SSDI, Medicaid SSI, Medicare SSDI. Does that help, Pat? Pat>> It does. Thank you. The next question is a little different in that somebody wants to know -- they're interested in learning something new, like they worked in a field before, and now they want to go into a different field. Is that something the Ticket program can help them with? Derek>> This is Derek. That's a great question. The answer is yes, you know, and we have a success story towards the end today of my comments that will reinforce this point. It's a great story, but it shows that people that are on SSDI or SSI can, in effect, learn something new and start a new career. So if you hear people saying, well, you don't have any experience, how could you get involved? I would suggest that we know of success stories where people reach out to their employment team, they establish their work goals, working with the employment team, and sometimes they have to learn those skills. Maybe they need some training. Maybe they need a specific computer skill, and they can take that class, and that will lead them to then be more prepared with the skill. In other cases, you know, sometimes we have WISE webinars on other ways to acquire skills, and we have the one on apprenticeships, and that's a great way to learn while you earn. And in apprenticeships, many of them don't have any prerequirements, but you can, through your employment team, explore fields of interest, create your plan, identify how you're going to acquire those new skills, and then go in that new career direction. So Pat, I appreciate the question a lot, because I think there's a lot of people out there, there's some misinformation about that, I think. Pat>> I think so, too. I think you mentioned before that you didn't have to have a paper ticket to start, right? Dere>> That's correct. Yeah, this is Derek. A long time ago, people received paper tickets. You don't need to have a paper ticket. You could reach out to, you know, we'll talk about these service providers later, but you could reach out to our helpline. I just gave that information. You could reach out to an Employment Network. Somebody's going to verify that you're eligible to participate, but they could look that up in a computer database and confirm for you and proceed. So it's not like you need to have a ticket in your hand to go access and have a conversation with these members of the employment team. Pat>> Thanks, Derek. I think we probably need to move on at this point. We'll be back with some more Q&A a little later in the webinar. Derek>> Excellent. Thanks, Pat. I enjoy the questions, so keep submitting them through that Q&A box, and Pat will pick them out, and we'll chat twice more during the session. Yeah, so Pat just asked, give us some definitions around Medicare and Medicaid. And, you know, here's where we enter the coverage, the Medicare and Medicaid coverage and the path to employment. And so this is where we're going to get into some really specific information. And I think the way that I'd like to start out is to get back to some myth busting. So here we have a myth. So true or false, if I go to work, I will automatically lose my Medicare or Medicaid? And it's my guess that you have heard different answers from different people over the time, but this is one of our biggest myths. And, you know, the correct answer is that this is false. You will not automatically lose Medicare or Medicaid. And we're going to spend some time today going through those details for you. You know, if you are receiving a benefit payment at any amount, you will keep your Medicare and Medicaid. And if your benefit payments stop due to earnings from work and you remain medically disabled, you can't show an improvement there, you have to remain medically disabled, then you may be able to keep your Medicare or Medicaid through either the Work Incentives or the buy-in programs. We'll look a little bit more at the buy-in programs, but these are in over 40 states have these buy-in programs. And, you know, everybody has a Medicare buy-in as well. We'll talk about both of those. So just remember, as we go to speak about Medicare and Medicaid, the insurance program, SSDI, that's attached to Medicare, and SSI comes with Medicaid, because we're about to jump into some more of these details on Medicaid and Work Incentives. What you have to remember here from that earlier discussion, so let's dive in with the next slide and talk about Medicaid and the Work Incentives. We're going to specifically talk about these two areas, Medicaid While Working, and that's what's known as commonly talked about as 1619B. If you've ever heard that term, everyone's going to understand what that is when you talk about Medicaid While Working. And we're going to talk about the Medicaid buy-in program. And both of these are important and they're really useful. And this is where we get into the details of how you can use these Medicaid Work Incentives to help you. So on this slide, Medicaid While Working, or that 1619B, when you think about Medicaid While Working, if you're receiving SSI, so that's important, you're able to continue to get health care while you're working. And then if your work has really been successful, meaning you keep earning, you can also make sure that you can keep some of the services that are directly supporting your work effort. I think it's really important to remember that you have to be receiving SSI and you have a chance to retain Medicaid While Working. Let's go into the details of how it works. If you're eligible for SSI, for an SSI payment for one month, if you are, then you're an SSI beneficiary. And that's probably what happened. You got a benefits payment, a cash payment at some point. So you have that in place. Next, you continue to meet the definition of disability. Remember we said you're not medically improved. But when you're working, you're not really worried about having Social Security purposely looking at you to figure out the disability status. Happens at times, but it's not happening to everyone. And if you remain meeting the definition, you're not medically improved, but you still have your disability, then you're still eligible. We do know that there's people that have gone years and years, and they continue to meet the definition of disability and they continue to work. So those are two. The next one is really important as well. You have to meet the other non- disability requirements of SSI. So Medicaid While Working also requires that they're going to look at the resources. They're not going to consider your income from work because that's key to getting into the program, 1619B, Medicaid While Working. But they might look at income you're receiving from somewhere else. So that's going to be a non-work-related income. So if you receive gifts or if you have something like a lot of stocks or something, they're going to look at non-work-related income. Number four, it's an important one too. You need Medicaid benefits to work. So you know, we need health care to work. We understand that. But the Ticket to Work Act was also the first time Congress ever said people need health insurance if they're going to work. And Medicaid While Working or the 1619B, it provides that very thing for you. So the benefit in health insurance allows you to get access to that health care. So you need the benefit to continue to work. And last, you have to have gross earnings before taxes that are below your state's threshold of eligibility. Now, in this area, each state has a different threshold for eligibility and they can differ pretty dramatically. You'll understand why it's the case when we get into that definition of threshold. So when we think about the 1619B qualifiers, remember, this is Medicaid While Working and this is for SSI beneficiaries who have earnings too high for an SSI cash payment that may be eligible for Medicaid if they meet the listed requirements. So folks use a threshold amount to measure whether a person's earnings are high enough to replace their SSI and Medicaid benefits. I get it. It's a lot of information. And now we're going to add in the threshold information to it. So the threshold amount is the measure that Social Security uses to decide whether your earnings are high enough to replace your SSI and Medicaid benefits. And how they figure that is the amount of the earnings that would cause SSI payments to stop in your state. Some states actually supplement the benefits. So each state, again, is going to be different. And that goes along with the average annual per capita Medicaid expenditures for your state. There's an actual formula out there every year and somebody's calculating that for each state. What I think is important to know is that if, let's say, I'm going to go to work, I would have to report how much money I'm earning and Social Security would then determine if I'm eligible for a payment. And then, the next step, Social Security is in contact with a state Medicaid agency so they can provide information about how much that average recipient on Medicaid living in the community each year and how much does the state spend on Medicaid. So you've really got to look at your particular state. And the threshold is based on the two bullets we have on the screen here. The amount of earnings that you would cause your SSI payments to stop in the state. And remember, the second one, the average annual per capita Medicaid expenditure for your state. And if you're interested, maybe after the webinar or you can go through the web link spot and look at these state threshold amounts. But I looked at some yesterday. I've been a little bit since I've done it. And so, you know, they range from around $37,000 to one state that's over $80,000. And they change each year. So I live in the state of Maryland. The threshold in Maryland this year is $48,604. So it's important to know this changes in each state. And that the threshold, you know, is a calculation that you need to be aware of. And the employment team will help with all of this. So to add one more layer to it, if you're receiving the 1619B Medicaid, remember that you're earning enough to get zero in SSI benefits. Right? So you don't qualify over there. But then you're receiving the 1619B, you're still SSI recipient eligible just for $0. And that's why your Medicaid can continue. So when we look at that, you can look at, you know, how Social Security can determine an individual threshold. You can look at a higher threshold if you use some of the other Work Incentives. And on this screen, we have five listed. And they're important ones. The first one is Impairment-Related Work Expenses. You might hear somebody refer to as an IRWE. These are costs for items or services that you need in order to work because of your disability. So Social Security actually deducts those expenses from Impairment-Related Work Expenses from your countable income. So that would change kind of threshold formulas. Right? So and these are items or services that help you work. You could need an item or service because of your disability. These things have to be in a reasonable range, but they're important that you consider as part of the formula. There's also Blind Work Expenses. Similar, but these allow blind individuals to exclude those reasonable unreimbursed expenses from their earned income. An example could be potentially transportation to and from work. And then next, we have the PASS plan. This is a plan to achieve self-support. A PASS is an SSI Work Incentive or provision to help individuals with disabilities return to work. So you can set aside some income or resources to pursue a work goal. And this will help in making that transition more possible. Potentially a good one out there for some of you. You could also learn more about the PASS and these others in that SSA Red Book that I referred you to before. I encourage you to check that out. There's other items that are considered, you know, when calculating thresholds like publicly funded attendant or personal care. And any time your medical expenses are more than the average, then the threshold can increase. So that you'll continue to get Medicaid as you work. So all of these are designed to extend your ability to continue to get Medicaid as you work. And really remember that this has to be requested, you know, so any time, you know, perhaps you see like attendant care or personal care attendants,this is something to consider because these are very expensive. But you have to bring this up to somebody on your employment team, perhaps your benefits planner or someone on an Employment Network. So keep that in mind. All right. Next up, we're going to look at Medicaid buy-in program. Remember, this was the second one. So like I said, in most states, there's a Medicaid buy-in program. And again, Medicaid is run by the state. Those thresholds are, you know, going to vary. But let's say we're in a $50,000 state and I'm earning now $51,000. If I wanted Medicaid, like because, you know, maybe I have an insurance provider now through my employer, but Medicaid has been paying for some of the really important services that private insurance might not cover, I can actually buy into the system. Just $1,000 over the threshold, but now I have Medicaid buy-in to keep that benefit that I need. So when you look at the national cost average of doing it, it's really inexpensive and it's something to consider. Some states can have a base payment. Other states tie it to an amount of income you're receiving. It just really differs. But the key for qualifying there is that you have to meet the definition of disability and you'd be eligible for SSI payments. And eligible for those payments, you know, if we didn't look at your earnings, it's just pretty simple when it comes down to that. So that's a great offering there. Also, you know, keep in mind here that people who receive SSDI can also be eligible depending on their income and other criteria. So we mentioned that this is SSI, but it is possible for some other eligibility there. Okay. On the next slide, we have Medicaid and Ticket program resources. Remember, I just went through these two, Medicaid While Working, 1619B, and Medicaid buy-in program. Well, I understand that's a lot of information. I wanted to ensure -- our team wanted to ensure that we gave you a couple tools to follow up on here. First, for 1619B this is information on Medicaid While Working. Check out the Continued Medicaid Eligibility link. This is a link that's in the deck here. And it's also going to be in our follow-up information on our website. I'm looking through and it looks like it's at the end of the web links pod on number 20 in your web links pod. You can go in there and select that one. I encourage you to do it. It will take you to the Social Security website to learn more about Medicaid While Working. For the second one, for the Medicaid buy-in program, state Medicaid agencies know what that threshold is for you. So you need to check that out and check the link out there in the web links pod number 21. That's going to take you to a cool map and you can select your state and get the information you need specifically for your state. All right. Two great resources there. Now, we're going to switch from Medicaid over to Medicare and Work Incentives. I know there's a lot of content; we're going to push on because we want to get through it and get to your questions. Next, Medicare Work Incentives and programs. We have Medicare with the extended period of Medicare coverage and also Medicare for people with disabilities who work. They both work a little differently. So let's dive into them and starting with the extended period. So most SSDI beneficiaries whose benefits stop because of earnings will continue to receive at least 93 months of hospital insurance. That's part A. And supplemental medical insurance. That's part B. That's basic health care along with the prescription drug coverage, part D. You have to be enrolled in part B and D as it says on the slide. Let's repeat that though. That's at least 93 months that you can receive this. That is over seven years. This is an exceptionally long period of time and that is after you finish your nine-month Trial Work Period with the Ticket program. So you can begin working, use your Trial Work Period, and then you will still have over seven years' worth of Medicare. That's for SSDI beneficiaries. That's a really long time with a safety net to allow you to, you know, access work, explore work, and then continue over a seven-year time to advance in work. And again, our success story a little bit later today will talk about that. And you're entitled to be a recipient with these Medicare benefits and you're working at those Substantial Gainful Activities. Similar to before, you also have to remain disabled. And remember, that means you're not medically improved, but you still have that protection for 93 months' worth of benefits. And you would think that was the end of it, but it's really not. There's even more to look at here. So when we go to the next slide, we look at Medicare for people with disabilities who work. And so, when we talk about that, after premium-free Medicare coverage, you know, that ends because of work you can continue to buy the coverage if you remain medically disabled. So at that point in time, you've been working for a long period of time. It could be over seven years. And then, if you are eligible, you can continue to buy the coverage that you need. So you can't be 65 yet, but remember, when you turn 65, you become eligible for Medicare based on age, not benefits or disability. The second point, you continue to have that disabling impairment, like you haven't medically improved, so you still have your disability. And the third point, your Medicare stopped due to earnings from work. Maybe that seven years went by. So it's really important that, you know, you have over seven years, but you can continue accessing Medicare coverage through a buy-in option. So that's a cool thing to keep debunking the myth of when you work, you don't have access to these Medicare or Medicaid offerings. So these healthcare benefits can be going on for years. And for more information on this, on this slide, we have some contact information. For more information on Medicare enrollment periods or to make an appointment to enroll, you should be calling Social Security. And that number is 1-800-772-1213. For TTY users, that's 1-800-325-0778. Again, that's for information on enrollment periods or to make an appointment to enroll for Medicare there. For help with paying those premiums, you can call Medicare at 1-800-MEDICARE. There's also the TTY number, 1-877-486-2048. Just know when you do reach out to that, they're going to want you to have your Medicare number, you know, when you're going to call about help for paying premiums. And you're going to have to tell them where you live, because this is, you know, state-dependent information as well. Well, look at that, Pat. We've gotten through the Medicare and Medicaid information, and it's now time for our second questions break. Pat>> Oh, boy. And we got some doozies. We got some that are a little complicated, Derek. So here we go. Somebody's decided that they're already working, or they are already working, and they've been offered their employer's insurance. What happens to their Medicare or Medicaid under those circumstances, say they take that employer's Insurance? Derek>> Yeah, so, thanks, Pat. This is Derek. So if you've been working and you take that employer's insurance, I mean, this is the vision. So I'd like to go back first and think about that. We got together with the employment team. We decided to work. We created the plan. We found the job. We started working, and then we were offered the employer's insurance. So this gives us the chance to get closer to that goal of earning but also having insurance. You have the option, though, to continue accessing through a buy-in option coverage for items that might not be covered by those employer insurance programs. So if there's something that's out there that you're like, well, I'm really concerned about that. I want to take my employer's insurance because it's a good program, but you put them side by side, and you're like, well, there's a few things that aren't covered here. Then you could access through the buy-in program an opportunity to have two insurance options, and I think that's an important thing to consider. So when you think about that, there is no need to have it end. You do have to maintain what we call medically disabled, but you can buy your Medicare coverage, different parts. Parts A, B, and D were the ones we were talking about, and that would give you the chance to have access to that and your employer insurance kind of working together in the most comprehensive coverage that you can think of, perhaps. And if you're unsure of how that works, we cover it today, but we encourage you to talk about that in your benefits planning process to make sure that you have the details that will really help you in your decision-making. You know, you have, in that case, you know, Pat mentioned it, but just to reinforce, you have state, like, health and human services organizations that are out there, and, you know, they could actually add in payment assistance in that model, too. So you got your employer insurance, and, you know, hopefully, they're covering a good portion of that, but then you could have that buy-in to Medicare, and then you might actually have some of that premium paid for by your state. So another reason -- well, you know, it sounds good, keep researching that with members of your employment team. Pat>> Thanks, Derek. That was a complicated one. Now how about this one? What happens if a person was working, they took their employer's insurance, and they stopped their Medicare? Now, they find that they can't work anymore. Can they get it back? Derek>> Yeah, that's a really good question. Yeah, it's a really good question. And it's attached to some of the myths that are out there. So like, if you took the insurance, but maybe your Social Security disability benefits also stopped due to earnings, you know, and so your MO, you have a chance to get these things back. So there's a process that's out there called Expedited Reinstatement. So it allows for benefits coverage, including Medicare, to get back to where it was, but you have to qualify for it. So you know, if you tried work, and something happened, your disability impacted you to a degree where you're unable to continue working, you're able to use Expedited Reinstatement if you make the request within 60 months of the original benefit ending. You know, so the benefit ended, you took your employer's insurance, but you have to be medically disabled. And in this case, we just offered that is the case. And then the reason you're unable to work is due to that disability that originally qualified you for SSDI or SSI. But that would allow you to get back to those Medicare offerings, like Part D, Part B, the real healthcare options, and those prescription coverages. So what I've heard many times is, you know, once I go to work and I transition, that I never have access to this coverage again. And what we encourage you to do is hear that that isn't the case for everyone. If you do remain eligible, you have access to things like Expedited Reinstatement, and this could get you back to Medicare coverage in this case. And we encourage you to talk to your employment team to ensure that you understand that, and this gives you the confidence you need to make the decisions that are right for you. Pat>> Thanks, Derek. This is Pat again. You've mentioned a couple times this employment team. Are those the people that can give people the best advice about all of these benefits and the incentives? Who are those? Derek>> This is Derek. Thanks, Pat. That's a good one. I mentioned that we're actually going to focus on, you know, some key members of the employment team, and we're going to point you to the website for how to find them. But they really are there, you know, they start with benefits planners. There's also some legal advisors, if you're having trouble along the way with what could be discrimination or uncertain on how to approach a question around reasonable accommodation. There's the state Vocational Rehabilitation agencies, and then there's the Employment Networks as well. So there's a lot of different members, and you kind of collect the team, and then you use these team members to design your customized and individualized plan and evolve with each one of the employment team members at different points in time. Those benefits planners, that's pretty key. We have disability benefits, but then we also also have Work Incentives and healthcare benefits. Well, they all kind of intersect, and we're going to cover benefits counseling in this final section. So I'll dig into that a little bit more deeply soon. Pat>> Thanks, Derek. Based on that, maybe we should just move into that section, because there seems to be a lot of interest in those counselors, for example. Derek>> Got it. Thanks, Pat. We'll be back to you in a little bit, but I'm going to proceed with the next section then, benefits counseling. So you know, first we talked about the benefits from Social Security, and then we talked about the Ticket program. Then we talked about the impact of work on transitioning to work in Medicare and Medicaid. Well, now we're going to look specifically in on the important role of benefits counseling and you. So with that, I'm going to transition here. So the important part about this is recognizing that benefits counseling is really a critical part of the return to work process. When you look at the benefits here, and you think of Medicare and Medicaid, you think of Social Security disability insurance, you think about supplemental security income and housing assistance, it goes on too. There's more benefits that are out there, like family assistance. You could have TANF, temporary assistance to needy families, or food stamps in the Supplemental Nutrition Assistance Program. All of these benefits can be affected by going to work and by earning money. So we really want to make sure that you understand who the benefits counselors are and how they can help you to ensure that you're navigating transition to work for the first time or return to work in a way that helps you and potentially helps your family. So I mentioned these when Pat asked me about the employment team. So we really look at these folks as benefits counseling service providers. They're a core part of your employment team, and they can be at different organizations that do different things. For service providers that provide benefits counseling today, we're going to cover three options for you. This slide has them listed. The first one are the Work Incentives Planning and Assistance Projects. We'll call those the WIPAs. The next one, the State Vocational Rehabilitation Agencies. You could hear that referred to as State VR. And the last one are the Ticket to Work Employment Networks or ENs. And so we have more details on each of these, and we're going to start out by covering for you now the WIPA projects. So the WIPAs, when you think about all the Work Incentives that I was talking about and how they intersect for different disability benefit programs and for different health care coverage, well, it gets complicated. And we recommend that you understand that there's somebody called a Community Work Incentives Coordinator or CWIC, and they're at these WIPA projects. And they are all certified to provide you free benefits counseling if you're eligible. And so we'll talk about eligibility, but for eligible Social Security disability beneficiaries, they're focused on how work and earnings will affectall those benefits. SSDI, SSI, Medicare, Medicaid, and all the other public benefits of which some I just mentioned. This can help you understand the Work Incentives and how they apply to your unique situations. I think it also important that they could explain the potential benefits of employment, not just, you know, the risks, but also if you navigate this map that you could create for yourself, the benefits of employment and dispelling the myths about working, they could give you more confidence in working with the rest of your employment team to go after that job or career that you really want. And in the end, they can really help you decide about the services and supports from the Ticket Program to see if they're a good match for you. We understand it can be a nerve-wracking decision. And we also know that a lot of folks get scared in taking the first step. When we think about, like, the idea of the pathway to work, we do think about the importance of you talking to the CWICs or the WIPAs themselves. So it's important to see if you're eligible. So who do the WIPAs serve? Right now it's important that you know that they are serving people who are currently working or currently self-employed, people who have a job offer pending, or you've been offered a job and are waiting to start, or this last category is important, people who are actively interviewing for jobs, which means that you had an interview in the past 30 days or you have something scheduled in the next couple weeks. So those are the categories that we're looking for, people that are either currently working, have a job offer pending, or that are actively interviewing. And so the WIPAs are there to support this group because we're looking to help transition people from the benefits to, you know, into work. And these are the groups that have priority to those services. Now there is one other group that they can serve, and those are individuals that are age 14 to 25. So this is more of your young adult population. And even if they're in an early stage of considering work, the purpose there is to help those individuals as they consider perhaps transition to work from school, that they would understand the implications or impact of work on their benefits and making those choices. So those are the WIPAs. Next, let's talk about the state VR agencies. A state VR agency, perhaps you're familiar with them, they can have a benefits planner on their staff. So many of them actually do have benefits counselors and planners, and they can provide you with what we'll call it in-house planning services. You know, so this is more like a one-stop shop where your state VR agency can help you with a lot of things. You know, and they can offer the benefits counseling, but they also help you with vocational rehabilitation, you know, if that's needed, or that training and education perhaps to prepare you for that new opportunity. Remember when Pat asked me about, are you going to be like learning a new field to go in a new direction? State VR can do that as well. So it's important to know that you can get all these services, including benefits planning, from the state VR agencies. I also think it's important for you to know that, you know, we have a link to all these resources on our website. We're going to share it so you can find help for the type of agency you choose to work with. And in some states there are separate VR agencies. So not all states, but some states have a VR agency that will serve individuals who are blind and visually impaired. That's separate from a state VR agency that serves other people with disabilities who are not blind or visually impaired. So just good to know in all cases they can also provide that benefits planning and help you navigate those decisions on your pathway to work. Next, we'll talk about the Employment Networks. You know, as part of your employment team, the Employment Network is available, and that's an organization. It can be either a private organization or a public one, but it has an agreement with the Social Security Administration to provide free employment support services to people who are eligible for the Ticket to Work program. So that's pretty important to consider that the EN could also, as part of that employment team, have a certified benefits planner available. And if you're working with them, that would be also in-house. Now if they don't, they would refer you to an appropriate WIPA or potentially state VR agency, but most likely to a WIPA. And in doing so, they would know that, okay, you're ready to interview, you have an interview scheduled, and we would want to add in the benefits planning because then you also qualify for the WIPA. The Employment Networks serve every part of the country, and some of them are, you know, based on a local region, like a zip code or a city, while others serve an entire state or somewhere national. So which Employment Network you choose is really up to you. You can choose one if you prefer to go into, you know, an office setting to meet somebody that's in your region. You can go to a local one. You could work with one that's a national provider. It's really up to you. You know, just navigate this choice by doing some research, and we'll show you how to look them up. Again, to be eligible for the Ticket to Work program, it's for disabled adults ages 18 through 64. I mentioned that early on, just want to reinforce that here. But there's three different ways to get pointed in the right direction around benefits counseling. Access a benefits planner, through your WIPA program, through the state VR program, or you could go to an EN, as an Employment Network, and when the time is right, if they don't have a benefits planner there, they'll know how to direct you to one. Okay, so these service providers, as part of the employment team, also can provide additional services, and these are really important to know as well. And it's really when it comes to things like career planning or counseling, you could get access to this for somebody who's trying to return to work in the same job or career that you had before, or maybe you're not able to do that anymore, and you have a new vision, and you want to try that new career pathway. So to talk about career planning, you could reach out to an EN or a state Vocational Rehabilitation agency, and they could help you. It goes further too though, they can assist with job search and job placement assistance. They, as I mentioned, with state vocational rehab, they have the vocational rehab services, but also training programs to help you get those new skills, to perhaps become more competitive for a specific type of job or career. There are special programs that exist with these organizations for veterans and youth in transition, so this is really important if you're a disabled veteran or a youth in transition from school to work to consider, does this agency have somebody I can talk to that can really navigate my needs from those identities. Ongoing employment support is also, of course, very important. So when you think about this, do I need a coach to help me with those ongoing supports, because I learned how to do my tasks, so I can do my essential job functions, but there's also kind of the game of work. How do I have these other relationships? When I get these questions from my supervisor, I'm not sure exactly what they're looking for. Well, that EN can provide some of that ongoing on-the-job support, and that can be really helpful in navigating how to not just get the job, but to stay at the job and potentially advance at the job too. When the two organizations connect, Vocational Rehabilitation and EN for consecutive services, so first you work with VR, and then they had your Ticket for a while, and then you go over to the Employment Network, that's called Partnership Plus, and you should be familiar with that. That allows you to get more services from two organizations, not at the same time, but for a longer period of time. And the last one here, assistance with job accommodations. You know, if you have conversations with the Vocational Rehabilitation agency or Employment Network about these are the things that I need to be successful at work and performing those essential job functions, those entities can help you. How are you going to bring reasonable accommodation up? When's the right time to bring it up? Are there parts that you don't need to bring up? That's a really personal discussion, and know that these agencies are available to provide those additional supports as well. All right, so we've been talking a lot about how to access employment team members for specific services and what those services are, and Pat asked during the previous break about, Derek, who is that employment team? On this slide, we have, you know, your entry point to find the employment team members. So to learn more about all these service providers and better understand the different types that are available, we have a fact sheet here, Ticket to Work, Meet Your Employment Team, and it looks like that's in the web links pod at item number 22. I encourage you to explore that to learn about the WIPAs, the state vocational rehabilitation agencies, the ENs. Oh, here's a different one. We have the workforce system Employment Networks. Those are the American job centers and other workforce system entities. They're available to you, and there's that legal wing that I mentioned before called Protection and Advocacy for Beneficiaries of Social Security, or the PABSS. Well, they're all listed. You can read the fact sheet, and we also have a way to explore them through our Find Help tool. So Find Help is a tool that's online, and it offers two ways to explore these entities that I've gone through the employment team. You could do what we call the guided search. So if you're not sure, Derek, there's all these service providers. Where should I start? Well, I'd recommend use the guided search. You're going to respond to a series of questions to help you determine your readiness for the program and then the types of service providers to meet you where you are. You know, where are you in the journey, and which is the service provider that's the right fit for you? Use the guided search. The Find Help tool is also available, though, for more of a direct search feature. So the second option, really, you know, I know what I want to do. I live in the state of Maryland, and I want to work with somebody in the state of Maryland that could help me. So I'm going to reach out through direct search with my zip code, and based on that, I'm going to see the different types of service providers. I want to work with an Employment Network because Derek told me that, you know, when I'm ready, they're going to help me put my plan together, and I'm going to wait till later to talk to the other team members. So then I'm going to have a narrowed result, and I can reach out with the Find Help tool to that Employment Network. I so encourage you to go to the website. This is web links pod number 10, the Find Help tool. You're going to be pleased with the information you find there through either one of those two search options. So and then here, choosing a service provider, you know, we're giving you a lot of options, but there's another couple resource links that are on this slide and in the web links pod for choosing a service provider. So if you go there and you're like, you know, Derek, I don't know which EN is right for me. Well, there's two links, finding an EN and assigning your Ticket so you understand how the process works, but also choosing the right EN for you. You can choose a national provider. You can choose a local one. As we said in the beginning, the choice is yours, and we want you to use these resources like the Find Help tool or these choosing service provider fact sheets to explore and prepare and make your own decision. So I encourage you to access those. Again, they're in the web links pod. It looks like they're number 24 and 25. All right. And, you know, we do this frequently, and I'm so excited to wrap up my comments before our final Q&A with a success story. So when we think of success stories, you know, we pulled one for you today about Amy. So you know, Amy grew up with a developmental disability, and she knew she wanted to work but wasn't sure about what her options would be, and she received services from her state VR agency to find work and actually through an EN later continued to help, you know, her with her job. And, you know, when I read her success story, you know, it was really connected to this eligibility for Medicaid While Working. That's that 1619B program that we talked about earlier. This allowed her to know she had access to 1619B if she wanted it, and she could focus on her work goals without losing healthcare coverage. So she had new confidence. Amy started an internship program through Project Search with a county department of finance. It was a whole new career direction, and this led her to a full-time offer. VR services ended, and then she went through Partnership Plus to that Employment Network that continues to support her. You know, Amy said, this job makes me feel needed and welcomed. I have learned about what motivates me and how to keep going even when things get hard. This is a great success story, and Amy's success should be celebrated. We hope that you've learned something today that could help you on your path to employment and independence and that perhaps one day you'll be our next success story. Pat, I think we made it to part three for questions. So Pat, yep, there you go. Pat>> Yes, someone needed to unmute me. You know, you had mentioned and exemplified it by Amy's story that first you can work with the VR and then after that with an EN, so it's not simultaneous but sequential. What about those other parts of the employment team? Can you work with them together like an EN and a WIPA at the same time? Derek>> Yeah, it's a great question. You know, frequently you're reaching out to one during one point in your employment journey, but there are times when you could be referred over to another. You have to be eligible for them, and so all those eligibility requirements that we discussed would count. But, you know, I bring up that idea of if you reach out to an Employment Network, you're a Ticket holder, you sign your Ticket, and you're working with them, and they don't have a benefits counselor that's available for you, then they could refer you to a benefits counselor as, you know, maybe you've interviewed and you're deciding, should I accept this or not? So that would be a case where you're not actually working with them at the exact same time, but one's referring you to the other. There's another case with the PABSS, the Protection and Advocacy for Social Security Beneficiaries, where you might run into some legal challenges, or you feel like there's been an issue around reasonable accommodation, and as a Social Security beneficiary, you could be referred over there. So there are opportunities there. With Vocational Rehabilitation, though, the example you brought up, that is that of sequential services. So you work with state VR first, then they close your Ticket, and then they can transfer it over to the Employment Network and Partnership Plus, there you're not working with both entities at the same time. They're definitely one after the other. Pat>> Thanks, Derek. I had somebody ask, it's kind of a specific question, but they live in a rural area. Are there ENs that could serve them, even if there's nobody nearby? Derek>> This is Derek. That's a great question, and the answer is yes. So I recommend, if you're comfortable with it, going to the Find Help tool, and you could do, you know, that zip code search, but you also find some national ENs that serve that, your region, because they provide long-distance services. Now, if the internet's not your thing, you can call the helpline. So by calling the helpline, you could also get a list of ENs that would be able to serve you, even if you're in a rural or mountainous area that doesn't have an EN that's readily in your local area. Pat>> Thank you. I wish we could have had more time, but we are running out of time, so I have to say thank you, Derek. You provided great information about the Ticket program, about the Work Incentives, how people could keep their Medicare and Medicaid, and take advantage of all the program has to offer. I would encourage everybody to look into the resources that Derek mentioned. We've given you a lot of information, and some of it was pretty intense and detailed. I think, if you take anything away from the webinar, I hope it'll be that there are people that are ready and willing to help you, and supports that can smooth your way to work, if that's the way you want to go. So thank you, Derek. And, before we end the call, there are a couple of other things I want to share, so that we can all stay connected with one another, and you can stay up to date with the program. If you want to get started on your path, or continue to expand your search, we've got some important points where you can just, you know, at your convenience. First, you can call the Ticket to Work Helpline. It's staffed with really highly trained support specialists, who can give you the kind of personalized information that we can't do on a national webinar. You'll notice most of the questions we asked were pretty general. We couldn't get too specific. So you can call them at 1-866-968-7842, or if you use TTY at 1-866-833-2967, and those lines are available Monday through Friday from 8 to 8 Eastern Time. Of course, you can visit the Ticket to Work website anytime. That's www.choosework.ssa.gov. There is a wealth of information on that website, not only about Medicare and Medicaid and the Ticket Program, but all the other Work Incentives as well. You can also follow us on social media, or subscribe to a blog, or email updates. Just visit https://choosework.ssa.gov/contact. That link is also in the web links pod that we've talked about, under Ticket to Work contact information. Any way you choose, what we encourage you to do is reach out in one of these ways to help you. Another way to get encouragement and read stories about people who achieve financial independence, just like Amy did, is to opt in to receive our text messages. Just text TICKET to 474747, and standard messaging rates will apply, or may apply, excuse me. It's important to note, if you need to contact Social Security's Office of Employment Support, that's the office that manages the Ticket to Work program, please do it electronically instead of by postal mail. Just email us at support@choosework.ssa.gov. As a reminder, please don't include any personal identifiable information. Or, as we've mentioned several times, you can talk to one of our specialists at the Ticket to Work Helpline. We'd like to invite you to join our next webinar, which will be on Wednesday, May 24th, from 3 to 4:30 Eastern Time. Registration is now open, or you can call the Ticket to Work Helpline. Finally, I mean really finally, help us plan future topics, and provide your feedback by taking our survey. A link will pop up after the webinar, or you can find the survey in the Web Links pod, or by visiting the Ticket Program website at choosework.ssa.gov/ surveys/wise. I want to thank you again for attending today to learn more about the program and the services and supports that are available to you. And this concludes today's webinar. Thank you.