When we make a substantial gainful activity (SGA) decision, we can deduct the cost of items and services that a ticketholder pays out of pocket that are needed to work because of their impairment. Some examples are: medicines, co-pays, service animals, counseling services, and attendant care services. It does not matter if the items/services are also needed for normal daily activities. We can usually deduct the cost of these same items from earned income to determine the SSI payment. (For more information on IRWE, see DI 10520.001 and SI 00820.540.)

When making an SGA determination, we use only earnings that represent the real value of the work performed. When someone's earnings are subsidized, they are receiving more pay than the actual value of the services they performed. (For more information on subsidies, see DI 10505.010)

We deduct the value of self-employment business support that someone gives a ticketholder without cost, when making an SGA determination. (For unincurred business expenses, see DI 10510.012.)

We do not count earnings during an unsuccessful work attempt when making an SGA determination. An unsuccessful work attempt is an effort to do substantial work, which the ticketholder stopped or reduced to below the SGA level after a short time (6 months or less) because of their disability, or removal of special conditions related to the disability. (For more information on unsuccessful work attempts, see DI 11010.145.)

Effective January 1, 2001, an individual whose disability benefits terminated because of work activity can request reinstatement of their benefits.

The ticketholder must be unable to work because of the original medical condition. Also, they must file the request for reinstatement within 60 months from the month of termination.

We may make provisional payments to the ticketholder while we are deciding on whether they meet the reinstatement requirements. (See DI 13050.000 for more information on expedited reinstatement.)

See Sections 1148( i ) of the Social Security Act and section 221(m) of the Social Security Act (added by section 111 of P.L. 106-170)

Effective January 1, 2002, if the SSDI beneficiary has received at least 24 months and is working, we do not use the work activity as a reason to conduct a medical continuing disability review (CDR).

We still conduct regularly scheduled CDRs, unless the ticketholder has assigned their ticket to an EN and is making timely progress towards their work and earning goals. (For information on Section 111 of P.L. 106-170 and DI 55025.010 for CDR policies on ticketholders, see DI 13010.012.)

If a ticketholder is medically ceased due to medical improvement, or if the ticketholder is 18 and we find that eligibility is medically ceased because the ticketholder does not meet the adult requirements for disability, benefits payments usually stop. However, if the ticketholder is participating in an appropriate program of vocational rehabilitation (VR) or similar services, including SSA’s Plan to Achieve Self Support (PASS), benefits may continue. To qualify for continued payments under section 301, the ticketholder must meet these requirements:

• •

  Must be participating in an appropriate program of the VR or similar services that began before disability ends under our rules.

• •

  We must review the program and decide that continued participation in the program will increase the likelihood of permanent removal from disability benefit(s).

(For more information, see DI 14505.010.)

The TWP allows an SSDI beneficiary the ability to work for at least nine months. During the TWP, an SSDI beneficiary will receive full benefits regardless of how earnings might be as long as the beneficiary reports the work activity and continues to have a disabling impairment.

The TWP starts when the beneficiary begins working and performing “services”. We consider the work to be services for the TWP if gross earnings are above the monthly TWP threshold (see DI 13010.060) or if the beneficiary works more than 80 hours in self-employment in a month. (For more information on TWP, see DI 13010.035.)

The EPE begins the months after the TWP ends, even if the ticketholder is not working that month.

The EPE first 36 months is the re-entitlement period. During the 36-month re-entitlement period, the ticketholder can get benefits for all months when earnings or work activity are below SGA, as long as the ticketholder continues to have a disability impairment. If earnings fall below SGA in the re-entitlement period, we can start benefits again.

During the EPE, we can reinstate a person's benefits without a new application or disability determination for people who meet certain conditions. (For more information on EPE, see DI 13010.210 .)

Effective October 1, 2000, most SSDI beneficiaries with disabilities, if enrolled in Medicare, can receive at least 93 consecutive months of hospital coverage (Part A) and medical insurance (Part B) if enrolled, and prescription drug coverage (Part D), if enrolled, after the TWP. This is true even if the beneficiary is working at the SGA level.

Prior to October 1, 2000, Medicare coverage continued for at least 39 months after the TWP. After the extended period of Medicare coverage, an individual can buy Medicare coverage by paying a monthly premium.

(For more information on Medicare continuation, see HI 00801.146, HI 00801.170 and HI 00820.025)

This provision allows a person, who is under age 22, and regularly attending school to exclude earnings from income when determining SSI payments. The amounts excluded are usually adjusted every year, see Student Earned Income Exclusion in SI 00820.510. (For more information on SEIE, see SI 01320.185.)

A PASS allows a beneficiary/recipient with a disability to set aside income or resources for a specified period of time so that the beneficiary/recipient may pursue a work goal that will reduce or eliminate SSI or SSDI benefits. We do not count the income or resources set aside when determining SSI eligibility or payment amount. (For more information on PASS, see SI 00870.001 and SI 01320.140.)

The BWE provision allows SSA to exclude from the earnings of an SSI recipient who is statutorily blind, earned income used to pay for work-related expenses. These expenses do not have to be related to the individual's disability. (For more information on BWE, see SI 00820.535.)

SSI recipients with disabilities can continue to receive cash payments even when the earned income is at the SGA level, if they are still disabled and meet all other eligibility rules, including income and resources tests. If the State in which the recipient lives provides Medicaid to people on SSI, Medicaid eligibility also continues. Once the earnings and other income are too high for an SSI cash payment, Medicaid coverage continues if certain conditions are met. (For more information about section 1619, see SI 02302.010)