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. (See DI 10520.001 and SI 00820.540 for more information on IRWE.)

When making an SGA determination, we use only earnings that represent the real value of the work performed. When someone's earnings are subsidized, he/she is receiving more pay than the actual value of the services he/she 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. (See DI 10510.012 on unincurred business expenses.)

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 his/her disability, or removal of special conditions related to the disability. (See DI 11010.145 for more information on unsuccessful work attempts.)

Effective January 1, 2001, an individual whose disability benefits were terminated because of work activity can request reinstatement of his/her benefits. The ticketholder must be unable to work because of the original medical condition. Also, he/she 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 he/she meets the reinstatement requirements. (See DI 13050.000 for more information on expedited reinstatement.)

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

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).

(See DI 14505.010 for more information.)

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. (See DI 13010.035 for more information on TWP.)

The EPE begins the months after the TWP ends, even if the ticketholder is not working that month. The first 36 months of the EPE 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 and/or disability determination for people who meet certain conditions. (See DI 13010.210 for more information on EPE.)

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 that are excluded are usually adjusted every year, and can be found in SI 00820.510 - Student Earned Income Exclusion. (See SI 01320.185 for more information on SEIE.)

A PASS allows a beneficiary/recipient with a disability to set aside income and/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. (See SI 00870.001 and SI 01320.140 for more information on PASS.)

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. (See SI 00820.535 for more information on BWE.)

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)