AP: Alternate Participants

AWIC: Area Work Incentive Coordinators

BPAO: Benefit Planning, Assistance and Outreach

BWE: Blind Work Expenses

CLIA: Clinical Laboratory Improvement Amendments

CMS: Center for Medicare & Medicaid Services

DME: Durable Medical Equipment

DMIE: Demonstration to Maintain Independence & Employment

DRG: Diagnostic Related Group

EARN: Employer Assistance Referral Network

EIE: Earned Income Exclusion

EN: Employment Network

EPE: Extended Period of Eligibility

EXR: Expedited Reinstatement

FBR: Federal Benefit Rate

FPL: Federal Poverty Level

GIE: General Income Exclusion

HIPAA: Health Insurance Portability and Accountability Act

HMO: Health Maintenance Organization

IDA: Individual Development Account

MIG: Medicaid Infrastructure Grant

PABSS: Protection and Advocacy for Beneficiaries of Social Security

PESS: Property Essential for Self-Support

PMPM: Per Member Per Month

SGA: Substantial Gainful Activity

SSA: Social Security Administration

SSDI: Social Security Disability Insurance

SSI: Supplemental Security Income

SVRA: State Vocational Rehabilitation Agency

TTH: Ticket to Hire

TTW: Ticket to Work

TWP: Trial Work Period

UWA: Unsuccessful Work Attempt

VR: Vocational Rehabilitation

WIPA: Work Incentives and Planning Assistance

WISE: Work Incentives Seminars on Employment

Terms

Area Work Incentives Coordinators (AWIC): Individuals dedicated to providing assistance to personnel in field offices on employment support and outreach issues. Specifically their roles and responsibilities include: coordinating and conducting local public outreach on work incentives; providing, coordinating, and overseeing training for all personnel on SSAs employment support programs; handling some sensitive or high profile disability work-issue cases; and monitoring the disability work-related issues in their respective geographic areas.

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Benefits Planning, Assistance and Outreach Program (BPAO): Section 1149 of the Social Security Act, as added by section 121 of the Ticket to Work Act, required an equivalent of the BPAO program, launched in 2000. The original purpose was information based: to conduct work incentive outreach and to increase beneficiary knowledge of work incentive provisions, which they did to over a quarter of a million disability beneficiaries. Initially there were 116 BPAO programs across the United States and five territories, employing over 500 benefits specialists charged with providing community education and outreach, individualized benefits planning, and assistance, information and referral, and problem solving about SSA's work incentives and other federal and state programs. Of the total number of projects, 33 percent were based in centers for independent living, 32 percent in other community-based organizations; 12 percent in state vocational rehabilitation agencies, and five percent each in protection and advocacy, university-based, advocacy-based and other state agencies. National data was reported across the 116 projects and compiled by a centralized data management function. The BPAO program ended in 2006.

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Blind Work Expenses (BWE) (SSI): Income earned by the visually impaired and used to meet expenses in earning that income, not counted by SSA in determining SSI eligibility and payment amount.  

Break-Even Point (SSI): The dollar amount of total income that will (after applicable deductions are applied) reduce the SSI payment to zero in a given set of case facts. The break-even point depends on earned and unearned income, living arrangements, applicable income exclusions, and state supplement, if any.

Centers for Medicare & Medicaid Services (CMS): US federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program. Formerly known as the Health Care Financing Administration (HCFA), they are the federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children's Health Insurance), HIPAA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs. Additional information regarding CMS and its programs is available at http://new.cms.hhs.gov/home/aboutcms.asp.

Childhood Disability Benefits (CDB): Children under age 18 may qualify for SSI benefits if they meet the defining characteristics: 1) the child must not be working and earning more than $900 a month in 2007 (this amount changes every year); 2) the child must have a physical or mental condition, or a combination of conditions, that results in “marked and severe functional limitations,” which means that the condition(s) must very seriously limit the child’s activities; and 3) the child’s condition(s) must have lasted, or be expected to last, at least 12 months, or must be expected to result in death. The income and resources of the child and that of family members living in the child’s household (if the child lives at home) are considered during the eligibility evaluation. Monthly SSI payments are limited to $30 when a child is in a medical facility where health insurance pays for his or her care. The amount of the SSI differs between states because some states add to the SSI payment. 

Clinical Laboratory Improvement Amendments (CLIA): The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total, CLIA covers approximately 189,000 laboratory entities. The Division of Laboratory Services, within the Survey and Certification Group, under the Center for Medicaid and State Operations (CMSO) has the responsibility for implementing the CLIA Program. The objective of the CLIA program is to ensure quality laboratory testing. Although all clinical laboratories must be properly certified to receive Medicare or Medicaid payments, CLIA has no direct Medicare or Medicaid program responsibilities.

Continuing Disability Review (CDR) (SSDI and SSI): A process that SSA conducts to obtain complete current information about a beneficiary's medical condition and any work activity completed to decide if SSDI and/or SSI benefits should continue.

Continuation of Medicare Coverage: An SSDI beneficiary can receive at least 39 consecutive months of hospital and medical insurance after the trial work period, (93 months if a "Ticket to Work" has been used). This provision allows health insurance to continue when a beneficiary goes to work and is engaged in Substantial Gainful Activity (SGA).

Countable Income (SSI): The amount of money remaining after SSA subtracts all available deductions from individual's total income. This amount is used to determine SSI eligibility and payment amounts.

Deeming (SSI): SSA’s process of considering some of the income and resources of a parent, spouse, or sponsor (if applicant is an alien) to be the applicant’s income and resources when s/he is applying for or receiving SSI benefits.

Demonstration to Maintain Independence and Employment (DMIE): Section 204 of the Ticket to Work and Work Incentives Improvement Act of 1999 directed the Secretary of the Department of Health and Human Services (DHHS) to establish a grant program that authorizes States to provide Medicaid benefits and services to workers who have physical or mental impairments that, without medical assistance, will result in disability. The goal of the Demonstration to Maintain Independence and Employment is to address the needs of those people who have specific physical or mental impairments that have the potential to lead to disability. This demonstration authority will allow States to assist working individuals by providing the necessary benefits and services required for people to manage the progression of their conditions and remain employed. The demonstration projects will be used to evaluate the impact of the provision of Medicaid benefits and services as related to extended productivity and increased quality of life. The Centers for Medicare and Medicaid Services (CMS) is the designated DHHS agency with administrative responsibility for this grant program. The Demonstration to Maintain Independence and Employment is authorized for 6 years and $250 million in funding has been appropriated for the program. There are no minimum or maximum grant awards per State or per project. Medicaid Infrastructure Grant (MIG) funds can be used to develop a demonstration.

Diagnostic Related Group (DRG):  A case rate established by Medicare that pays hospitals based on a prospective price per admission for a clinical diagnosis or procedure. 

Disability: Defined as the inability to engage in substantial gainful activity due to physical or mental impairment(s) that have lasted or can be expected to last for at least 12 months or can be expected to result in death.

Durable Medical Equipment (DME): A general term that refers to patient supplies such as wheelchairs, crutches, and other devices. Medicaid tends to be more generous in its coverage of these equipment costs than private health insurance. 

Earned Income Exclusion (EIE): For individuals who work and earn a wage, they are provided a $65 EIE subtracted from income received by the recipient prior to SSA applying the $1 for $2 Exemption.

Employer Assistance Referral Network (EARN): Established in March 2001 by the U.S. Department of Labor, Office of Disability Employment Policy (DOL/ODEP), EARN is a free nationwide employment referral service that provides employers with recruitment resources to identify qualified job seekers within their local communities for current personnel openings. EARN connects the business community and employers with job openings to placement agencies and service providers who are poised to match qualified job-ready candidates with disabilities to those jobs. Further, they also provide needed information and referrals regarding accommodations, disability laws, assistive technology, disability management, and effective and non-discriminatory recruitment and hiring practices. EARN actively recruits both employers and service providers to join, and as of March 28, 2003, EARN reported more than 33,000 employers and 48,000 service providers in their network. EARN has referred 866 qualified job candidates to employers with posted employment opportunities since its inception.

Employment Network (EN): An EN consists of any agency or instrumentality of a private or public entity that enters into a contract with SSA to assume responsibility for the coordination and delivery of appropriate employment, employment activities, and other support services under the Ticket to Work Program. SSA selects and enters into contracts with ENs for services under the Program. An EN must either be a single provider of such services or an association of entities organized so as to combine their resource into a single entity. An EN must provide the full range of services necessary to prepare and place beneficiaries in employment.

Expedited Reinstatement (EXR): Qualified individuals may request reinstatement of benefits, within 6 years of benefits having stopped, without having to file a new application. Up to 6 months of provisional benefits are available while we make a decision on the request.

Extended Period of Eligibility (EPE): A component of the SSDI Work Incentives, the EPE is a consecutive 36 month period during which a working beneficiary may receive cash benefits for any month(s) countable income falls below the SGA level. The EPE begins the month immediately after the Trial Work Period (TWP) ends. If a beneficiary qualifies, SSDI benefits may be restarted without a new application.

Extended Medicare Coverage: Section 202 of the Ticket to Work Act further extended Medicare coverage for most DI beneficiaries who engage in work to get an additional 4 1/2 years coverage beyond the current 24-month extension. This translates into a total of 8 1/2 years health coverage, including the TWP.

Federal Benefit Rate (FBR): The basic standard used in computing the amount of Federal SSI benefits for individuals and couples. The FBRs are increased annually to reflect increases in the cost of living. For 2007: Individuals $623.00; Couples $934.00; Essential Person $312.00.

Federal Poverty Level (FPL): The poverty guidelines are the other version of the federal poverty measure. They are issued each year in the Federal Register by the Department of Health and Human Services. The guidelines are a simplification of the poverty thresholds for use for administrative purposes — for instance, determining financial eligibility for certain federal programs. 

 2007 HHS Poverty Guidelines

SOURCE:  Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148

 General Income Exclusion (GIE): Individuals who receive unearned income are provided with a $20.00 General Income Exclusion that can be subtracted from the total amount of unearned income they receive or, if they receive no unearned income, can be deducted from earned income.

Health Maintenance Organization (HMO): A type of managed care plan, often with state Medicaid programs, that offers prepaid comprehensive health care coverage for hospital and physician services, relying on its medical providers to minimize the cost of providing services. HMOs contract with or directly employ participating health care providers, and enrollees must pay a higher out-of-pocket cost for services outside the network of providers. 

Health Insurance Portability and Accountability Act (HIPAA): The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's health care system will improve the use of electronic data interchange. The HIPAA Privacy Rule for the first time creates national standards to protect individuals’ medical records and other personal health information. It gives patients more control over their health information; sets boundaries on the use and release of health records; establishes appropriate safeguards that health care providers and others must achieve to protect the privacy of health information; holds violators accountable, with civil and criminal penalties that can be imposed if they violate patients’ privacy rights; and it strikes a balance when public responsibility supports disclosure of some forms of data – for example, to protect public health.

Impairment-Related Work Expenses (IRWE) (SSDI and SSI): SSA deducts the cost of items and services that an individual needs to work because of his or her impairment (for example, attendant care services and medical devices) when they decide if an individual is engaging in SGA. It does not matter if the individual also needs the items for normal daily activities. The cost of these same items are usually deducted from earned income to determine SSI payment.

Individual Development Account (IDA): A savings account which low-income individuals, including SSI recipients, may establish in order to save for purchasing a first home, meeting the costs of post-secondary education, or capitalizing a business. An individual's deposits into an IDA are matched by a sponsoring nonprofit organization, or State or local government participating in the program.

Income (SSI) SSI income is: Earned income - money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, and some royalties and honoraria; and Unearned income - money received from all other sources, for example gifts, interest, Social Security, veteran's benefits, pensions. Unearned income also includes “in-kind income” (free food, clothing, or shelter) and “deemed income” (some of the income of a spouse, parent, or sponsor of an alien).

Medicaid (Medi-Cal in California, AHCCS in Arizona) (SSI):  A public health insurance program administered by states for eligible participants with low incomes.  Medicaid is financed by federal and state governments, using a federal system of matching funds based on each state's per capita income.  Asset and income eligiblity criteria are defined in each state's title XIX program statute.  Individual beneficiaries who are eligible for both Medicaid and Medicare (see definition below) are also called "dual eligibles". 

Medicaid Infrastructure Grant (MIG): Section 203 of the Ticket to Work and Work Incentives Improvement Act (TWIIA) of 1999 directed the Secretary of the Department of Health and Human Services (HHS) to establish a grant program to support state-level efforts to enhance employment options for people with disabilities. The goal of the Medicaid Infrastructure Grant program is to support employment for people with disabilities by providing money to the states to develop infrastructure and resources needed to implement the core elements of the TWWIIA.  The Centers for Medicare & Medicaid Services (CMS) is the designated federal agency that admininsters this grant program. The Medicaid Infrastructure Grant program is authorized for 11 years, and $150 million in funding has been appropriated for the first five years of the program. The minimum grant award to an eligible state is $500,000 per fiscal year.

Medicaid Protection for Individuals with Disabilities Who Work: A state may provide Medicaid coverage for individuals with disabilities who: have earnings that are too high to qualify under current rules; are at least 16, but less than 65 years of age; and meet state resource and income limits. A state may also provide Medicaid coverage to these individuals when they lose coverage due to medical improvement, but still have a medically determinable severe impairment.

Medical Improvement Expected (SSDI and SSI): Documentation made by SSA when an  individual has a disabling impairment, but the disabling impairment(s) may improve, to indicate the individual's case will need a future review.

Medicare (SSDI):  A public health insurance program for the elderly and disabled, that is financed and admininstered by the federal government.  Part A provides hospital insurance for inpatient care, home health agency visits, hospice care, and skilled nursing facility care.  The elderly are responsible for a deductible but do not have to pay an annual premium.  Part B includes payments for physician visits, physician-ordered supplies and services, and outpatient hospital services.  This part is voluntary and the elderly pay an annual premium in addition to a deductible and copayment.  Part C, enacted as part of the Balanced Budget Act of 1997, expands the range of private health plans that may contract with Medicare to provide care to beneficiaries.  Part D, enacted as part of the 2003 Medicare Modernization Act, provides outpatient prescription drug coverage to the elderly, who are responsible for copayments. 

Medicare for People with Disabilities Who Work: Some people with disabilities who qualify for SSDI and have returned to work can buy continued Medicare coverage when their premium-free Medicare ends due to work activity. States are required to help pay the hospital insurance premiums for some working individuals with disabilities.

One Stop Career Centers -- Department of Labor: The One Stop Career Centers were created by the Workforce Investment Act (WIA) of 1998: Locally based one-stop service delivery systems to provide many employment and training services funded by the federal government. The purpose of the One-Stop career system is to resolve many of the previous fragmentation problems in employment and training. The idea of the one-stop approach is to streamline and consolidate programs, resources, and services such as unemployment benefits, state job services, public assistance, training programs, and career services. The Centers also have Disability Coordinators to assist their customers with disabilities.

Plan to Achieve Self-Support (PASS) (SSI): Under an approved PASS, a beneficiary may set aside income and/or resources over a reasonable time period, which will enable s/he to reach a work goal to become financially self-supporting. The beneficiary then can use the income and resources set aside to obtain occupational training or education, purchase occupational equipment, establish a business, etc. SSA does not count the income and resources set aside under a PASS when they decide SSI eligibility and payment amount.

Project NetWork: Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management and referral approaches to providing rehabilitation and employment services; used random selection into treatment or control groups to ensure an unbiased measure of demonstration effects; carried out over 24 months in eight geographically dispersed sites during the early to mid-1990s. One of the following four models was each tested in two sites : (1) the SSA Case Management Model - SSA staff provided case management : (2) the Private Contractor Model - case management services delivered by private rehabilitation organizations under contract to SSA : (3) the VR Outstationing Model - services provided by State VR agency case managers who were outstationed in local SSA offices : and (4) the SSA Referral Manager Model - this was the least intensive case and referral management services provided by SSA staff.

Protection and Advocacy for Beneficiaries of Social Security program (PABSS): In April, 2001, PABSS grants were made available to 57 individual states, territories, and Native American protection and advocacy agencies to provide information and advice about obtaining vocational rehabilitation and employment services and advocacy or other services that a beneficiary needs to secure or regain employment. Since the beginning of fiscal year 2003 through the end of fiscal year 2006, PABSS programs had documented 14,0037) client concerns across 13 major categories requiring individual advocacy and/or representative. The largest percentage of client concerns came in the following issue categories: vocational rehabilitation services / state agency (25%); entitlement overpayments (23%); benefits planning (12%); employment discrimination (10%); other agency (5%); employment networks (4%); benefits (4%); improper benefits planning (4%); Social Security (4%); and less than 3% in each of the following areas: transportation, assistive technology, and transition.

Section 1619(a): Section 1619(a) allows SSI recipients to continue to receive a cash benefit even when their earnings are considered to be at or above the SGA level

Section 1619(b): Continuing Medicaid. Section 1619(b) of the Social Security Act provides continued Medicaid eligibility for SSI recipients whose income is too high to qualify for a cash benefit but not high enough to offset the loss of Medicaid or publicly-funded attendant care. Only a recipient whose sole purpose for cessation of cash benefit was earnings is eligible for this provision. Further, the recipient's gross earnings must fall below certain state thresholds to qualify although waivers for individual threshold amounts can be requested if the individual has unusually high medical costs, work expenses or a PASS.

Social Security Administration (SSA): An independent federal agency established by law currently codified at 42 U.S.C. § 901.  Its current commissioner is Michael J. Astrue who was sworn in on February 12, 2007 and whose 6-year term expires on January 19, 2013.  The SSA manages the United States' social insurance program, consisting of retirement, disability, and survivors' benefits, including the SSI and SSDI programs.  To qualify for these benefits, most American workers pay Social Security taxes on their earnings; future benefits are based on employees' contributions.

Social Security Disability Insurance (SSDI): SSDI is authorized under Title II of the Social Security Act. SSDI provides benefits to disabled or blind individuals who are "insured" by workers' contributions to the social security trust fund. These contributions are the Federal Insurance Contributions Act (FICA) social security tax paid on their earnings or those of their spouses or parents.

State Children’s Health Insurance Program (SCHIP): CMS Administers the State Children's Health Insurance Program (SCHIP).  Program benefits became available October 1, 1997 and will provide $24 billion in federal matching funds over 10 years to help states expand health care coverage to over 5 million of the nation's uninsured children. The State Children's Health Insurance Program (SCHIP) is jointly financed by the Federal and State governments and is administered by the States.  Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures.  SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years (FY) 1998 through 2007.  Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.

State Vocational Rehabilitation Agency (SVRA):  The organization in each state, the District of Columbia or U.S. Territory, that is the designated entity responsible for providing vocational rehabilitation services and counseling to people with disabilities. In some states, a separate State Vocational Rehabilitation agency exists to provide assistance to individuals with a visual impairment.

Student-Earned Income Exclusion (SEIE): Student-Earned Income Exclusion is another earned income exclusion that is applied in the calculation discussed above before any other earned income exclusions and allows recipients under age 22 who regularly attend school and are not considered head of household or married to exclude as of January 2007 up to $1,510 of earned income per month up to a maximum of $6,100 per year.

Subsidies and Special Conditions: Supports received on the job that could result in more pay than the actual value of the services performed. The SSA would deduct the value of subsidies and special conditions from the earnings when determining SGA.

Sources

Social Security Administration online glossary (http://www.ssa.gov/glossary.htm) (http://www.socialsecurity.gov/OACT/ssir/SSI07/Glossary.html )

Centers for Medicare & Medicaid Services online glossary (http://www.cms.hhs.gov/apps/glossary/default.asp?Letter=ALL&Language=English)

Susanne M. Bruyére, Thomas P. Golden, Ilene Zeitzer. 2007. “Evaluation and Future Prospect of US Return to Work Policies for Social Security Beneficiaries.” Disability & Employment. 59; 53-90.

Department of Health and Human Services. Poverty: (http://aspe.hhs.gov/poverty/07poverty.shtml) and HIPAA: (http://www.hhs.gov/ocr/hipaa/)

Paul J. Feldstein. Health Policy Issues, 3^rd edition, (2003): Health Administration Press; Chicago, IL, pp.457-467 (glossary section).

Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148