Honorable Commissioner Jo Anne Barnhart

Social Security Administration

P.O. Box 17703

Baltimore, Maryland 21235-7703

Dear Commissioner Barnhart:

We submit this letter in support of the comments on the Proposed
Regulations submitted by Health & Disability Advocates. As an agency
that DESCRIBE YOUR AGENCY, we are very concerned the Proposed
Regulations will create new work disincentives and request that you
amend the regulations to remove these disincentives.

We understand that the Medicare Modernization Act of 2003 (the MMA)
requires the promulgation of regulations concerning eligibility for the
low-income subsidy programs that are based on and no more restrictive
than the income (Section 1905(p)(1)(B) of the Social Security Act which
refers to Section 1612 of Title XVI) and resource rules utilized by the
Supplemental Security Income (SSI) Program (Section 1613 of Title XVI).
MMA, 1860D-14(a)(3)(C) and (D). We submit that these regulations should
also be promulgated in such a way as to assure that the low-income
subsidy rules are consistent with and compliment the Social Security
Administration's rules and regulations regarding treatment of employment
income and the work incentives. Failure to do this will undermine and
derail the years of policy development work that the Social Security
Administration and Congress have done to assure that Social Security
beneficiaries are encouraged to seek employment and a higher level of
self-sufficiency. Ticket to Work and Work Incentives Improvement Act of
1999 (P.L. 106-170).

SSDI beneficiaries do not receive their Medicare benefits in a vacuum.
Rather, a negative impact on eligibility for a Medicare low-income
subsidy due to employment income will dissuade individuals from working
even if the SSDI work incentives apply. Under these Proposed
Regulations, what the SSDI work incentives give, the new Medicare Part D
regulations take away.

**Health and Disability Advocates** provided several specific references
in their comments where the Proposed Regulations fail to follow the SSI
program's income and resource rules and/or create new work
disincentives. These references were as follows:

1.  **Proposed Regulations 418.3120 and 418.3123** fail to consider many
    changes in circumstances on a monthly basis and provide no explicit
    statement of procedures and timing of the change in subsidy for
    individuals who become full-benefit dual eligible under 42 CFR
    423.773(c).

2.  **Proposed Regulations 418.3120(a)(9) and (c)** may harm the
    effectiveness of the Medicaid Buy-In Programs created under the
    Balanced Budget Act of 1997 or the Ticket to Work and Work
    Incentives Improvement Act of 1999.

3.  **Proposed Regulations 418.3315-418.3350's** definitions of
    countable income fail to include the Student Earned Income Exclusion
    under 20 CFR 416.1112(c)(3).

4.  **Proposed Regulation 418.3325** fails to disregard earned income
    during the Trial Work Period or an Unsuccessful Work Attempt.

5.  **Proposed Regulation 418.3325** fails to exempt earned income
    determined by the Social Security Administration to be a subsidy or
    special condition.

6.  **Proposed Regulation 418.3325** fails to deduct unincurred business
    expenses from the income of a self-employed individual as does 20
    CFR 404.1575.

7.  **Proposed Regulation 418.3120 and 418.3123** fail to properly
    consider changes in income due to a decrease in employment income
    immediately is inconsistent with SSI income eligibility rules and
    the SSI/SSDI Expedited Reinstatement Process created by the Ticket
    to Work and Work Incentives Improvement Act.

8.  **Proposed Regulation 418.3325 (5) and (7)** should calculate
    impairment-related work expenses and blind work expenses as the
    average percentage of gross earnings or the actual expense,
    whichever is higher.

9.  **The Proposed Regulations** provide no words to protect the
    potential effect of the low-income subsidy on recipient's
    eligibility for other federal benefits programs.

We share Health & Disability Advocate's concerns as outlined above and
request that SSA make the appropriate amendments to align the Medicare
Part D low-income subsidy rules with the SSI income rules as required by
the MMA and the SSDI work incentives.

> Respectfully submitted,
>
> (Name) Lavonzell Paige
>
> (Title) Project Director
>
> BPA&O Chicago