Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility

Patti Hackett, MEdCo-Director

Healthy & Ready to Work National Resource Center

Bangor, ME

Baylor University-School of MedicineTransition Conference 08

November 8, 2007

Just the Facts: Key Benefits

OVERVIEW

• SSI

• Medicaid

• Voc Rehab

• Maintaining Private Health Insurance

Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility

FORMAT

• Dispelling the Myths

• The Intent of the Service

• Roles: Physicians, Care Coordinators

Families & Youth

Just the Facts: SSI

The Myth:

All applications get denied first time around.

The Intent:

• Supplemental Security Income (SSI) 1972 Federal funded by general tax revenues (not Social Security taxes)

Designed to help aged, blind, and disabled people, who have little or no income; and

Provides cash to meet basic needs for food, clothing, and shelter (assets $2,000 single/$3,000 couple)

Just the Facts: SSI

Insider Info:

• Applications will receive a timely impartial review IF

the complete paperwork is received.

• Medical and other evidence is not complete.

• Documentation doesn’t follow disability criteria.

* SSA staff receive raises in part based on paperwork flow.

An individual is "disabled" if he or she has a medically determinable physical or mental impairment

• Can be expected to result in death

• Has lasted or can be expected to last for a continuous period of not less than 12 months

• Child - Marked & severe functional limitations

• Adults -Inability to engage in any substantial gainful activity (2007-$900/mo)

Just the Facts: SSI – Disability Criteria

Just the Facts: SSI - Listings

1. Musculoskeletal System2. Special Senses and Speech3. Respiratory System4. Cardiovascular System5. Digestive System6. Genito-Urinary System7. Hemic and Lymphatic System8. Skin9. Endocrine System10.Multiple Body Systems11.Neurological12.Mental Disorders13.Neoplastic Diseases Malignant14.Immune System

www.ssa.gov

search BLUE BOOK

Just the Facts: SSI

111.07 Cerebral palsy with:A. Motor dysfunction meeting the requirements of 101.02

or 111.06; or

B. Less severe motor dysfunction (but more than slight) and 1 of the following:

1. IQ of 70 or less; or

2. Seizure disorder, with at least one major motor seizure

in the year prior to application; or

3. Significant interference with communication due to

speech, hearing, or visual defect; or

4. Significant emotional disorder

Just the Facts: SSI

Disability Criteria for Children: Domains

- Acquiring and Using Information;

- Attending and Completing Tasks;

- Interacting and Relating with Others;

- Moving About and Manipulating Objects;

- Caring for Yourself; and

- Health and Physical Well-being

Just the Facts: SSI

CHILDREN - Meets or Equals

Functionally = "listed impairment”

• Marked limitations in 2 of these domains interferes seriously with the child's ability to

independently initiate, sustain, or complete activities.

• Extreme limitation in 1 domain, interferes very seriously with these abilities.

Just the Facts: SSI

Disability Criteria for Adults

• Meets the Listing - one of the Listings by comparing it to the specific requirements in the Listings.

• Meets or Equals - impairment(s) is equal in severity and duration to a listed impairment.

• Residual Functional Capacity - disability is severe, but does not meet or equal a listed impairment

Just the Facts: SSI -- Roles

Physicians, Care Coordinators - Use the Blue Book to understand criteria- Give Families/youth copies of medical records

Families/Youth- Gather medical and other evidence- Send application with ALL the documentation- Open separate checking account- Fill in rental form- Fill in Personal Representative

Just the Facts: Medicaid

The Myths: • Medicaid is the same for children and adults.

• You cannot be eligible for Medicaid if you have other health insurance.

• Medicaid is only for people who are poor and don’t work.

The Intent:

To provide basic health care to children, youth, and adults who meet the eligibility criteria (including specific income limits) for one of the 30 Utah Medicaid programs.

Just the Facts: Medicaid

Physicians, Care Coordinators & Families

• Make a friend @ the local Medicaid Office

• Attend meetings open to public

• Keep up with program changes yr-to-yr

• Advocate for changes e.g., vision & dental

Just the Facts: VR

The Myth:

They purposely delay applications.

They only serve people who are easy to place.

The Intent:

To assist and empower eligible individuals with disabilities to achieve and maintain meaningful employment

Just the Facts: VR

TRAINING• Supported Employment • Short-Term, Vocational Training • College or University-based education

EMPLOYMENT SUPPORT• Job Coaching • On-the-Job Training

Just the Facts: VR

Physicians, Care Coordinators

- Help gather medical & other evidence for disability determination

Families & Youth

- Portable Medical Summary-ICD9 codes

- 1st appt have ALL paperwork completed.

- Be part of the solution, be proactive.

Handouts: VR

Documenting Disability- Sample Letter from Physician

• Families need to learn how to draft letter

• Medical Team reviews/edits

• Youth learn the rules and regs.

Just the Facts: Private Health Insurance

The Myth:

• My disabled child will not age out of my health care insurance.

• All young adults are covered by Medicaid so why should we continue the private coverage

The Intent:

• It’s a state mandated benefit.

Handouts: Private Health Insurance

Dependent Coverage – Up to Age 26 UT Code Ann. Section 31A-22-610.5

Dependents must be covered to age 26. Insurers dependency requirement must treat all

dependents equally, be the same for all ages, and may not require student status.

Handouts: Private Health Insurance - 411

Extension of Policy for Dependent Child with a Disability UT Code Ann. Section 31A-22-611 Provides coverage for disabled dependents that have

been continuously covered under any accident and health insurance coverage since age 26.

Employee 1. FORM - continuation of coverage 2. FORM - Attending physician statement of mental retardation or physical handicap.

3. Both forms submitted to the employer for review and signature before forwarding to the claim office.

Just the Facts: Private Health Insurance

Physicians, Care Coordinators

- More than letter from God

- Discuss before age 17, 26

Families & Youth

- Transition of Care Notebook

to concise thin files and sample documentation

- Don’t wait to be informed – get the forms early

TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application - Ask for review before submitting

4. Come ready (paperwork completed) the day of “intake”

Patti Hackett, MEdpattihackett@hrtw.org

Co-Director, Healthy & Ready to Work National Resource Center

Bangor, ME

Just the Facts: SSI -- Resources

SSA websitewww.ssa.gov/ssi

Benefit Eligibility Screening Tool (BEST) On-line tool - eligible for benefits from any of the programs

Social Security administers. https://secure.ssa.gov/apps7/best/benefits/

Understanding Supplemental Security Income, 2007

http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

Just the Facts: SSI -- Resources

www.ssa.gov search BLUE BOOK

Disability Evaluation Under Social Security

http://www.ssa.gov/disability/professionals/bluebook/

Listing of Impairments - Childhood Listings www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

Listing of Impairments -  Adult Listings www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

Just the Facts: SSI -- Resources

Ultimate Social Security Disability Guide

http://www.ultimatedisabilityguide.com/index.html

Understanding the GRID Rules

http://www.ultimatedisabilityguide.com/grid_rules.html

FORMS-Residual Functional Capacity (mental) (physical)

http://www.ultimatedisabilityguide.com/rfc_forms.html