Overview of Social Security Disability & Medicaid

Slides:



Advertisements
Similar presentations
Presented by Michael D. Steinhardt Managing Attorney December 3, 2013.
Advertisements

MA Chapter of the National Marfan Foundation,
Disability: Social Security and SSI AIDS Clinic January 30, 2004.
Social Security Administration Disability Programs Disability Programs.
Continuing Disability Reviews & Age-18 Redeterminations
Understanding Social Security Disability. Two Different Programs Title 2 SSDI Requires work: 5 years out of last 10 5 month waiting period 24 month Medicare.
Understanding Social Security: Can It Be Done? February 18, 2004 Toni Bender-ERI Holly Johnson-ERI.
Social Security Administration Disability Programs Disability Programs.
Social Security - The Basics Anne S. Quincy Legal Aid Society of Minneapolis (612)
Benefits of Disability Benefits LAW OFFICE OF JONATHAN EDWARD MOODY SOCIAL SECURITY DISABILITY ATTORNEY.
Social Security Disability Basics Prepared by: Saundra McDowell Based on material from websites provided by SSA and NOSSCR in addition to experience in.
Physician’s Guide to Documenting Disability in Social Security and Welfare Cases Presenter: Kevin Liebkemann, Esq. Chief Section Counsel Legal Services.
State as a Model Employer Training Series Basics of Social Security Disability Benefits: Your First Step Towards Benefits Planning Youth Transition Toolkit.
Social Security Administration Yolanda York
Florida Developmental Disability Council Presents: Understanding Asset Building and Benefits for People with Disabilities PART I—September 10, 2012.
Disability Seminar Introductions Goals of the presentation.
Employment for Youth in Transition.
Social Security Retirement John S. Whitelaw Community Legal Services 1410 West Erie Avenue Philadelphia, PA July 2014 This presentation was sponsored.
0 Disability and Related Issues Anthony J. DeLellis 1565 Hotel Circle South, Ste 370 San Diego, CA
Social Security Disability Claims Primer by Troy G. Rosasco, Esq. Turley, Redmond, Rosasco & Rosasco, LLP NY-DBLAW National.
Supplemental Security Income (SSI) for Adults with Disabilities
An Overview Kelly Blad, MA, EDPNA Traumatic Brain Injury and the Social Security Disability Process.
1. Link to OVR’s Website The Pennsylvania Office of Vocational Rehabilitation (OVR) provides vocational rehabilitation services to help persons with disabilities.
Principles of SSI Unit 8. Medicaid eligibility SEC [42 U.S.C. 1383c] (a) The Commissioner of Social Security may enter into an agreement with any.
Social Security Disability Lecture 16. Disability in SS Reform Debate It is important to keep in mind that workers and retirees are not the only ones.
Disability Benefits What to Expect When You Can No Longer Work.
Work Incentive Programs and Building Financial Assets for People with Disabilities Presented by: Karla Bell Project Specialist, California Health Incentives.
PAST RELEVANT WORK: SSD/SSI Claims. Presenter: Mike Miskowiec, Esquire
1 SOCIAL SECURITY BENEFITS FOR PERSONS WITH DISABILITIES Amy C. O’Hara, Esq. Littman Krooks LLP
Social Security and SSI Practice—Deconstructing a Denial Notice Thomas Yates Health & Disability Advocates
Association of Administrative Law Judges 23 rd Annual Educational Conference Savannah, Georgia October 7-9, 2014.
Presented by Scott Leonard and Joanne O’Neill Department of Community and Human Services Developmental Disabilities Division.
A Basic Guide to Social Security Disability Benefits Presented by Matthew Lane and Nancy Goodwin of Ziegler & Lane, LLC.
APPLYING FOR DISABILITY Jonathan Rodis, National Disability Advocate Kathleen Kane, ESQ Disability Attorney.
Understanding Social Security & SSI Presented by Matthew D. Lane, Jr.
Welcome to our Columbus Ohio Adult Congenital Heart Disease Patient Education Presentation Adult Congenital Heart Disease at Nationwide Children's Hospital.
Understanding Social Security & SSI Presented by Matthew Lane and Nancy Goodwin
(202) King Street, Suite 650 Alexandria, VA WASHINGTON, DC DISABILITY QUALIFICATIONS.
Social Security Administration or TTY or TTY
KELLEY LAND, MPA CENTER ON COMMUNITY LIVING & CAREERS INDIANA INSTITUTE ON DISABILITY & COMMUNITY INDIANA UNIVERSITY Improving Financial Literacy for Individuals.
1.03 Healthcare Finances.
What to Expect When You Can No Longer Work
Regional Center Services for Consumers with Developmental Disabilities James F. Huyck Public Benefits Consultant/Advocate (916)
SOCIAL SECURITY BENEFITS FOR PERSONS WITH DISABILITIES
Elizabeth Horn Disability Rights Advocate
Social Security
1.03 Healthcare Finances.
NEVER WORK WITHOUT A NET:
Social Security Programs
HOW WILL EMPLOYMENT AFFECT MY CHILD’S DISABILITY BENEFITS?
Title II Disability Benefits and Work
Title II Disability Benefits and Work
Master Trust Accounts and Social Security
Michael Dalto Consultant 2018
Transitioning to Adult Disability Benefits
1.03 Healthcare Finances.
The Nuts & Bolts of Social Security Disability
Title II Disability Benefits and Work
Working with public benefits
CDR Felix Vaks Actuary, Office of the Chief Actuary
Social Security Disability Benefits By Sara G. Khaki, Esq
Social Security Disability for the Pro Bono Lawyer
1.03 Healthcare Finances.
1.03 Healthcare Finances.
Title II Disability Benefits and Work
Applying for Social Security Disability and SSI
1.03 Healthcare Finances.
1.03 Healthcare Finances.
Social Security Disability
Medicare - the Basics Jeff Barlow – (949)
Presentation transcript:

Overview of Social Security Disability & Medicaid Health Justice Clinic 2018

Disability Income Social Security Programs: Social Security Disability Income (“SSDI” “Title II”) Supplemental Security Income (“SSI” “Title XVI” Private Disability Insurance Short Term Disability Long Term Disability

Social Security Disability Insurance (“SSDI”) (“Title II”) Monthly cash benefit to disabled persons and dependents Insurance – based on payroll taxes (FICA) Must have worked long enough and recently enough (5 out of last 10 years) Payment amount dependent on earnings history No “partial” disability.

Supplemental Security Income (SSI) (“Title XVI”) Monthly benefits to aged, blind or disabled persons Needs-based program, considers income and assets Payment amount supplements any other income up to a maximum Year 2018 maximum payment: $753 per month http://www.ssa.gov/OACT/COLA/SSIamts.html (This link has updated maximum benefit amounts.

Social Security: Comparisons Both programs use the same rules to determine whether claimant is disabled Different rules for financial eligibility Both programs governed entirely by federal law Statute Regulations Agency Rulings (“Social Security Rulings”) POMS (Program Operating Procedures) HALLEX (Hearing Office Rules)

Medicaid Joint Federal and state health insurance for uninsured low-income/resource people Administered by the stt In non-expansion states, like NC, only select groups of people can qualify for Medicaid Can qualify if disabled under the SSA rules for disability Appeals heard by State hearing officers

Statutory Definition of Disability Severe mental or physical impairment Medically verifiable by lab tests, physical examination or other objective medical procedures has lasted, or is expected to last, at least twelve consecutive months or result in death renders claimant unable to engage in substantial gainful activity (“SGA”)

Three domains Medical Functional Capacity Vocational Impairments Identifying them Proving them with medical records, tests, labs, etc Functional Capacity Limitations that result from impairments and/or treatments What causes them? Vocational Client’s vocational history Job analysis How the functional limitations affect work related activities

Disability application process Initial application Filed at local Social Security office or online Disability evaluation done at State Agency (Disability Determination Service) Should take a couple months – often takes much longer About on third approved. If denied: Request for Reconsideration File within 60 days of denial (paper or online) DDS again looks at whether claimant is disabled This can take a couple months up to 4-6 months or more About 10% approved

Further appeals Administrative Hearing (after denial of reconsideration) Hearing before Administrative Law Judge (Raleigh, Wilmington, Fayetteville, Greensboro, Charlotte, etc.) Wait time for hearing 18-24+ months from time of request for hearing Approval rate 52% in NC Appeals Council (approved or remanded: 12%) Federal Court (reversed or remanded: 49%)

Two important limitations Substance Abuse: Claimant may not received benefits if substance abuse “contributes materially” to the finding of disability (20 CFR 404.1535) Compliance with treatment: No benefits if claimant fails to follow prescribed treatment that would restore ability to work. (20 CFR 404.1530) Acceptable excuses: treatment contrary to religion, very risky; considers physical, mental, educational, and linguistic limitations §404.1535 How we will determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) General. If we find that you are disabled and have medical evidence of your drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability. (b) Process we will follow when we have medical evidence of your drug addiction or alcoholism. (1) The key factor we will examine in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether we would still find you disabled if you stopped using drugs or alcohol. (2) In making this determination, we will evaluate which of your current physical and mental limitations, upon which we based our current disability determination, would remain if you stopped using drugs or alcohol and then determine whether any or all of your remaining limitations would be disabling. (i) If we determine that your remaining limitations would not be disabling, we will find that your drug addiction or alcoholism is a contributing factor material to the determination of disability. (ii) If we determine that your remaining limitations are disabling, you are disabled independent of your drug addiction or alcoholism and we will find that your drug addiction or alcoholism is not a contributing factor material to the determination of disability. §404.1530 Need to follow prescribed treatment. (a) What treatment you must follow. In order to get benefits, you must follow treatment prescribed by your physician if this treatment can restore your ability to work. (b) When you do not follow prescribed treatment. If you do not follow the prescribed treatment without a good reason, we will not find you disabled or, if you are already receiving benefits, we will stop paying you benefits. (c) Acceptable reasons for failure to follow prescribed treatment. We will consider your physical, mental, educational, and linguistic limitations (including any lack of facility with the English language) when determining if you have an acceptable reason for failure to follow prescribed treatment. The following are examples of a good reason for not following treatment: (1) The specific medical treatment is contrary to the established teaching and tenets of your religion. (2) The prescribed treatment would be cataract surgery for one eye, when there is an impairment of the other eye resulting in a severe loss of vision and is not subject to improvement through treatment. (3) Surgery was previously performed with unsuccessful results and the same surgery is again being recommended for the same impairment. (4) The treatment because of its magnitude (e.g. open heart surgery), unusual nature (e.g., organ transplant), or other reason is very risky for you; or (5) The treatment involves amputation of an extremity, or a major part of an extremity.

Five-Step Sequential Evaluation Is the claimant doing Substantial Gainful Activity (SGA)? Does the claimant have a “severe” impairment? Does the impairment meet or equal a listed impairment? Can the claimant do past relevant work? Can the claimant do any work existing in significant numbers in the national economy?

Sequential Evaluation Step 1: Work Is the claimant engaged in substantial gainful activity (“SGA”)? “Substantial” means work activity that involves significant physical or mental activities For 2013, “gainful” means resulting in income of $1040/month (gross income minus impairment related work expenses) http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_sid=FOkyfxzg&p_lva=&p_faqid=310&p_created=959273961&p_sp=cF9zcmNoPSZwX2dyaWRzb3J0PSZwX3Jvd19jbnQ9NjA2JnBfcGFnZT0x&p_li= Good source for financial data (if this URL works) Also: SSA FAQ’s: http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_alp.php (can link to tax, benefit, earnings amounts) The mere fact that the claimant is not working is not sufficient to disqualify. have to assess whether the work is a real job -- substantial AND gainful -gainful generally considers earnings, but definition is broad: -”Work activity is gainful if it is the kind of work usually done for pay or profit, whether or not a profit is realized. 20 CFR s. 404.1472(b) -special rules for self-employment

Sequential Evaluation Step 3: Listings Does the impairment, or combination of impairments, meet or equal a “listed impairment”? Organized by body systems Impairments presumed to prevent the ability to engage in SGA Each listing includes a diagnosis as well as certain findings which must be included in medical records many listings include durational requirements and severity levels

Important Listings 14.11 – HIV Listings 12.00 -- Mental Disorders 12.04 -- Affective Disorders (e.g. depression) 12.06 – Anxiety Disorders 13.00 -- Cancer listings

Steps 4 & 5 Residual functional capacity (“RFC”) What can the claimant do in spite of her/his impairments? Assess physical, mental Strength, manipulative limitations, environmental restrictions, etc. Ability to sit, stand, walk, lift, carry, etc. Strength classifications Heavy, Medium, Light, Sedentary RFC is what the claimant can sustain on a full-time basis, 5 days/week, 8 hrs/day or equivalent

Step 4 Step 4: Past RELEVANT Work Work done at the SGA level within the past 15 years, long enough to have learned the job You have to find out about all the client’s past jobs Job title, tasks performed, physical demands, skills/tools used Full time/part time Pay rate

Step 5 Step 5: Any work Consideration of vocational factors Jobs Client’s age, education, work experience Claimants over age 50 considered to have less ability to adjust to new work, so easier to be approved Jobs Jobs considered are those listed in the Department of Labor’s Dictionary of Occupational Titles Doesn’t matter whether there are available jobs or whether claimant could get the job Must be able to work on a full-time and sustained basis

Step 5 Considers combined impact of all impairments, including “non-exertional” limitations, e.g., need for frequent breaks, difficulty getting along in workplace, absenteeism Medical-vocational guidelines – (“Grids”) Direct an outcome based on client’s profile Strength: heavy, medium, light, sedentary Age Education Skill level of past work Grids don’t take non-exertional limitations into consideration

Proving Disability Medical Records Affidavits/statements from Doctors & other health care providers Social Workers, Case Managers Employers, friends, family who are aware of limitations, other relevant facts Other records, e.g. School Records Work records