Just the Facts: Accessing Adult Services It’s Moving from Entitlement to Eligibility Patti Hackett, MEd Co-Director Healthy & Ready to Work National Resource Center Bangor, ME Baylor University-School of Medicine Transition Conference 08 November 8, 2007

Just the Facts: Key Benefits OVERVIEW SSI Medicaid Voc Rehab Maintaining Private Health Insurance

Just the Facts: Accessing Adult Services It’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 activitysubstantial gainful activity (2007-$900/mo) Just the Facts: SSI – Disability Criteria

Just the Facts: SSI - Listings 1.Musculoskeletal SystemMusculoskeletal System 2.Special Senses and SpeechSpecial Senses and Speech 3.Respiratory SystemRespiratory System 4.Cardiovascular SystemCardiovascular System 5.Digestive SystemDigestive System 6.Genito-Urinary SystemGenito-Urinary System 7.Hemic and Lymphatic SystemHemic and Lymphatic System 8.SkinSkin 9.Endocrine SystemEndocrine System 10.Multiple Body SystemsMultiple Body Systems 11.NeurologicalNeurological 12.Mental DisordersMental Disorders 13.Neoplastic Diseases MalignantNeoplastic Diseases Malignant 14.Immune SystemImmune System search BLUE BOOK

Just the Facts: SSI Cerebral palsy with: A. Motor dysfunction meeting the requirements of or ; 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 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 -1 st 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 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 Extension of Policy for Dependent Child with a Disability UT Code Ann. Section 31A 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, MEd Co-Director, Healthy & Ready to Work National Resource Center Bangor, ME

Just the Facts: SSI -- Resources SSA website Benefit Eligibility Screening Tool (BEST) On-line tool - eligible for benefits from any of the programs Social Security administers. Understanding Supplemental Security Income,

Just the Facts: SSI -- Resources search BLUE BOOK Disability Evaluation Under Social Security Listing of Impairments - Childhood Listings Listing of Impairments - Adult Listings

Just the Facts: SSI -- Resources Ultimate Social Security Disability Guide Understanding the GRID Rules FORMS-Residual Functional Capacity (mental) (physical)