Social Security Disability Attorneys in Delaware. Help with SSDI and SSI Claims » Medicaid

Social Security Disability Law Weekly Episode 5 – Technology, Uninsured, and DDS Turnover

Steven Butler — Thu, 01 Apr 2010 03:46:45 +0000

Episode 5 – Technology, Uninsured, and DDS Turnover

Social Security Disability Law Weekly, Episode 5, includes discussion of use of technology in disability claims; alcohol abuse and mental health claims; importance of trying work before applying for disability; problem of being disabled and uninsured; how to qualify for Social Security based on mental illness/bipolar disorder; improve your Social Security Reconsideration appeal; and, more reasons to file an appeal of your disability denial. Download Episode 5 or press play below to listen in your browser.

Show Notes: Social Security Disability Law Weekly Podcast Episode 5

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This Week’s Topics:

Why Technology is Important to Social Security Disability Law
- Discussion of my attendance at American Bar Association TechShow in Chicago
- Discussion of how technology has improved Social Security’s processing of disability claim files
Question from Last Week’s Podcast
- Does Alcohol Dependence in Mental Health/Depression claims guarantee that your disability claim will be denied?
Issues during my week in practice
- Attempting to obtain disability benefits without ever attempting to work
  - Discussion of importance of trying work before applying for Supplemental Security Income Payments
  - Link to Delaware Division of Vocational Rehabilitation
- Serious medical problems without medical insurance
  - Review of how lack of medical insurance limits options for individuals that have disabilities
  - Link to Delaware Division of Social Services Medicaid Information Page
Social Security News (Discussion of Topics Reported in the News and Blogs this Week)
- Bipolar Disorder and Social Security Disability by Aaron Rifkind of Illinois Social Security Blog
  - Explanation of the Medical Listing criteria for qualifying for disability benefits based on Bipolar Disorder
  - Important to also determine if you qualify based on your Residual Functional Capacity
- Four Tips for Filing for Your Social Security Disability Reconsideration by Cavey Barrett, Attorneys at Law
  - Steps you can take to improve your reconsideration appeal
- Another Reason to Appeal Your Denial by Gordon Gates of the Social Security Disability Lawyer Blog
  - Discussion of how high turnover at Disability Determination Services impacts denial rates at the initial application and reconsideration levels

Closing Credits:

Contact Steve Butler to Discuss Social Security Disability Law Weekly
- DelawareDisability.com Contact Form
- Email: Steve@SSAlaw.us
- Twitter: @DisabilityGuy
- Facebook: http://facebook.com/SSALaw

I hope you enjoyed the fifth episode. Please feel free to give me any feedback for improving future episodes. If you enjoy the podcast, you can subscribe in iTunes.

Social Security Disability Law Weekly is a podcast devoted to issues in Social Security Disability Law. Discussion is focused on Social Security Disability Insurance and Supplemental Security Income payments. Social Security Disability Law Weekly is hosted by Steven Butler of Linarducci & Butler, PA.

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Importance of Healthcare Debate for Social Security Disability Applicants

Steven Butler — Tue, 15 Dec 2009 20:45:03 +0000

There has been much discussion in the news recently as Congress has been debating reforms to healthcare. In just the last week, 50% of individuals I met with did not have healthcare coverage. These individuals had lost healthcare coverage because they were unable to continue to perform their jobs because of disability. They do not qualify for any State-Assisted Medical Coverage because of household income, and their spouse does not have a healthcare plan that they are eligible to enroll in. Due to limited income, severe pre-existing conditions, and lack of affordable healthcare coverage, these individuals are forced to go without medical coverage.

Why Change Anything, I Am Happy with My Health Insurance?

Most individuals I speak to regarding these issues are not worried about the healthcare debate because they are happy with the current coverage that they have. These individuals often ignore how easy it would be to lose this coverage. For the majority of Americans, healthcare coverage is linked to your job. If you lose your job, you also lose your medical coverage. Although this is not an issue for a healthy individual that is able to obtain a new job (and new coverage), if you have lost your job because of your medical condition, you may quickly find yourself without medical insurance coverage. Even if you are eligible for COBRA coverage, when the choice is paying your mortgage and buying groceries or paying for health insurance, most individuals choose the necessities. No one ever expects to be in a position that they will not have health insurance available to them.

Medical Coverage does not Begin Immediately with Social Security Disability

What is shocking to most people is that if they are found disabled by the Social Security Administration, they do not immediately qualify for healthcare coverage. Under the best-case scenario, an individual that is ultimately found disabled is not entitled to Medicare coverage until 29 months after they last worked. (This is assuming that the individual was found disabled on the first of the month that they stopped working, and that the Social Security Administration determined that the medical condition was severe enough that they were entitled to disability from the day that they stopped working.)

If you are found entitled to Supplemental Security Income payments, you are entitled to Medicaid coverage immediately. However in order to qualify for SSI, you must be able to establish that you have very little assets, and little or no income on a monthly basis. Your spouse’s income is considered when determining your eligibility for SSI. The majority of the time if you qualify for SSI, it is likely that you already had Medicaid coverage, because the Medicaid criteria are similar to SSI.

During the waiting period for Medicare, no assistance is provided for medical treatment. If you do not have health insurance, you are expected to pay for your treatment out-of-pocket. Due to the amount of your Social Security Disability Insurance, you normally do not qualify for any income-based assistance from your State. Although the government has determined that your condition is severe enough to prevent you from performing work, no help is provided to obtain the treatment you need. Once Medicare beings, these benefits are just extended to the disabled individual and are not available to a spouse or dependents.

The Importance of COBRA

The thing that surprises me about many of the uninsured people that I meet is that they had an opportunity to purchase COBRA. The individuals refused COBRA because of the cost of the coverage. These individuals were unaware of the wait time for Medicare coverage and did not realize that they would not qualify for Medicaid because of their household income. Their immediate concern was paying their existing bills. They rarely considered the impact that one hospitalization could have on them financially. Many of these individuals are later forced into bankruptcy because of the cost of required medical care.

Even though COBRA initially sounds like a expensive alternative, you must consider how much your treatment will cost without insurance coverage. I have several clients that have medications that would cost more than the monthly COBRA premium. They quickly find after they refuse COBRA coverage, that the cost of one hospitalization would have paid for 12 months of COBRA. These individuals also discover that when they are unable to pay for medical treatment, it becomes less likely that they can establish their eligibility for Social Security Disability. Since they are unable to work and they do not have medical coverage, their financial situation only becomes worse.

Alternatives for individuals without Healthcare Coverage

It is possible for individuals without healthcare coverage to purchase personal policies. However these policies are often expensive, and rates raise with age. Insurers are allowed to consider your pre-existing health conditions, and in certain situations even exclude coverage based on pre-existing conditions. Affordable personal healthcare policies for older individuals normally require high deductibles. A yearly deductible of $5000 or more may be enough to prevent an individual from obtaining treatment even though they have healthcare insurance.

Medicaid is available to individuals with financial need, but if you have any source of income or your spouse is employed, it unlikely that you will qualify for this program. If you do not qualify for Medicaid, Delaware Residents may qualify for the Community Healthcare Access Program (“CHAP”). CHAP is a network of physicians and healthcare centers in Delaware that agree to provide discounts for medical services. There are still financial eligibility guidelines, but CHAP extends medical coverage to an additional group of individuals that normally would not qualify for help.

If you do not qualify for Medicaid or CHAP, healthcare is also available through a sliding-scale healthcare center. These facilities determine your eligibility for their services based on financial criteria, and limit the number of patients that they can see. Households with higher incomes will still be required to pay out-of-pocket co-pays for healthcare treatment, but will receive a substantial discount off the normal cost.

Although all of these options are better than no treatment, you will still not receive the same level of care that you would with a traditional health insurance plan. It will be harder to obtain specialist treatment for your condition, and some tests and medications that are needed will be excluded. Since treatment will be limited, establishing disability will be harder.

Pay Attention to Healthcare Debate

The purpose of this post is not to advocate any specific plan for reform, but instead to raise awareness of unforeseen healthcare concerns. Most of the uninsured people that I meet never expected to find themselves uninsured. They are normally hard-workers that simply did not realize that if their job ended due to disability, they would also lose medical benefits. These are individuals that always had healthcare coverage, and now when the need it the most, no affordable option is available.

Because continuing treatment is important to the Social Security Disability determination, many of these people will be denied benefits that they deserve because they cannot obtain the medical treatment that they need. These people need to share their stories with elected officials, family, friends and the public. It is only through increased awareness of these problems that there will ever be support for meaningful reform.

Relevant Links:

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Don’t lose Medicaid Because of the Receipt of Social Security Disability Insurance Benefits

Steven Butler — Fri, 18 Sep 2009 18:31:23 +0000

Because of financial struggles that occur when an individual is disabled and unable to perform work, it is common for an individual to qualify for Medicaid coverage (poverty based medical insurance program) in Delaware prior to applying for or being found disabled under the Social Security Disability Insurance (SSDI) program of the Social Security Administration. Prior to March 1, 2001, many individuals who were on Medicaid before they were approved for SSDI, lost their eligibility for Medicaid as a result of being approved for SSDI. Once an approval was issued, the Delaware Division of Social Services would send an individual a notice indicating that their Medicaid was terminated because of their income from SSDI.

Effective March 1, 2001, Delaware extended Medicaid eligibility to certain individuals that were approved for SSDI. The program was named “Medical Assistance During Transition to Medicare” or “MAT” and was codified as part of the Delaware Administrative Code. (See Title 16 Sec. 17800 of Delaware Administrative Regulations).

Beginning March 1, 2001, individuals in Delaware who were already receiving Medicaid and were approved for at least one month of Supplemental Security Income payments (SSI is the Social Security Administration’s poverty based disability program) no longer lost their eligibility for Medicaid because of the receipt of SSDI. The only requirements were that 1) the individual lost Medicaid because of receipt of SSDI, and 2) they were not yet eligible for Medicare. This was an important change, because previously these same individuals would lose eligibility for Medicaid if their SSDI payments were above the State income limits. Since Medicare does not begin until 24 months after eligibility for the first SSDI payment, before MAT, it was common for individuals to lose Medicaid and have to go months or even as long as 2 years without government provided medical coverage, despite being found disabled by the Social Security Administration.

Unfortunately, MAT did not extend Medicaid coverage in every situation. Only individuals that were approved for SSDI and had at least one month of SSI eligibility qualified for this program. The result was that anyone in Delaware that was receiving Medicaid and approved for SSDI, but was not approved for SSI (or never applied for SSI), still lost their Medicaid eligibility and had no government provided medical insurance coverage until Medicare began.

Effective September 1, 2008, Delaware extended MAT to any individual that was 1) not yet eligible for Medicare and 2) lost eligibility for Medicaid on or after January 1, 2008 due to the receipt of SSDI. As a result, even if an individual never met the requirements for SSI, they became eligible to retain Medicaid as long as they were receiving Medicaid before their SSDI claim was approved. This change in the Administrative Regulations closed a loophole that was causing many individuals in Delaware to lose all government provided medical coverage once they were approved for SSDI until they were finally eligible for Medicare.

In effect, this now means that no Delaware resident who is receiving Medicaid should lose government provided medical insurance just because of being found disabled by the Social Security Administration. Unfortunately, the regulations are not being applied consistently by the Delaware Division of Social Services. Many of my clients have had Medicaid benefits terminated after being approved for SSDI benefits, even though they should still qualify under MAT. I have found that several employees of the Delaware Division of Social Services are still not aware of these changes, and need reminders on how to properly apply the MAT Regulations.

I recommend that individuals that receive a notice that their Medicaid coverage has been terminated because of receipt of SSDI (who are not yet eligible for Medicare), print out copies of the applicable regulations and provide them to their Social Worker. Additionally, the individual should provide the Social Worker with the Notice of Approval from the Social Security Administration to prove that the source of their new income is SSDI benefits.

In order to implement this Medicaid gap coverage, individuals that fall within these limited categories are made eligible for $5.00 in an optional Delaware SSI State Supplement program regardless of the amount of their earned or unearned income. A Medicaid redetermination may be necessary after qualifying for SSDI, but the Administrative Regulations provide that eligibility for Medicaid continue until Medicare eligibility begins.

Remember, both of these extensions of Medicaid only apply if you were already receiving Medicaid before you were approved for SSDI. If you did not qualify for Medicaid before being found disabled under the SSDI program, you will still need to wait 24 months from the date of your first SSDI payment until you are eligible for Medicare Coverage. If you have not yet been approved for SSDI, and do not have medical insurance, you can use the Delaware Division of Social Services online Application for Social Services and Internet Screening Tool to determine if you qualify for State Assistance while waiting for your disability determination.

If you were represented by an attorney for your Social Security disability claim, and your Medicaid is terminated before you are eligible for Medicare, I would recommend that you ask your attorney to write a letter to your Social Worker describing the applicable regulations and explaining why you should retain your eligibility. If you live outside of Delaware, it is important that you determine if your State has a similar MAT program.

Relevant Links

Applicable Medical Assistance during Transition to Medicare Regulations

Delaware Administrative Code Title 16, Section 17800 Medical Assistance during Transition to Medicare
Delaware Administrative Code Title 16, Section 17801 Status Eligibility
Delaware Administrative Code Title 16, Section 17802 Financial Eligibility
Delaware Administrative Code Title 16, Section 17803 Eligibility Determination
Delaware Administrative Code Title 16, Section 13434 Recipients of Optional State Supplement Payments

Delaware Medicaid

Medicare

United State Medicare

Sample Letter

Sample Letter Requesting Redetermination of Medicaid Termination

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Improving Your Social Security Disability Claim Before Applying

Steven Butler — Fri, 11 Sep 2009 20:33:33 +0000

There are a number of steps you can take to improve your chances of being approved for Social Security disability benefits before you apply. The most important thing is that you know the disability requirements first. The basic requirement of Social Security disability is that you have a medical impairment or combination of impairments that will cause limitations for at least 12 months or the condition is expected to result in death. If you are under the age of 50, and your impairment (or impairments) must prevent you from performing all full-time work or must be serious enough that you qualify under a medical listing.

The majority of individuals that seek the assistance of an attorney do not qualify under medical listings. Instead they must be able to prove that their medical diagnosis causes limitations that will make it impossible to perform full-time work. If you are under the age of 50, it is not important whether you can perform your past work, just whether you are capable of performing any full-time work based on your limitations.

Generally, you are found to able to perform full-time work if you can stand for a total of at least 15 minutes of every hour during an eight hour work day (for a total of two hours in an eight hour workday), remain seated for a total of 45 minutes out of each hour for an eight hour workday, and have the ability to lift more than 3 pounds of weight on an occasional basis throughout the workday. If your impairment limits your ability to stand for less than a total of two hours during an eight hour workday, it is normally difficult to perform even sedentary work. Additionally, if your impairment causes frequent unscheduled breaks during an eight hour workday, or frequent absences on a weekly or monthly basis, most employers will not tolerate your loss of productivity. Vocational experts generally indicate that if an individual is unproductive for 15% or more of a workday, they are not employable.

For individuals age 50 or older, the disability standard is somewhat more lenient. You must still have a medical diagnosis that will result in limitations in the ability to perform work, but it is possible to be approved for benefits even if there are still jobs that you could perform on a full-time basis. If you are between the age of 50 and 54, and limited to a sit-down job that requires very little skills, generally you are found disabled unless you have performed similar jobs in the past. If you are age 55 or older, it is possible to be approved for benefits even if you can still perform jobs that require standing up six hours or more during an eight hour workday, and lifting up to 20 pounds on an occasional basis. The main question for individuals between the ages of 50 and 64 will be the type of work that they performed in the past, and whether the skills that you have learned from the past work will transfer to easier work. If an individual age 55 and older is only able to perform work with lifting restrictions of less than 20 pounds, and has no transferable skills to work that is consistent with their remaining abilities, generally they will be found disabled.

Before applying for benefits it is a was important that all individuals have treatment for their condition. If you are suffering from an impairment, it is important that it is diagnosed. Simply having aches and pains without a medical diagnosis is generally not sufficient. Social Security considers all physical and mental conditions when determining your disability. If you are experiencing any medical problems, it is in your best interest to discuss those with a doctor and to follow your doctor’s treatment suggestions. Even if you did not stop working as a result of medical condition that you are suffering from, it is important that you have treatment for these conditions and that you disclose your condition to the Social Security Administration.

While pursuing treatment for your condition, it is important that you see specialists for confirmation of your diagnosis, and to obtain suggestions for improvement of your condition. Often, I am unable to offer my assistance to individuals because they have not received sufficient care for their condition. If you are suffering from back pain, arthritis, depression, or any other condition that is preventing you from performing work, it is normally important that you see a specialist for your condition. If there are objective tests to determine if your condition exists, Social Security will normally expect that those tests be performed prior to your application. If your doctor prescribes medications, it is important that you take your medications as prescribed. Failure to follow or comply with your doctor’s instructions can result in a denial for benefits. If you have difficulty following your doctor’s instructions, it is important that you speak with your doctor concerning the difficulties.

For individuals that do not have medical insurance, it is possible to receive treatment through clinics. In Delaware, there are several different low cost physical and mental health clinics that are available. These clinics usually see patients on a sliding scale basis. Information will be asked about your resources and income and the clinics will determine the most that you can pay for the services that are available. Often these clinics are able to provide services to low income individuals free of charge. If you have limited income and resources it is also important that you apply for medical assistance through the state that you live in. If you are below the poverty level, you often will qualify for free medical care through the state you live in. The Medicaid program in the State of Delaware provides better coverage than the majority of health care plans that individuals can purchase on their own. Generally, with Medicaid in Delaware, all doctor and hospital visits are free of charge. Transportation is available at a low cost, and prescriptions are normally less than five dollars.

When you apply for disability benefits, Social Security considers your medical condition and also information that you provide them. It is important that Social Security finds you to be a credible person when you apply for benefits. Social Security looks for inconsistencies in the statements that you provide, and inconsistencies between your statements and statements in your physician’s reports. The use of illegal substances, or the abuse of alcohol can cause problems for you during your application. If your use of illegal substances or alcohol is material to your condition, even if you are disabled, Social Security will deny you benefits. Even if your use of illegal substances or abuse of alcohol does not contribute to your condition, it can still be used as a factor in determining your credibility. If you are using illegal substances, you are breaking the law, and this is a relevant factor when determining if you are believable. Even if you do not disclose information about your use of alcohol or illegal substances, normally this information is found through your medical records.

You cannot begin your application for disability benefits until you are out of work, or your earnings from work have been reduced to a point that you are making less than $980 per month (this is the maximum you can make and still apply for benefits in 2009). Although you can apply for benefits the first day after your employment ends (or your earnings are reduced below the allowable limit), I normally recommend that individuals wait to apply until sufficient proof of their disability is available. Since Social Security must be convinced that your condition will prevent you from returning to work for at least 12 months, or result in death, it is often hard for individuals to be approved if they apply for benefits shortly after employment has ended.

The exception is if you have been diagnosed with a terminal illness. When you have been diagnosed with a terminal illness, it is important to apply as soon as possible. When you apply for a condition that may improve, commonly the Social Security Administration will deny your application even if you are currently disabled. It may be determined that even though you are currently unable to work, your condition is expected to improve within 12 months. Before applying for benefits, I suggest that my clients discuss their options with their treating physicians, make sure that their treating physicians are supportive of their application, and also discuss the expected duration that their condition will prevent them from working. If it is unknown if the condition will result in the inability to work for at least 12 months, I normally suggest waiting to apply until closer to the 12 month mark.

It is always important that you communicate with your physicians throughout this process. You should find out if your doctors are going to support your application for disability, and whether they will be willing to provide information that is necessary to help you be approved. I also commonly ask that my clients have forms completed by their doctors before filing an application for benefits. This gives me a better idea of what your doctor thinks, and allows me to better determine if you have a condition that meets the disability requirements. It is important to communicate with your physicians that you would prefer to work, and that you are only pursuing disability benefits because that is your only option based on your limitations. I always encourage my clients to remind their doctors that they are willing to take any steps necessary to allow them to return to productive work in the future.

Even when everything is done properly for an application for disability benefits, it is a time-consuming process. The average time for a decision in Delaware is between 4 to 7 months on the initial application. Failure to provide all of the needed information to the Social Security Administration can result in delays, and failure to seek necessary treatment can result in a denial. If you are considering applying for disability benefits, I recommend that you contact my office for assistance at the earliest possible time. Although it is possible to pursue disability benefits without the help of an attorney, it is helpful to have an experienced person help navigate you through the process. Please contact my office if you would like a free initial consultation.

Relevant links:

10 Things to Know Before Applying for Social Security Disability Before you begin an application for Social Security Disability Insurance...
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