We explain when vocational factors must be considered along with
the medical evidence, discuss the role of residual functional capacity
in evaluating your ability to work, discuss the vocational factors
of age, education, and work experience, describe what we mean by
work which exists in the national economy, discuss the amount of
exertion and the type of skill required for work, describe and tell
how to use the Medical-Vocational Guidelines in appendix 2 of this
subpart, and explain when, for purposes of applying the guidelines
in appendix 2, we consider the limitations or restrictions imposed
by your impairment(s) and related symptoms to be exertional, nonexertional,
or a combination of both. A decision by any nongovernmental agency
or any other governmental agency about whether you are disabled
or blind is based on its rules and is not our decision about whether
you are disabled or blind. We must make a disability or blindness
determination based on social security law. Therefore, a determination
made by another agency that you are disabled or blind is not binding
on us. The law defines disability as the inability to do any substantial
gainful activity by reason of any medically determinable physical
or mental impairment that can be expected to result in death or
which has lasted or can be expected to last for a continuous period
of not less than 12 months. To meet this definition, you must have
a severe impairment, which makes you unable to do your previous
work or any other substantial gainful activity that exists in the
national economy. To determine whether you are able to do any other
work, we consider your residual functional capacity and your age,
education, and work experience.
There are specific rules and requirements that must be met before
even the consideration of coverage under SSA will even regard as
viable before a determination will be made: income, the ability
to work (or is there some other type of work the claimant can perform),
education or lack or (can the claimant work at a lower scale if
able to), gifts to the claimant, etc. This must be met or the claim
may to rejected as unsound.
|
Document Name & Link to Document
|
Description
|
File Size /Type**
|
|
2005 Medicaid and Medicare Cutbacks |
Federal
legislation & state responses to Hurricanes Katrina & Rita
were still pending on 9/30 & aren’t addressed in this
issue. |
|
|
2007-Coverage through the “Doughnut Hole” |
Unlike
most forms of insurance, the Medicare Part D prescription
drug program has a hole in its middle. This coverage gap,
colloquially known as the “doughnut hole,” is perhaps the
most bizarre and troublesome aspect of the Part D drug
program. After beneficiaries reach their initial limit of
total drug expenses ($2,250 in 2006), they have no
prescription drug coverage until their total drug expenses
reach a catastrophic threshold for the year ($5,100 in
2006). While beneficiaries are in the doughnut hole, they
must continue to pay their monthly premiums, although they
do not receive any drug benefits. Only after they have spent
thousands of dollars of their own money to get out of the
hole ($2,850 in 2006), in addition to their monthly
premiums, does their coverage resume. |
Pdf 534 kb |
|
2005-06 State Medicaid Cuts & Expansions:
|
Proposed
cuts in funding & Enacted draft # 1, January 1, 2006 |
|
|
2006- State Medicaid and Health Cuts & Expansions |
Current
changes in Medicaid cutback and expenses |
|
|
|
|
A CONSUMER’S GUIDE TO HEALTH INSURANCE
|
This
booklet, developed by the Vermont Department of Banking,
Insurance, Securities and Health Care Administration, helps
you understand health insurance and how it works. It
explains the different types of insurance policies available
to you and what to expect once you have health insurance.
With a little knowledge, you can choose the right kind of
coverage for you and your family. |
|
|
Childhood-Disability Evaluation Under Social Security-2003 |
Rules and regulations for childhood disability |
502 kb pdf |
|
Compassionate Allowances |
Under
titles II and XVI of the Social Security Act (the Act), we
pay benefits to individuals who meet our rules for
entitlement and have medically determinable physical or
mental impairments that are severe enough to meet the
definition of disability in the Act. The rules for
determining disability can be very complicated, but some
individuals have such serious medical conditions that their
conditions obviously meet our disability standards. |
Pdf 53 kb |
|
Disability
|
Hepatitis and Social Security Disability Benefits-What
you need to know
|
PDF / 445 KB
|
|
Disability Evaluation Under Social Security |
This edition of Disability Evaluation Under Social Security has
been specially prepared to provide physicians and other health
professionals with an understanding of the disability programs
administered by the Social Security Administration. It explains
how each program works, and the kinds of information a health
professional can furnish to help ensure sound and
prompt decisions on disability claims
|
903 kb pdf |
|
Disability Evaluation Under Social Security-Listing of
Impairments—Part A |
Complete
listing of impairments-2003 |
644 kb pdf |
|
Disparities in State Health Coverage: A Matter of Policy or
Fortune? (Large
Report-Increase Download Time) |
This paper explores the reasons why states differ in their
Medicaid coverage of the at-risk population, focusing in particular
on the large disparities in Medicaid spending associated
with these differences.
|
3378 kb pdf |
|
Guilty until proven innocent-Dealing with a flawed SSDI
Application process
|
The Social
Security Disability Insurance system, which is supposed to
protect workers from suddenly losing all sources of income
with an unexpected disability, is seriously flawed and
becoming more so. There's a widespread national myth that
people are "faking it". I understand that Connecticut spent
over a million dollars to unroot all those fakers in their
system, and only found 6 |
|
|
Handbook
|
SSA Handbook on obtaining benefits
|
PDF / 8,144 KB
|
|
HEALTH AND
DISABILITY INSURANCE, and SOCIAL SECURITY DISABILITY: A HANDBOOK
FOR IBD PATIENTS,
|
Patients
with chronic illnesses unfortunately must advocate for
themselves, whether it be with a doctor or an insurance company.
Knowing your rights will help. If you have internet access, you
have access to the best research tool in the world. |
|
|
Hepatitis
C & Disability
|
Social Security disability benefits are often
the ultimate safety net for
persons suffering from medical impairments which make it impossible
for them
to work
|
|
|
Hepatitis
C-Information
on Disability
|
Links to agency’s
|
|
|
Health Hippo:
Evaluations of Social Security Disability Part ONE
(Large report-increased
download time)
|
HIPPA regulations
|
|
|
Health Hippo:
Evaluations of Social Security Disability Part
TWO
(Large report-increased
download time) |
HIPPA regulations
|
|
|
Health Hippo:
Evaluations of Social Security Disability Part THREE
(Large report-increased
download time) |
HIPPA regulations
|
|
|
|
|
How States Can Make More Patients Eligible for Part D’s Full
Low Income Subsidy/Extra Help at Little or Even No State
Cost
|
Medicare
patients with incomes (using the SSI income counting rules
and disregards) under 135% of the Federal Poverty Level, or
FPL ($1103 monthly for one) and with assets (other than a
home of any value; any vehicles of any
value; and a separate burial fund up to $1500 per person)
under $6.000 ($9,000 per couple) qualify for full Low Income
Subsidy (LIS) Extra Help Medicare Part D prescription
coverage: No deductible or premium; no donut hole; co-pays
of only $1/$2 per generic and $3/$5 per brand name drug.
Co-pays and income and asset levels will rise with inflation
yearly, as will the non-Extra Help Part D premiums,
deductibles and donut hole and catastrophic thresholds.
|
|
|
MEDICAID AND PERSONS WITH DISABILITIES |
Special
Medicaid Eligibility Provisions for Persons with
Disabilities for New York |
Pdf 163 kb |
|
Medicaid Watch: State Medicaid and Health Cuts & Expansions |
July 5,
2006-- resources to oppose state health cutbacks. |
|
|
Medicaid Watch: State Medicaid and Health Cuts & Expansions |
October 1,
2006 Medicaid and Health Cuts & Expansions |
|
|
Medicaid Watch: State Medicaid and Health Cuts & Expansions
4-07 |
Cuts in
Medicaid within the US |
|
|
Medicare Stand-Alone Prescription Drug Plans |
By state |
|
|
MSP PROGRAMS OFFER $88.50 MORE IN SOCIAL SECURITY CHECKS,
PRESCRIPTIONS WITH SMALL CO-PAYS AND EVEN---FOR MANY--
COVERAGE OF MEDICARE DEDUCTIBLES AND CO-PAYMENTS |
The
little-known Medical Savings Programs (MSPs) can mean an
extra $88.50 monthly in Social Security checks in 2006 and
extra medical and prescription drug benefits for disabled
and elderly persons who are on Medicare but are not also
on SSI or Medicaid already. |
|
|
Pulling away the safety nets |
The Safety
Net She Believed In Was Pulled Away When She Fell Debra
Potter made a good living selling disability coverage. But
like many working Americans, she learned the hard way that
federal law now favors insurers. |
|
|
The Language
of Disability
|
Language. . .has as much to do with the philosophical
and political conditioning of a society as geography or climate.
. .people do not realize the extent to which their attitudes
have been conditioned since early childhood by the power of
words to ennoble or condemn, augment or detract, glorify or
demean.
|
|
|
REDDICK v CHATER |
This case
involves a claim for Social Security disability benefits by
Susan Reddick ("Claimant") who was diagnosed with Chronic
Fatigue Syndrome ("CFS"). The Administrative Law Judge ("ALJ")
found that Claimant suffered from CFS but that she was not
disabled because the disease did not undermine her ability to
perform substantial gainful work. The district court concluded
that the ALJ's decision was supported by substantial evidence
and granted summary judgment for the Commissioner. A principal
issue in this case is whether the ALJ was justified in
discounting the testimony of Claimant, her treating doctor,
and an examining doctor concerning her disability from
fatigue, and instead relying upon the testimony of two
consultative examiners who concluded that she was not
disabled. |
|
|
Sample Disability Policies |
The
following sample policy statements are for various types of
disability policies. Generally, disability leaves are granted
with pay, or with pay provided through an insurance plan, and
without loss of credit for the employee’s length of service with
the company for short-term disability. The following samples
are for illustration purposes only. The policy terms and
conditions available from your insurer could be quite different
from the terms set out in these policies. These policies,
however, should be useful in giving you a sense of how a
disability policy is structured and the types of issues you’ll
need to discuss with your insurer. |
|
|
Social Security Bulletin-2005 |
Current
information about SSI benefits as of 2005 |
1300 kb
pdf |
|
Social Security findings should play key role |
''As long as
the worker can engage in 'substantial gainful activity,' he is
not disabled even if the only work that he is capable of doing
is only part time. E.g., Brewer v. Chater, 103 F.3d 1384,
1391-92 (7th Cir. 1997); 20 C.F.R. §404.1572(a). Of course, the
work must not be so meager as not to be substantial and gainful.
See 20 C.F.R. §§404.1573(e), 404.1574(a), (b). But the same, it
turns out, is true under ITT's disability plan |
|
|
SSA
ISSUES RULES IMPORTANT TO BENEFICIARIES IF SSA DECIDES THAT
THEIR CONDITIONS ARE NO LONG DISABLING |
For over two
decades, federal law has required that the Social Security
Administration continue payment of disability benefits to a
person whom SSA has determined if SSA determines that the person
is participating in a vocational rehabilitation program and
there is a likelihood that completing the program will make it
less likely that the person will need to resume receipt of
Social Security or Supplemental Security Income disability
benefits in the future...The purpose of this paper is to explain
the new regulations and to alert people with disabilities, their
families, schools, service providers, and advocates that these
regulations will take effect on July 25, 2005 and will be of
significant benefit to some individuals who otherwise would lose
their benefits when SSA decides that they currently are no
longer disabled |
|
|
STATE ELIGIBILITY POLICIES WHICH DISCRIMINATE
AGAINST THE DISABLED IN THE MEDICAID, MEDICAID WAIVER
EXPANSION, CHIP, AND STATE-FUNDED HEALTH & PHARMACY
ASSISTANCE PROGRAMS |
Some state
Medicaid, Medicaid waiver expansion, Child Health Insurance
(CHIP), state-funded health assistance and state pharmacy
assistance programs (SPAPs) have rules that deny
eligibility, coverage, equal income levels or benefits to
disabled and aged persons. |
|
|
State Medicaid Eligibility Cutbacks & Exclusions-Proposed &
Recently-Enacted, 2001-04 |
Nonetheless, many states dropped coverage of legal
aliens; cut eligibility and benefits for, or even dropped,
state-only medical assistance for the federally-unmatchable
poor; added or raised premiums and copays and cut "optional"
services in S-CHIP and Medicaid; raised Medicaid drug copays;
added preferred formularies, generics requirements and monthly
number limits for Medicaid drugs; stopped “presumptive”
eligibility for pregnant women (a clever back-door way to bar
otherwise-federally-mandated coverage of citizen-to-be fetuses
of poor illegal alien mothers) and curtailed services and
enrollment in expensive home and community-based (HCB)
waivers. |
|
|
State Medicaid Actions—2005: What the States
Said, Did and Plan to Do |
States
faced gaping budget deficits that required lawmakers to cut
program spending, including that for higher education,
social services and health care. During this period the
states reduced spending by $236 billion due to shortfalls in
revenue |
1675 kb
pdf |
|
State Medicaid Buy-In Programs:
Implementation Status, Enrollment and Program Design
Features |
By state
and features of each |
|
|
State Pharmaceutical Assistance Program (SPAP)
Legislation & Policy Changes To Coordinate With & Supplement
Part D: Issues, Possibilities & Challenges for HIV, Disabled
& Other Patients |
Several
states passed legislation and/or regulations creating,
altering or--in once case-- abolishing SPAPs in response to
the coming implementation of Medicare Part D, especially to
coordinating with and supplement drug coverage for those Low
Income Subsidy (LIS)/”Extra Help” patients with incomes
under 150% FPL. SPAPs can cover drugs not on individual
Part D plans’ formularies; pay LIS/Extra Help patients’
co-pays, coinsurance, deductibles and premiums; do likewise
for slightly “richer’ limited income patients (as some
newly-created or adapted SPAPs will do); and---if they meet
CMS standards—have such drug payments count toward True Out
Of Pocket (‘TrOOP”) credit for moving patients over 150% FPL
through and out of the donut hole and into Part D’s
catastrophic coverage. |
|
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