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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Hepatitis C:
Social Security & Disability Insurance

 

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Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

"Meeting or Equaling the Listings of Impairments

Essentially there are two ways to prove disability in Social Security claims. The first requires medical proof that meets specific medical standards contained in Social Security's Regulations. These standards are known as the "Listings of Impairments." If medical proof meets or equals the appropriate standard the Claimant may be presumed disabled and benefits awarded, as long as the non-disability requirements of the law are also met.

The Listing for liver diseases is fairly complex and specific. There is no specific Listing for Hepatitis C. The Listing used by SSA for person with liver disease is found at Section 5.05 of the Listings of Impairments:

5.05 (Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With:

A. Esophageal varices (demonstrated by X-ray or endoscopy) with a documented history of massive hemorrhage attributable to these varices. Consider under a disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment; or

B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or

C. Serum bulirubin of 2.5 mg. per deciliter (100 ml.) or greater persisting on repeated examinations for at least 5 months; or

D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbumnemia of 30 gml per deciliter (100 ml.) or less; or

E. Hepatic encephalopathy. Evaluated under the criteria in listing 12.02; or

F. Confirmation of chronic liver disease by liver biopsy (obtained independent of social security disability evaluation) and one of the following:

-Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

-Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations for at least 3 months; or

-Hepatic cell necrosis or inflammation persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.

Even a cursory review of the Listing makes it obvious that this is a medical standard that will not be met by the medical evidence in most claims. The Listings are intended to be a difficult standard. Liver transplant claims will likely be analogized to the Listing for kidney and heart transplants. Those Listings presume disability for one year from the transplant. After that, SSA will conduct a review to determine whether the organ is functioning and whether the Claimant remains disabled. A Claimant with liver disease should provide a copy of this Listing to the treating physician to obtain a medical opinion as to whether this standard has been satisfied." Obtaining Social Security Benefits for Patients with Liver Disease.

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /Type**

2006 VA HEALTH, INCOME AND OTHER BENEFITS

Many fans of movie musicals can recall Joan Blondell belting out “Remember My Forgotten Man” against a moving tableau of World War I doughboys in Busby Berkeley’s film, Golddiggers of 1933.  In one of Hollywood’s rare early forays into social issues, the song and dance number called for better treatment of the World War I veterans who’d just been spurned by President Hoover, the lame-duck GOP Congress and even future World War II hero General Douglas MacArthur, who used tanks to disperse thousands of unemployed and disabled veterans demonstrating peacefully for benefits in Washington the year before.

But over 70 years later, Blondell’s torch-song lament still rings true:  Most of us aren’t aware of benefits which are available to all veterans – and especially disabled veterans  -- and they and the benefits due them too often remain “forgotten.”  (For just one example, in 2000 Lawrence Deyton, MD, the VA’s national coordinator of  HIV care, estimated that only 18,000 of an estimated 85,000 to 130,000 eligible HIV-positive veterans had signed up for the VA health care to which they’re entitled.) Here’s a brief survey of income and health coverage programs for veterans of active duty with general or honorable discharges.
 
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

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A History of the Disability Listings In order to facilitate the process, the Social Security Administration created a list of diseases and conditions which were felt to be incompatible with substantial gainful activity (gainful employment). Persons who were not engaged in substantial gainful activity, and whose conditions met the requirements of one or more of the listed conditions, were considered disabled. Called the listings, the criteria proved so useful that they were retained and revised periodically, and have been kept in continuous use ever since. Pdf 248 kb
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
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.   

Disability

The problem of being denied SS benefits appears to affect people with Hepatitis C Virus even more, for several different reasons

PDF / 445KB

Handbook

(Very Large report-increased download time)

Explanation of benefits from SSA

PDF / 8.1MB

Health and Disability insurance and Social Security Disability 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. 487 kb pdf

Hepatitis C-information on Disability

Links to US government sites

Health Hippo: Evaluations of Social Security Disability part one 

Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For most people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow.

Health Hippo: Evaluations of Social Security Disability part two Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For most people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow.  
Health Hippo: Evaluations of Social Security Disability part three Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For most people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow.  

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
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.

 

 

Obtaining Social Security Benefits for Patients with Liver Disease

Evaluation of Social Security Disability

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.  

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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.  
SHOULD NEEDY FAMILIES BE REQUIRED TO TAKE DRUG TESTS TO RECEIVE AID?

Sen. David Vitter (R-LA) introduced a bill that would amend the Social Security Act to require States to implement a drug testing program for applicants for and recipients of assistance under the Temporary Assistance for Needy Families (TANF) program. 

If an applicant fails a drug test, or was convicted of a drug related crime they can be denied aid. Also, states would be allowed to require random or set time drug tests.  A person can be permanently denied aid if they fail three drug tests or receive three drug related convictions.
 
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  

SSI Disability and Hepatitis B and C

Often Hepatitis patients become so critically ill that they can no longer work. They can go through their savings quickly, especially those who are on REBETRON or Interferon therapy.

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 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.  

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.

Widening State Pharmacy Assistance Programs (SPAPs) for the Aged Only to Cover the Disabled Too While state Medicaid programs appear to be prohibited by the new law in most, if not all, cases from offering secondary, "wraparound" drug coverage to "dual eligibles" [those Medicare patients who are also poor enough to be on Medicaid too] this is not so for SPAPs. They're allowed to be secondary, "wraparound" payers if they choose to do so. Given state budget problems, some may propose terminating SPAP programs to save state funds, on the [disingenuous] grounds that the new Medicare drug benefit makes the state program unnecessary. But either way, enactment of the Medicare Part D  drug benefit means enormous savings to SPAPs---in addition to the savings states will get from Part D displacing some state Medicaid drug expenses.  For example, Pennsylvania was predicted to save $150 million just from the preliminary Medicare interim $600 drug discount card program; New Jersey’s savings were to be $90 million; Connecticut’s were to be $15 million; and all SPAPs will save proportionately at least as much when the full, permanent Part D program becomes primary payer in 2006.    

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