"The Social Security Administration administers
two programs that provide benefits based on disability: the Social
Security disability program (Title II) and the supplemental security
income program (Title XVI). Title II provides benefits to individuals
who are insured under the Act by virtue of their contributions to
the Social Security trust fund through tax on their earnings. Title
XVI provides payments to individuals who are disabled and have limited
income and resources.
What follows is a linked outline to legal resources organized under
the Office of Hearings and Appeals five-step sequential evaluation
process for reviewing social security disability claims, as set
out in 20 CFR 404.1520. The rules under Title II and XVI are identical
in most cases, so only Title II rules are linked below.
Social Security Ruling 86-8: THE SEQUENTIAL EVALUATION PROCESS.
The regulations state that a sequential evaluation process is followed
whereby current work activity, severity and duration of the impairment(s),
ability to do past work and vocational factors are considered in
that order." Health Hippo: Evaluations of Social Security Disability
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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. |
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2005-06 State Medicaid Cuts & Expansions: |
Proposed
cuts in funding & Enacted draft # 1, January 1, 2006 |
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2006- State Medicaid and Health Cuts & Expansions |
Current
changes in Medicaid cutback and expenses |
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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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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 |
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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. |
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Childhood-Disability Evaluation Under Social Security-2003 |
Rules and
regulations of claiming disability as a child |
502 kb pdf |
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DETERMINING
MEDICAL EQUIVALENCE IN CHILDHOOD DISABILITY CLAIMS
WHEN A CHILD HAS MARKED LIMITATIONS IN COGNITION AND SPEECH
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To provide a policy interpretation that children who
have a "marked" limitation in cognitive functioning
and a "marked" limitation in speech have an
impairment or combination of impairments that medically equals
Listing 2.09. Also, to provide guidance for determining when a
child has a "marked" or an "extreme"
limitation in each of these areas.
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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
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903 kb pdf |
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Disability Evaluation Under Social Security-Listing of
Impairments—Part A |
Complete
listing of impairments-2003 |
644 kb pdf |
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DUAL-ELIGIBLE BENEFICIARIES WITH RETIREE DRUG COVERAGE: What
Retiree Plan Sponsors Should Know About the Risks and
Choices Facing Retirees, Spouses & Dependents, and What They
Can Do to Help |
Based on
the best available data, several tens of thousands of dually
eligible individuals also receive retiree drug coverage from
an employer or union plan sponsor. While this number is not
large compared with the total number of Medicare-eligible
retirees, it is large enough that many retiree plans will
cover one or more affected retirees. Because the
consequences for an affected retiree are so significant, it
is important that every employer and union plan sponsor be
aware of these issues and consider taking steps to reduce
the risk to and adverse impact on affected retirees.
This document provides an overview of the choices faced by
these retirees and outlines best practices employer and
union plan sponsors can adopt |
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Guilty until proven innocent-Dealing with a flawed SSDI
Application process
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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 |
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Handbook
for SSI Guidelines
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Provided
by SSA
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8,144 kb pdf
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Health
Hippo: Evaluations of Social Security Disability part 1
(Large report-increased
down-load time)
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The Social Security Administration administers two programs that
provide benefits based on disability: the Social Security
disability program and the supplemental security income program .
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Health
Hippo: Evaluations of Social Security Disability part 2
(Large report-increased
down-load time) |
The Social Security Administration administers two programs that
provide benefits based on disability: the Social Security
disability program and the supplemental security income program
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Health
Hippo: Evaluations of Social Security Disability part 3
(Large report-increased
down-load time) |
The Social Security Administration administers two programs that
provide benefits based on disability: the Social Security
disability program and the supplemental security income program
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Helping
your Social Security Claim through the system
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The
majority of people who file for Social Security Disability
benefits, either SSDI or SSI, complete the requested
paperwork, submit it—then they wait. Sometimes for months
without hearing a word.
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Hepatitis
C and Social Security Disability Benefits
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Rules
for applying
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445 kb pdf
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HIV and Public Benefits: Your Legal Rights-Jan. 2002 |
Many
people who need to apply for public benefits, like Social
Security, Food Stamps or a Medicaid card, have no idea where
to begin. And once they start the process, they often find it
extremely confusing and frustrating. This booklet is designed
to make that process easier to understand, and to provide the
information you need to get the benefits you are entitled to. |
110 kb pdf |
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HIV Testing, Confidentiality, and Discrimination: An Outline
of Legal Protections for Persons with HIV in Connecticut |
Informational booklet
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94 kb pdf |
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Home-care use and Expenditures among Medicaid Beneficiaries
with AIDS |
This
article compares the use and cost of home-care services among
traditional Medicaid recipients with AIDS and among
participants in a statewide HIV-specific home and
community-based Medicaid waiver program in New Jersey, using
Medicaid claims and AIDS surveillance data |
62 kb pdg |
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HUD-Homeless Management Information Systems
(Large file-please allow extra time for download) |
This
program requires organizations providing services to the
homeless to collect certain data and report that data to HUD
for use in a federal database. Although the exact terms of
use of the database vary by region, at a minimum the data will
be accessible to other service providers within the same
region. The stated purposes of the program include allowing
HUD to get an unduplicated count of homeless persons and to
encourage coordination among different providers. The
collection of this information, however, poses some very
serious privacy concerns. Particularly troubling is that
service providers are encouraged/required to report HIV
status, medical treatment, and mental health status (among
other information) in a format that does nothing to protect
the privacy of the individuals involved - their names, social
security numbers and other identifying information will also
be available in the database. Whether a person sought
treatment from an HIV-related care provider would also be
included in the database. While HUD has encouraged the use of
certain security protections for the data, we are also
concerned that the required protections do not appear to go
far enough to protect the confidentiality of this
information. |
1006 kb pdf |
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Law
and Treatment Access |
Power
Point presentation-Feb. 2003 |
197 kb |
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New
Therapies Pose Quandary for Medicare
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The federal Medicare program is expected to decide this
week whether to pay for an aggressive and expensive lung
operation that could offer a lifeline to tens of thousands of
elderly patients.
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Obtaining
Social Security Benefits for Patients with Liver Disease
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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. For people
suffering with Hepatitis C and liver disease, the requirements
of the Act can appear overwhelming.
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MEDICAID AND PERSONS WITH DISABILITIES |
Special
Medicaid Eligibility Provisions for Persons with Disabilities
for New York |
Pdf 163 kb |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions |
July 5,
2006-- resources to oppose state health cutbacks. |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions |
October 1,
2006 Medicaid and Health Cuts & Expansions |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions
1-2007 |
Planned
cutbacks on Medicaid and other healthcare coverage |
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Medicare Stand-Alone Prescription Drug Plans |
By state |
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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.
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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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Proposed Rules Revising Medical Criteria for Evaluating
Immune System Disorders |
Set forth
below are comments on the Proposed Rules revising the criteria
in the Listing of Impairments used by the Social Security
Administration to evaluate claims involving Immune system
disorders |
Pdf 1391
kb |
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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. |
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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 |
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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. |
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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
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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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The
Language Of Disability: Problems Of Politics And Practice
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Language.
. .has as much to do with the philosophical and political
conditioning of a society as geography or climate. . .people
do not realise 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.
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TIICA-Glossary of Wonky Medicaid, Medicare, VA, Health &
Other Related Program Terms: |
Definitions used by the US Government concerning Medicaid,
Medicare, VA, Health and other related programs |
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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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