Social Security Insurance Issues
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"The new chief of the Social Security
Administration criticized the way her agency's disability
benefits program works after hearing tearful horror stories
Wednesday from sick Houston-area residents who battled the
system. One woman told Commissioner Jo Anne Barnhart it took
eight years and congressional intervention for her husband, a
Vietnam War veteran with multiple sclerosis, to get approval
for disability benefits. Another local woman, a former
department store executive, said Social Security
administrative law judges have denied her benefits request for
the last three years despite medical evidence that a rare
liver disease robs her of the energy to work. "It's
heartless, heartless," Brent Bowers of Pipefitters Local
Union 211 called out from the back of the crowded room as the
witnesses told their tales. Several injured union members have
sought the benefits.
Barnhart, who took over the federal agency in November with
promises of reform, said the testimony showed she has several
problems to tackle. "The kind of stories we heard today
... is not what was intended by Congress and certainly not
what was intended by the vast majority of people in the Social
Security Administration," Barnhart said. Barnhart, joined
at a downtown Houston hearing by five area congressmen and
other officials, said she will make sure the judges follow the
law. "I intend to make sure that everybody throughout the
agency is doing the job the way they are supposed to, in a
manner we can all be proud of," she said.
About 6 million U.S. residents get disability benefits,
averaging about $750 a month. The witnesses at the hearing
sold some of the congressmen on the idea that Social Security
judges don't apply the law evenly. "Too many of these
cases are handled with no consistency," said U.S. Rep.
John Culberson, R-Houston. Democratic U.S. Reps. Gene Green,
Ken Bentsen and Sheila Jackson Lee also attended.
Gisela Montano of Houston testified that the judges
originally rejected the disability claim from her husband,
Michael, who is afflicted by MS. "The judge refused to
look at all the facts," she said, explaining that a
second judge reversed the rulings with the same evidence.
Donna Brown, the former department store executive, tearfully
told Barnhart that without disability benefits, she had to
borrow money for her cancer surgery scheduled for Friday.
"I don't know what you can do about a judge ignoring
medical evidence, (but) that has to be a reform," she
told Barnhart." SOCIAL SECURITY CHIEF AGREES SYSTEM
HAS FLAWS
ADDITIONAL ARTICLES:
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Document Name & Link to
Document
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Description
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File Size /Type
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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:
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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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A CONSUMER’S GUIDE TO HEALTH INSURANCE
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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 CLAIMS
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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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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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Hepatitis
C and Social Security Disability Benefits
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Over 50%
of the initial applications for disability benefits
are denied, not because the disability definition is
that difficult to meet, but primarily because the
applicant didn’t understand the disability
determination process and didn’t give Social
Security the information they needed to award benefits
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445 kb
pdf
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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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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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SOCIAL
SECURITY CHIEF AGREES SYSTEM HAS FLAWS
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The new
chief of the Social Security Administration criticized
the way her agency's disability benefits program works
after hearing tearful horror stories Wednesday from
sick Houston-area residents who battled the system.
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Health
Hippo: Evaluations of Social Security Disability #1
Health
Hippo: Evaluations of Social Security Disability #2
Health
Hippo: Evaluations of Social Security Disability #3
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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 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.
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How States Can Make More Patients Eligible for Part
D’s Full Low Income Subsidy/Extra Help at Little or
Even No State Cost
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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.
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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. Negative
language inflicts the subconscious of most people from
the time they first learn to speak. Prejudice is not
merely imparted or superimposed. It is metabolised in
the bloodstream of society.
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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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