www.hrtw.org

Patti Hackett, MEdHRTW Co-Director, Bangor, ME

PacRim Conference, Honolulu, HIApril 14, 2008

Healthy & Ready to Work, to Live and to Participate!

“Celebrate the Paperwork: It Means You Are Alive!

Making the Paperwork Work: Expediting Program Eligibility

www.hrtw.org

Today’s Outcomes

By the end of 1 hour success will look, sound and feel like:

• New knowledge of how to draft disability documentation

• Ways to increase family involvement in their own care

• Energized by working in a brain compatible learning environment that you can model in your work

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About You & Me

About HRTW

Entitlement-Eligibility

Essential Paperwork

Just the Facts

Resources

www.hrtw.org

You, Me, Looking for ?

•Affirm

• Ah ha!

•Squirm

•Disagree

Who You Are?

Experts in the Room

About me!

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Transition to Adulthood

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Just the Facts: Key Benefits

• “Celebrate the Paperwork: It Means You Are Alive!

• Making the Paperwork Work: Expediting Program Eligibility

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Take Home Messages

1.Paperwork is a reality no positives in whining

2. Indentify the shortcuts put energy on solutions

3. Draft the paragraph, create the one pager

Trim done the care notebook

4. Families NEED to learn this they get the denials and the stress

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Survival Tips: Why NOT try some

1.No is just the first answer until additional information is provided

2. Speak their language, terms Compliment, address by name

3. Scheduled stress day-deal w/ forms, bills. - Open mail on the 15th - Take action on 17th prep relax bath

4. Three way call

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SKILLS FOR YOUTH

1.Practice filling in forms (Home & School)

2. Cheat sheet: portable medical summary

3. Tracking to avoid forgetting

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Just the Facts: Key Benefits

OVERVIEW

• SSI

• Voc Rehab

• Maintaining Private Health Insurance

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Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility

FORMAT

• Dispelling the Myths

• The Intent of the Service

• Roles: Teachers,

• Physicians, Care Coordinators

Families & Youth

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Just the Facts: SSI

The Myth:

All applications get denied first time around.

The Intent:

• Supplemental Security Income (SSI) 1972 Federal funded by general tax revenues (not Social Security taxes)

Designed to help aged, blind, and disabled people, who have little or no income; and

Provides cash to meet basic needs for food, clothing, and shelter (assets $2,000 single/$3,000 couple)

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Just the Facts: SSI

Insider Info:

• Applications will receive a timely impartial review IF

the complete paperwork is received.

• Medical and other evidence is not complete.

• Documentation doesn’t follow disability criteria.

* SSA staff receive raises in part based on paperwork flow.

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An individual is "disabled" if he or she has a medically determinable physical or mental impairment

• Can be expected to result in death

• Has lasted or can be expected to last for a continuous period of not less than 12 months

• Child - Marked & severe functional limitations

• Adults -Inability to engage in any substantial gainful activity (2007-$900/mo)

Just the Facts: SSI – Disability Criteria

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Just the Facts: SSI - Listings

1. Musculoskeletal System2. Special Senses and Speech3. Respiratory System4. Cardiovascular System5. Digestive System6. Genito-Urinary System7. Hemic and Lymphatic System8. Skin9. Endocrine System10.Multiple Body Systems11.Neurological12.Mental Disorders13.Neoplastic Diseases Malignant14.Immune System

www.ssa.gov

search BLUE BOOK

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Just the Facts: SSI

111.07 Cerebral palsy with:A. Motor dysfunction meeting the requirements of 101.02

or 111.06; or

B. Less severe motor dysfunction (but more than slight) and 1 of the following:

1. IQ of 70 or less; or

2. Seizure disorder, with at least one major motor seizure

in the year prior to application; or

3. Significant interference with communication due to

speech, hearing, or visual defect; or

4. Significant emotional disorder

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Just the Facts: SSI

Disability Criteria for Children: Domains

- Acquiring and Using Information;

- Attending and Completing Tasks;

- Interacting and Relating with Others;

- Moving About and Manipulating Objects;

- Caring for Yourself; and

- Health and Physical Well-being

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Just the Facts: SSI

CHILDREN - Meets or Equals

Functionally = "listed impairment”

• Marked limitations in 2 of these domains interferes seriously with the child's ability to

independently initiate, sustain, or complete activities.

• Extreme limitation in 1 domain, interferes very seriously with these abilities.

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Just the Facts: SSI

Disability Criteria for Adults

• Meets the Listing - one of the Listings by comparing it to the specific requirements in the Listings.

• Meets or Equals - impairment(s) is equal in severity and duration to a listed impairment.

• Residual Functional Capacity - disability is severe, but does not meet or equal a listed impairment

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Just the Facts: VR

The Myth:

They purposely delay applications.

They only serve people who are easy to place.

The Intent:

To assist and empower eligible individuals with disabilities to achieve and maintain meaningful employment

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Just the Facts: VR

TRAINING• Supported Employment • Short-Term, Vocational Training • College or University-based education

EMPLOYMENT SUPPORT• Job Coaching • On-the-Job Training

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Just the Facts: VR

Physicians, Care Coordinators

- Help gather medical & other evidence for disability determination

Families & Youth

- Portable Medical Summary-ICD9 codes

- 1st appt have ALL paperwork completed.

- Be part of the solution, be proactive.

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Handouts: VR

Documenting Disability- Sample Letter from Physician

• Families need to learn how to draft letter

• Medical Team reviews/edits

• Youth learn the rules and regs.

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Just the Facts: Private Health Insurance

The Myth:

• My disabled child will not age out of my health care insurance.

• All young adults are covered by Medicaid so why should we continue the private coverage

The Intent:

• It’s a state mandated benefit.

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Handouts: Private Health Insurance

Maine Health Insurance Statute – up to age 25 Chapter 33:§2742-A. Extension of coverage for dependent children Effective August 23, 2006

Dependent child; definition.   A.  Is unmarried;

B.  Has no dependent of the child's own;

C.  Is a resident of this State or is enrolled as a full-time student at an accredited public or private institution of higher education; and

D.  Is not provided coverage under any other individual or group health insurance policy or health maintenance organization contract or under a federal or state government program.

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Handouts: Private Health Insurance

Requires

An insurer may require, as a condition of eligibility for continued coverage in accordance with this section, that a covered person seeking continued coverage for a dependent child provide written documentation on an annual basis that the dependent child meets or continues to meet the requirements

Celebrate Annual Documentation!

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Handouts: Private Health Insurance - 411

Extension of Policy for Dependent Child with a Disability

Employee 1. FORM - continuation of coverage 2. FORM - Attending physician statement of mental retardation or physical handicap.

3. Both forms submitted to the employer for review and signature before forwarding to the claim office.

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Just the Facts: Private Health Insurance

Physicians, Care Coordinators

- More than letter from God

- Discuss before age 17, 26

Families & Youth

- Transition of Care Notebook

to concise thin files and sample documentation

- Don’t wait to be informed – get the forms early

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TIPS: Navigating & Documenting

1. Prepare the medical and other evidence

2. Know the eligibility requirement

3. Prepare the application - Ask for review before submitting

4. Come ready (paperwork completed) the day of “intake”

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TIPS: Creative Health Insurance

ex #1, 3rd wife

Ex #2

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Patti Hackett, MEdCo-Director, HRTW Center, Bangor, ME

pattihackett@hrtw.org

www.hrtw.org

Resources - 04

HRTW Portal - Laws that Affect CYSHCNhttp://www.hrtw.org/tools/laws_leg.html

• The Term Special Health Care Needs or Disability

• Disability Rights Portals

• Education Issues

• Employment & Disability

• Equal Opportunity Access (504, 508 & ADA)

• Family Medical Leave Act

• HRSA/MCHB – Title V Legislation

• Health Insurance Benefits

• SSI/SSDI

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Just the Facts: SSI -- Resources

SSA websitewww.ssa.gov/ssi

Benefit Eligibility Screening Tool (BEST) On-line tool - eligible for benefits from any of the programs

Social Security administers. https://secure.ssa.gov/apps7/best/benefits/

Understanding Supplemental Security Income, 2007

http://www.socialsecurity.gov/ssi/text-understanding-ssi.htm

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Just the Facts: SSI -- Resources

www.ssa.gov search BLUE BOOK

Disability Evaluation Under Social Security

http://www.ssa.gov/disability/professionals/bluebook/

Listing of Impairments - Childhood Listings www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

Listing of Impairments -  Adult Listings www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

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Just the Facts: SSI -- Resources

Ultimate Social Security Disability Guide

http://www.ultimatedisabilityguide.com/index.html

Understanding the GRID Rules

http://www.ultimatedisabilityguide.com/grid_rules.html

FORMS-Residual Functional Capacity (mental) (physical)

http://www.ultimatedisabilityguide.com/rfc_forms.html

www.hrtw.orgwww.familyvoices.org

www.hrtw.org

www.hdwg.org/catalyst/index.php

State-at-a-GlanceChartbook onCoverage and Financingof Care for Children andYouth with Special Needs

www.hrtw.orgMedicalhomeinfo.org

www.hrtw.org

www.hdwg.org/catalyst/index.php

State-at-a-GlanceChartbook onCoverage and Financingof Care for Children andYouth with Special Needs

www.hrtw.org

http://www.championsinc.org