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What this presentation is not about:
• Differences between SSI and SSD• Social Security Work Incentives• Childhood disability determination
(detailed info in “Red Book”)
• How to “game” the system
• Description of all the various conditions under disability determination for SSI/SSD
(detailed info in “Blue Book” at SSA.gov)
What this presentation is about:
• Why important to get the right determination 1st time through
• The process for applying for SSI at age 18• Tips on how to effectively go through the SSI
intake process• Tips on how to receive an accurate
determination in the shortest time possible
Why important to get this right the 1st time.
• Transition is time sensitive. Limited time for resources to overlap for 18 to 21 year olds
• Initial determination can take 3 to 4 months• If denied, a reconsideration can take another 3
months• If denied on reconsideration, a hearing can take 18
months or more to happen• 64% Denial Rate At Initial Application, 76% Denial
Rate At Reconsideration, 38% Denial Rate At Hearing
BENEFITS OF SSI
• SSI eligibility establishes eligibility for Medicaid• Medicaid besides providing medical insurance also provides
the funding for individual brokerage budgets• Increases feasibility of receiving services from OVRS• Provides real money for an 18 to 21 instructional program on
money management, budgeting for real expenses (have to vs want to)
• Reduces the likelihood of homelessness becoming an employment barrier
• Provides the opportunity of time to seek the “right” job, rather than any job due to financial crisis.
POTENTIAL DISADVANTAGES OF OBTAINING SSI
• $700+ a month can create a sense of false affluence if not tied into the real expenses of daily living and a structured budget
• Family dependency on SSI can conflict with the goals of the individual to become more self sufficient and independent
• Young adult might establish a pattern of not working and settle into a $700 a month lifestyle
• Might see SSI as not being able to work, when there are many work incentives through SSI that encourage working
Question of Eligibility
• Financial eligibility. Only resources of student are considered at age 18.
• Disability determination is based on the person’s ability to work
• Important to note: The ability of the Disability Determination Specialist to accurately recommend a ruling is as good as the disability related material submitted
Who can assist?
• Time available and expertise are important factors• Lane County Examples:
- Special ed teacher and/or case manager- YTP specialist if part of YTP - Developmental Disabilities Case Mgr (if DD eligible)- Lane County Direction Service Case Mgr- VR counselor- Workforce Navigator/ Work Incentives Network
(LILA)- Brokerage PA if presumptive medicaid is in place
In Your Community?
When To Use A Lawyer
Initial Application?Usually not
Reconsideration?Sometimes, but not if they just resubmit same medical information.
Hearing?Most definitely. Biggest incentive at this point for a lawyer. If approved, lawyer receives 25% of back payments up to a set limit.
Preparing Students and Parents for SSI
• Provide Transition Related Information Events for Parents( ie in Lane County TLC)
• Set aside time at each IEP meeting to explain various services, with emphasis at age 17 approaching 18.
• Incorporate assistance from DD case management if eligible for their services
STEPS INVOLVED
– INITIAL PHONE CALL TO SSA TO BEGIN PROCESS– FILLING OUT ADULT DISABILITY REPORT ON LINE– IN OFFICE INTAKE APPOINTMENT– FOLLOW UP INFO REQUESTS, SUBMISSIONS AND
FORMS– ACTION UPON POSITIVE DECISION– ACTION UPON NEGATIVE DECISION
PHONE CALL
• Call at age 18 or shortly after, unless in foster care, then can begin process 90 days before turning 18.• Give yourself ample time to make and complete this
call.• Go through call options in order to get to a rep to apply
for SSI• Have student’s SS#, date of birth, what the disability is• OUTCOME: DATE AND TIME OF SSI IN OFFICE INTAKE
APPOINTMENT
Contacting Social Security
• National Phone: 1-800-772-1213• Inter-Net: www.ssa.gov• Locate your local office at
www.ssa.gov/locator
DISABILITY REPORT – ADULT10 Sections (12 Pages)
1. Information about disabled person2. Contacts3. Medical Conditions4. Work Activity5. Education and Training6. Job History7. Medicines8. Medical Treatment (6 to 7 pages)9. Other Medical Information10. Only if already receiving SSI
QUESTION OF DISABILITY
SSA will assess physical and mental limitationsResidual Functional Capacity(RFC) describes what
you are able to do despite the combined effects of all your impairments
Important to include any impairment or medical condition that might affect your ability to work, even those that might seem minor
SSA must consider the totality of all the medical evidence
TIPS ON FILLING OUT ADULT DISABILITY FORM
• Go to ssa.gov for form, fill out on line, time limits for each section, but can save and go back to it at a later time
• Fill out form completely• Medical evidence- names, addresses, phone numbers,
dates of service for all the doctors, hospitals, clinics you have seen for your “illness, injury, condition”
• School contact information very very important in gathering school records as well as where to direct the Teacher Questionnaire
• Print before submitting completed form
DO THE WORK OF RECORD GATHERING
• Months leading up to SSI Intake Interview gather medical and school records that will support your application and assist the Disability Determination Specialist in making an accurate decision
• Do not count on your medical sources in submitting information in a timely manner or at all
• BRING IT!!!!!
KEY DOCUMENTATION
• Relevant medical and education information that focuses on the claimant’s ability, despite his/her impairment(s) to do:
physical work related activities such as sitting, standing, lifting, carrying, handling objects, hearing, speaking and traveling
mental functions such as capacity to understand, concentrate, to carry out and remember instructions, respond appropriately to supervision, co-workers, and work pressures
SCHOOL RECORDS FROM ACCEPTABLE SOURCES
• IEPS, Statement of Eligibility, Psychological Assessments
• Statements from “Treating Sources” and “Acceptable Sources” carry a lot of weight
- licensed school psychologist, qualified speech and language pathologists, occupational therapists, physical therapists, autism consultants, behavior management specialists, classroom teacher, work experience coordinator
KEY STATEMENTS FROM SCHOOL PERSONNEL
• Beyond testing, IEPS, transcripts, it is important to submit statements from each of the professionals that work with the student, that focus on the student’s limitations, highlights the degree of specialized support and environmental features for the student to function, in regards to being able to be successfully employed
Formal Testing Provided By School
• Formal Testing From School At Age 17/18- used to be an expectation- then a courtesy- now, beyond school
responsibilities• If there is inadequate medical info for Soc Sec
to make a determination, they will arrange for a Consultative Exam (CE)
IN OFFICE INTAKE APPOINTMENT• Meet with Initial Claims Rep and if approved then with a Post Entitlement
Claims Rep.• Who to Bring
- Student, parent, advocate (DD, School, …..) Do not bring little children.• What To Bring
- Printed copy of Adult Disability Report, School and Medical Records, RFC’s and Statements from Physicians and school professionals - Filled out Teacher Questionnaire and Function Reports by individual if able, and by parent - Proof of student’s resources (bank statements) - Important to sign releases for medical and educational records as well as release that allows advocate or parent to speak to SSA. Remember student is 18.
INTAKE APPOINTMENT(continued)
• Process and questions to expect:- will review your application and adult
disability report, might ask for clarification, and then to verify that all the information is correct
- questions about living arrangements, best to establish flat room and board
- might go into Payee application as well
What Slows the Process Down
• Incomplete information on application and disability report
• Lack of detailed names, addresses, phone numbers in order to obtain medical and school records
• Does not keep appointments or follow through on requests for additional or clarifying information
• Did not fill out info releases completely• Too many medical sources from which to obtain
information
WHAT TO DO AFTER INTAKE INTERVIEW
• Submit as quickly as possible any additional information requested by the Initial Claims Rep
• Connect with any sources on the Adult Disability Report to submit requested information if not already submitted at interview
• Check your mail and respond as required by SSA(could be a function report, or other info requested). Ask for help if unclear on info being requested. Copy original letter, put SS# on all correspondences
TEACHER QUESTIONNAIRE7 Sections (8 Pages)
1. Acquiring and Using Information2. Attending and Completing Tasks3. Interacting and Relating With Others4. Moving About and Manipulating Objects5. Caring For Himself or Herself6. Medical Conditions and Medications/Health
and Physical Well Being7. Additional Comments
Note: Important to focus on deficits, and to compare student to a “normal” 18 year old
Mental Residual Functional Capacity Assessment (part 1)
• Rating categories:– 1. Not significantly limited– 2. Moderately limited– 3. Markedly limited– 4. No evidence of limitation in this category– 5. Not ratable on available evidence
Mental Residual Functional Capacity Assessment (part 2)
Mental Activity Categoriesa. Understanding and Memoryb. Sustained Concentration and Persistencec. Social Interactiond. Adaptation
Function Report – Adult( 5 sections and 8 pages)
• 1. General Information• 2. Information About Your Illnesses, Injuries,
Or Conditions• 3. Information About Daily Activities• 4. Information About Abilities• 5. Remarks• Notes: Very important document. Sometimes parents
overstate abilities of their child or do not fully describe the support required for their child to function.
Medicaid
• Once determined SSI eligible, make appointment with local Area Agency on Aging(AAA) or Aged and Persons with Disabilities(APD) to obtain OHP
• This is the funding that provides individual brokerage funding as well health care
• Process is very quick once SSI eligibility is in place
Contacting DHS Division of Seniors and People With Disabilities
• To locate your local office, call: 1-800-
282-8096• Inter-Net: www.oregon.gov/DHS
On left side click on “Local Offices”Click on “Seniors and People With
Physical Disabilities
Click on Area Agencies on Aging(AAA)
Click on your County
Medicaid Strategy
• At age 18, when applying for SSI also apply for Presumptive Medical with your local AAA office
• If eligible for Presumptive Medical, you can be served by the brokerage(when your case is sent from your DD office) while you go through initial SSI determination, SSI reconsideration if necessary, and up through an SSI hearing if necessary
IF DENIED
• Formally request a “Reconsideration” as your denial letter will mention within a stated deadline
• Confusing part in this process, where you want to review how the determination was made and submit new evidence specific to the areas you believe were assessed incorrectly
• You can request the file from SSA, look for the Residual Functional Capacity Assessment summary, and look for areas that did not fall under moderately or markedly limited. Check to see what info had been submitted, and then submit new info or highlight previous info to help disability determination specialist connect the dots.
