Transcript Healthy and Ready to Work - Syntiro

Healthy & Ready to Work,
to Live and to Participate!
“Celebrate the Paperwork:
It Means You Are Alive!
Making the Paperwork Work:
Expediting Program Eligibility
Patti Hackett, MEd
HRTW Co-Director, Bangor, ME
Texas Transition Conference
College Station, TX
February 4, 2008
www.hrtw.org
Maine to Texas
WEATHER:
MILES:
ATM:
16-38
o
2,124
French & English
TODAY: 5” snow
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
www.hrtw.org
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
www.hrtw.org
Who You Are?
Experts in the Room
About me!
Transition to Adulthood
www.hrtw.org
www.hrtw.org
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Just the Facts: Key Benefits
• “Celebrate the Paperwork:
It Means You Are Alive!
• Making the Paperwork Work:
Expediting Program Eligibility
www.hrtw.org
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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www.hrtw.org
Just the Facts: Key Benefits
OVERVIEW
• SSI
• Voc Rehab
• Maintaining Private Health Insurance
www.hrtw.org
Just the Facts: Accessing Adult Services
It’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)
www.hrtw.org
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.
www.hrtw.org
Just the Facts: SSI – Disability Criteria
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)
www.hrtw.org
Just the Facts: SSI - Listings
1. Musculoskeletal System
2. Special Senses and Speech
3. Respiratory System
4. Cardiovascular System
5. Digestive System
6. Genito-Urinary System
7. Hemic and Lymphatic System
8. Skin
9. Endocrine System
10.Multiple Body Systems
11.Neurological
12.Mental Disorders
13.Neoplastic Diseases Malignant
14.Immune System
www.hrtw.org
www.ssa.gov
search
BLUE BOOK
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
www.hrtw.org
Just the Facts: VR
TRAINING
• Supported Employment
• Short-Term, Vocational Training
• College or University-based education
EMPLOYMENT SUPPORT
• Job Coaching
• On-the-Job Training
www.hrtw.org
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.
www.hrtw.org
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.
www.hrtw.org
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.
www.hrtw.org
Handouts: Private Health Insurance
Adult Disabled Dependent
• TX Code Ann. Section
21.24-2, Section 3.70-2 (C)
Coverage for dependent children cannot be
terminated while a person is incapable of
employment due to mental retardation or
physical handicap and chiefly dependent on the
insured.
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Handouts: Private Health Insurance
Adult - Expand Age to 25/FT student
• HB 1446 (Companion bill SB 927) makes
dependent status available for full-time
students until they are 25 years or older (in
some cases).
• Texas state statute puts the maximum age for
dependents at 19 if they are not enrolled in an
educational institution.
• Passed; Effective Sep. 2003
www.hrtw.org
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.
www.hrtw.org
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
www.hrtw.org
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”
www.hrtw.org
TIPS: Creative Health Insurance
Ex #2
ex #1, 3rd wife
www.hrtw.org
Patti Hackett, MEd
Co-Director, HRTW Center, Bangor, ME
[email protected]
www.hrtw.org
Resources - 04
HRTW Portal - Laws that Affect CYSHCN
http://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
www.hrtw.org
Just the Facts: SSI -- Resources
SSA website
www.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
www.hrtw.org
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.org
www.hrtw.org
www.hdwg.org/catalyst/index.php
State-at-a-Glance
Chartbook on
Coverage and Financing
of Care for Children and
Youth with Special Needs
www.hrtw.org
www.hrtw.org
Medicalhomeinfo.org
www.hdwg.org/catalyst/index.php
State-at-a-Glance
Chartbook on
Coverage and Financing
of Care for Children and
Youth with Special Needs
www.hrtw.org
http://www.championsinc.org
www.hrtw.org