DISABILITY PROGRAMS
078-05-1120
400,000 people reported this
number as their SSN, and
12 people continued to use
it as late as 1977
Types of Disability Programs
•
Social Security benefits for workers
•
Social Security benefits for adults disabled since
childhood
•
Supplemental Security Income (SSI) for children
and adults
•
Aged Alien – Applicant is a non-citizen, over
age 65, and in qualified alien status
Social Security Disability Insurance
• To qualify, the disabled person must have a recent
work history
• The amount of work needed depends on the
person’s age
– A 22 year old needs to have worked 1 ½ years in the 3
year period before becoming disabled
– A 45 year old would have to have worked five out of the
10 years before disability began
Supplemental Security Income (SSI)
Who Can Get SSI?
People with limited income and resources (Example:
$2,000 for individuals, $3,000 for couples) who are:
•Blind, at any age; or
•Disabled, at any age; or
•Age 65 or older
SSI Benefits for Adults
• What’s counted as resources?
–
–
–
–
–
Bank accounts (CDs, IRAs)
Second car
Stocks, bonds, 401ks
Liquid assets
Property other than where you live
• What’s not counted as resources?
– Home where you live
– First car
– Burial plots
Remember: Anybody can apply for Disability Benefits!
SSI Benefits for Children
•
Supplemental Security Income (SSI) pays benefits to
disabled children living in households with limited
income and resources
•
For eligibility, we look at the income and assets of
parent(s) living in the household and those of the
child who is disabled
•
•
•
$4,000 if living with 1 parent
$5,000 if living with 2 parents
$2,000 if living with other than parents
Determining Disability for
Children Under Age 18
Must have a physical or mental impairment
(or combination) that:
•
Results in marked and severe limitation in
functioning AND
•
Must have lasted, or be expected to last, at
least 1 year or result in death
When the child turns 18:
•
Eligibility must be re-established based on
the child’s income & resource
information, not the parents’
•
A new disability determination is made
using the adult criteria
What is Disability under SSA
Must have a physical or mental impairment (or
combination of conditions) that results in:
• Inability to perform substantial
work activity AND
• Is expected to result in death OR
• Has lasted or can be expected to last for a
continuous period of at least 12 months
Complex Cases by Health Condition, 2014
Condition
Cardiology/HTN
N
%
102
24%
Blindness/Vision
37
9%
Mental Health
37
9%
Pregnancy
35
8%
Asthma
27
6%
Diabetes
19
5%
Orthopedics
18
4%
Deafness/Hearing
17
4%
Physical Disability
16
3%
Developmental Delay
14
3%
Gastroenterology
10
2%
Other†
90
21%
Total‡
422
100%
†Includes
infectious disease,
kidney, thyroid,
hematology, ENT,
gastroenterology,
immunology,
pulmonary,
migraines,
malnutrition,
seizure disorder,
OB/GYN
‡Sum of health
conditions > total,
due to multiple
conditions per
case (34% of cases
had more than
one condition)
N=293
The Disability Process
• Application taken at the SSA office or online
• Transferred to state DDS
• DDS requests medical records, obtains relevant information and
makes assessment with assistance from State Agency Medical
Consultants
• If evidence is not sufficient to assess the claim, a consultative
exam may be ordered. This one-time exam is paid for by the
State of MN.
• Once DDS adjudicates claim, claim transferred back to SSA
office, they recheck financial eligibility, and notices are mailed
• Claimant has 60 days to appeal claim for reconsideration
• Additional appeal levels: hearing before an Administrative
Law Judge, Appeals Court hearing and Federal Court review
Evaluation Process for Adult Claims
1. Is the person working?
2. Does the person have a severe impairment?
3. Does the impairment(s) meet or equal the criteria
of a medical listing?
4. Are they capable of performing their past relevant
work?
5. Are they capable of performing other work?
Disability Listings—The Blue Book
http://www.ssa.gov/disability/professionals/bluebook/
Broken down by body system for both adults
and children
• 2.00 Special senses (vision & hearing) and speech
• 2.02 – Loss of Central Visual Acuity
• 2.03 – Contraction of the visual field in the
better eye
• 12.00 Psychological
• 12.06 – Anxiety-related disorders (including
PTSD)
Presumptive Disability
Payments may be initiated more quickly than usual in some
cases. There are certain eligibility criteria and limits to
Presumptive Disability benefits:
• Must be an SSI claim (limited income/resources)
• Benefits last 6 months, while DDS is making final decision on
the claim
If the claim is eventually denied disability benefits, but had
previously received Presumptive Disability benefits, the claimant
is not required to repay these benefits.
Conditions that may result in
Presumptive Disability
•
•
•
•
•
•
•
•
•
•
•
Amputation of extremity
Total deafness or blindness
Total immobility due to a long term condition.
Cerebral palsy or muscular dystrophy
Down Syndrome
Severe mental deficiency
Very low birth weight (for child younger than 1)
Terminal illness
End Stage Renal Disease (ESRD)
Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease)
Spinal cord injury resulting in inability to ambulate without assistance
The Disability Application
Applicants can apply for benefits several ways:
• Online at www.socialsecurity.gov
• Calling or visiting any Social Security office to schedule an
appointment
• Calling SSA toll-free at 1-800-772-1213
A disability starter kit is available online:
https://www.ssa.gov/disability/disability_starter_kits.htm
What Info We Need
• Signed authorization to disclose information to SSA (827)
– SSA now allows for electronic signature on release
• Complete list of medical sources (include any upcoming
appointments) along with address, doctors seen, and phone
number
• Names of current medications
• Education history
• Work history, including work outside of the US
• Contact information for a third party (family member, friend,
social worker, etc.) who speaks & understands English and is
familiar with their medical condition(s)
How Can You Help?
• Prepare the Disability Report (3367/3368) ahead of time
• Provide a copy of the Refugee Health Screening report
• Bring copies of medical records from outside the US to the
SSA office
• Include contact info for medical case manager or community
service worker
• Include contact info for a third party who speaks English
• Provide field office with all languages and dialects spoken
• Continue to update the DDS examiner/field office with
changes in address or phone number.
• Provide filled out copies of the daily functioning and in-depth
work history forms (available online)
Past and Current Work
We require descriptions of the last 15 years of the
claimant’s work, even if work was conducted outside the
United States
• Descriptions of work should reflect the activities
actually performed, not whether or not the claimant is
still capable of performing the work.
If the claimant’s occupation outside of the US did not
necessarily earn monetary income, but was the
claimant’s livelihood and provided enough means to
subsist, please describe this activity (farming, etc.)
Minnesota DDS Statistics
• 1.5% of the national disability workload
• Allowance rate of 34.6% (Fiscal year 2015)
• Processing time approximately 80 days (does
not include SSA office processing time)
• Net accuracy measured through 6/2015 was
98.6%, which is consistent with Regional and
National levels
Common Myths About Disability
Myth
Fact
Decisions are based on impact on
functioning, age, education and
“You have to apply 3 times before
work history, NOT on how many
times a person has applied.
being approved.”
Average claim processing time is
“It takes a year to get a decision.”
80 days, not including SSA office
processing time.
The severity and impact on
“Everyone with ____ diagnosis is
functioning is evaluated, not
allowed.”
merely the presence of a
diagnosis.
“I was approved for county benefits/ Being denied/allowed for another
program doesn’t guarantee
long term disability benefits, so I
denial/approval for SSA Disability
should be approved for SSA
benefits. Most programs use
disability benefits”
different definitions & criteria for
establishing disability.
“Everyone is denied the first time.”
Questions?
Anne Heintz
Medical Relations Officer
Minnesota DDS
651-259-7838 or 800-657-3577
[email protected]
Tanya Heitzinger
Medical Relations Officer
Minnesota DDS
651-259-7835 or 800-657-3583
[email protected]
Elise Whitesparks
Medical Relations Officer
Minnesota DDS
651-259-7974 or 888-234-2682
[email protected]