Diane M. DeGroat Staff Attorney HIV/AIDS Law Consortium Training - PowerPoint PPT Presentation

The Basics for Adult Cases Diane M. DeGroat Staff Attorney HIV/AIDS Law Consortium

Training Objectives  Understand the difference between Social Security Disability (SSD) and Supplemental Security Income (SSI) and the basic eligibility requirements for each benefit program.  Understand the 5 step process that is used by the Social Security Administration (SSA) to determine whether an adult applicant is disabled.  Learn practical steps to support clients/patients who are applying for Social Security benefits or appealing Social Security denials.

Poll: Who is in our audience? I am a: A. Case/care manager B. Social worker C. Mental health counselor D. Substance use counselor E. Peer educator/navigator F. Other

Poll: What is your experience/interest in learning about Social Security? A. I help clients apply – it’s easy! B. I help clients apply – it’s hard! C. I have not helped a client apply, but would like to provide this service in the future. D. I can’t help directly with applications, but knowing more about Social Security disability would help me in my job. E. Other

What kinds of Social Security disability benefits are there for adults?  Two types: 1. Supplemental Security Income (“SSI”) 2. Social Security Disability (“SSD”)  Also known as Social Security Disability Insurance (“SSDI”)  May receive only SSI, only SSD, or both SSI and SSD

Overview: SSD v. SSI SSD SSI  “Title II” benefit  “Title XVI” benefit  Earned benefit  Need-based benefit  Funded by taxes paid by  Funded by general federal workers and employers government revenues  Worker’s benefit can be paid to  Benefit paid to disabled adult disabled worker, or worker’s or disabled child  But: different rules for disabled widow/widower, children’s SSI spouse, or child(ren)  Income/resource limits apply  Additional requirements apply  Amount received based on  No income/resource limits living arrangement and other  Amount received based on past income earnings and tax paid  Recipient eligible for State  Recipient eligible for Medicare Supplement Program (SSP) after 2 years; may be eligible  Recipient eligible for Medicaid for Medicaid

TRUE or FALSE? Financial eligibility for Social Security Disability (SSD) is partially based on work history. A. TRUE B. FALSE

Financial Eligibility: SSD v. SSI SSI: SSD: Financial eligibility for SSI Financial eligibility for is based on financial need SSD is based on work for food and shelter. An history . An individual individual’s income and needs to have worked resources have to be and earned enough under certain limits to be income over a certain eligible. A person does period of time to be not need to have worked eligible for SSD. before to be eligible.

Multiple Choice To be considered disabled, you must have a medical condition that has lasted or is expected to last at least _________________ A. 6 months B. 12 months C. 18 months D. 24 months or is expected to result in death.

Simplified Definition of “Disability” A person is disabled under Social Security law if:  S/he has a severe physical or mental health condition.  The condition has lasted or is expected to last at least 12 months or result in death.  The condition prevents the person from working 8 hours/day, 5 days/week, or the equivalent, in his/her past work or any other types of work.

How will the Social Security Administration (SSA) decide if you are disabled? Five Step Analysis 1. Are you earning more than “substantial gainful activity”? 2. Do you have a severe physical or mental impairment? 3. Do your conditions meet or equal a Listing? 4. Can you do your “past relevant work”? 5. Can you do any other work?

The same disability definition and 5 step analysis apply to SSD and SSI.

Step 1: Are you earning more than substantial gainful activity (“SGA”)? 2017 Income Limit: If you work and earn more than $1,170 per month in gross income and you are not statutorily blind, then you are earning more than SGA. If you earn more than SGA, then you are not disabled.  Exceptions:  Accommodations or Employer Subsidy/Sheltered Work  Impairment-Related Work Expenses  Unsuccessful Work Attempt If you are not earning more than SGA, then SSA goes to the next step .

Step 2: Do you have a severe physical or mental impairment?  Impairment is “severe” if: • it significantly limits your ability to perform basic work activities; and • has lasted or is expected to last for a continuous period of at least 12 months or result in death. If you do not have a severe impairment, then you are not disabled. If you do have a severe impairment, then SSA goes to the next step.

Step 3: Does your condition meet or equal a Listing? • What are LISTINGS? • Legal definitions of different physical and mental conditions • Ex.: major dysfunction of a joint; disorders of the spine; anxiety disorders; depressive disorders; intellectual disorder; chronic heart failure; asthma; chronic pulmonary hypertension • Found in Social Security regulations • Includes diagnosis, symptoms, and limitations that a person must experience • Elements must be documented in medical records

Summary: Listing 14.11 Human Immunodeficiency Virus (HIV) Infection Need documented HIV/AIDS diagnosis PLUS: - Documented diagnosis of one of the listed related illnesses; OR - CD4 count of 50 cells/mm3 or less; OR - CD4 count of 200 cell/mm3 or less or CD4 percentage of less than 14% PLUS BMI of less than 18.5 or hemoglobin measure of less than 8.0 g/dL; OR - Complications of HIV infection requiring at least 3 hospitalizations in 12 month period, at least 30 days apart, lasting at least 48 hours each; OR - Repeated manifestations of HIV infection resulting in significant documented symptoms or signs AND marked limitations in activities of daily living, social functioning, or completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Step 3: Does your condition meet or equal a Listing? If your condition meets or equals a Listing, then you will be found disabled. If your condition does not meet or equal a Listing, then SSA will go to the next step.

Step 4: Can you do your past relevant work? Past Relevant Work :  Work that you have done within the past 15 years;  That was substantial gainful activity (SGA);  Note: SGA limits change year to year  That lasted long enough for you to learn how to do it.

Step 4: Can you do your past relevant work? SSA will consider your age, education level, and the limitations you have, and then SSA will determine if you are able to do your past relevant work as it was actually and generally performed.  If you can do any of your past relevant work, you are not disabled.  If you cannot do your past relevant work, then SSA goes to the last step.

Step 5: Can you do any other work? • SSA will decide whether you can do any other types of jobs that exist in significant numbers in the national economy, taking into account your age, education, experience, limitations, and skills that you acquired in your past jobs. • The jobs do not have to exist in New York. • The jobs do not have to be jobs that you have done before.

Step 5: Can you do any other work? • If you can do any work that exists in significant numbers in the national economy, then you are not disabled. • If you cannot do any work that exists in significant numbers in the national economy, then you are disabled.

HYPOTHETICAL Jane Doe is HIV+, and she suffers from anxiety and depression. Her viral load is undetectable, and she is asymptomatic for HIV. Based on her medical records, she will not meet the HIV Listing. If Jane applies for Social Security disability benefits, will her application be denied because she does not meet the HIV Listing? A. YES B. NO NEED MORE INFORMATION C.

HYPOTHETICAL Jessica Doe is pregnant, and she works full-time as an office assistant. Jessica’s doctor puts her on bed rest for the last four months of her pregnancy due to medical complications. She is not able to work while on bed rest. She is expected to be able to return to work once she has the baby, and she has no other medical conditions. Would Jessica qualify for Social Security disability benefits while she is on bed rest? A. YES B. NO NEED MORE INFORMATION C.

HYPOTHETICAL John Doe has arthritis in his knees and back, and he suffers from depression. John works as a grocery store cashier, and his income is about $900 per month. If John applies for Social Security benefits, will his application be denied because he is working? A. YES NO B. NEED MORE INFORMATION C.

Drug Addiction & Alcoholism TRUE OR FALSE? A person cannot qualify for Social Security disability benefits if they have active substance abuse. A. TRUE B. FALSE

Drug Addiction & Alcoholism  People with active drug addiction and alcoholism (DAA) may still be eligible for SSD/SSI.  If DAA are present, then SSA will decide if the DAA is material to the determination of disability.  DAA are material if the person would not meet the definition of disability if s/he were not using drugs or alcohol.  If DAA are material, then the person is not disabled.  If DAA are not material, then the person may still be found disabled based on their other impairments.