Tips on Applying for SSI 2013 OAVSNP Conference David Abramowitz

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 1 st 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 1 st 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: Inter-Net: Locate your local office at

DISABILITY REPORT – ADULT 10 Sections (12 Pages) 1. Information about disabled person 2. Contacts 3. Medical Conditions 4. Work Activity 5. Education and Training 6. Job History 7. Medicines 8. Medical Treatment (6 to 7 pages) 9. Other Medical Information 10. Only if already receiving SSI

QUESTION OF DISABILITY SSA will assess physical and mental limitations Residual 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 QUESTIONNAIRE 7 Sections (8 Pages) 1. Acquiring and Using Information 2. Attending and Completing Tasks 3. Interacting and Relating With Others 4. Moving About and Manipulating Objects 5. Caring For Himself or Herself 6. Medical Conditions and Medications/Health and Physical Well Being 7. 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 Categories a. Understanding and Memory b. Sustained Concentration and Persistence c. Social Interaction d. 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: Inter-Net: 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.

SOCIAL SECURITY CONTACT Professional Relations Officer