navigating the maze:

NAVIGATINGNAVIGATING THETHE MAZE:MAZE:

An Overview of An Overview of

Services and Laws Services and Laws

Impacting Children Impacting Children

with Disabilitieswith Disabilities

Materials developed by the Tennessee Disability Coalition with funding from:

-The US Department of Human Services’ Health Resources and Services Administration, Maternal and Child Health Bureau (Project # H84MC00004-09-00)--The Tennessee Affordable Care Act Family-to-Family Health Information Center.

-The U. S. Department of Education-Specifically, contents of this training module regarding the Americans with Disabilities Act (ADC) were developed under a subcontract from Syracuse University, under Prime Agreement Award Number H133A110021. However, those contents do not necessarily represent the policy of Syracuse University of the Department of Education, and you should not assume endorsement by Syracuse University or the Federal Government.

-The Tennessee Disability Coalition

SESSION OVERVIEWSESSION OVERVIEWEligibility factorsSSI...Medicaid…TennCareWorkplace benefits and rightsACA (Affordable Care Act)Title V – Children’s Special ServicesState Family Support ProgramMedicaid HCBS waiverTEIS (IDEA Part C, Early Intervention)Special Ed. (IDEA Part B)...FERPAVocational Rehab Act…Section 504ADA…DD ActLegal Services...Advocacy tipsResources

ELIGIBILITYELIGIBILITY FACTORSFACTORSEligibility requirements for the particular

service or program, such as:Disability label or diagnosisAge requirement Income guidelines

State participation: Is it mandatory?Available funds for the program Availability of program and/or service

provider in your geographic area.

SSI FOR CHILDRENSSI FOR CHILDREN A federal program administered by

the Social Security Administration.

Purpose: To provide monthly SSI (Supplemental Security Income) to children with disabilities and their families.

www.ssa.gov

SSI -- WHO IS ELIGIBLE?SSI -- WHO IS ELIGIBLE?Eligibility is based on the child’s and

parents’ resources.

A Medical Determination of the disability must be made for eligibility to be determined.

Ages newborn to 18 are eligible.

Individuals 18 and older apply based on their own resources (not the parents).

ENROLLMENT ENROLLMENT CONSIDERATIONSCONSIDERATIONS

SSI may be applied for at any time.

SSI can be applied for by phone or in person at the local or nearest Social Security Administration Office.

ENROLLMENT ENROLLMENT CONSIDERATIONSCONSIDERATIONS

Once the criteria of the financial guidelines and medical determination are met, SSI benefits will begin.

Note: SSI recipients automatically become enrolled in Medicaid TennCare from the date of the SSI application. However, there is a one month waiting period for SSI financial benefits to begin.

MEDICAID TENNCAREMEDICAID TENNCARECriteria At or below 100% of the poverty level * Medically eligible due to pre-existing condition No access to group, or private health insurance

Automatic eligibility for persons receiving SSI, SSDI, or Families First.

* http://aspe.hhs.gov/poverty

TENNCARE MEDICAID ELIGIBILITY Medicaid Poverty Level Income Standard

• For Kids 19 and under/pregnant women• Based on family income for the last 8

weeks• Savings and other resources don’t matter• Open to families who have other

insurance

MEDICAID ELIGIBILITY CONTINUED

TennCare Medicaid Spend Down

• For kids under 19 and pregnant women• No income limits• Based on recent family medical bills and

resources• Bills incurred in the month of application

(paid or unpaid)• Bills paid during the month of application• Bills incurred during the 3 calendar

months prior to the month of application (paid or unpaid)

• The family can have other insurance

APPLYING FOR TENNCAREAPPLYING FOR TENNCAREApply at local DHS (Food Stamps Office).

To request application:•Call TennCare: 1-800-669-1851•Apply online at: www.tennessee.gov/huumanserv

Call Family Assistance Service Center 1-866-311-4287

COVERKIDSS-CHIP PROGRAM

CoverKids of Tennessee• Is not a TennCare Program• It is a Federal Program• Insurance coverage is through

Blue Cross Blue Shield • Income levels up to 250% FPL

($57,625 for family of 4 as of 1/1/2012)

S-CHIP CONTINUED

• Families above 250% FPL can “buy in” to purchase coverage for their child.

• Premiums are up to $341 per month per child.

COVER KIDS CONTINUED

Applications are available online in English and Spanish at:

http://www.covertn.gov/web/coverkids_app.html

For more information contact:

-Cover Kids at 1-866-268-3786

HEALTH INSURANCE LAWS AT HEALTH INSURANCE LAWS AT WORK AND RELATED RIGHTSWORK AND RELATED RIGHTS

COBRA

HIPAA

Family Medical Leave Act

www.dol.gov/pwba/health.htm

COBRA:COBRA: CONSOLIDATED OMNIBUS BUDGET RECONCILIATION CONSOLIDATED OMNIBUS BUDGET RECONCILIATION

ACTACT

Requires employers with 20 or more employees to continue to offer coverage in the group health plan to certain former employees, retirees, spouses, and dependent children at employee’s own expense.

Note: Must exhaust COBRA benefits before applying for TennCare.

COBRA COBRA COVERAGE PERIODSCOVERAGE PERIODS

Qualifying Event Beneficiary Eligiblefor COBRA

Maximum CoverageTime

Termination of Job orQuit Voluntarily/Reduction in Hours

Employee, Spouse,Dependent Child

18 months

Employee Entitled toMedicare/ Divorce orLegal Separation/Death of Employee

Spouse, DependentChild

36 months

Loss of Dependent-Child Status

Dependent Child 36 months

HIPAAHIPAA: HEALTH INSURANCE : HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACTPORTABILITY AND ACCOUNTABILITY ACT

The purpose of the law is to:

• Ensure the continuum of healthcare coverage for individuals changing jobs.

• Provide a system of managing healthcare information.

• Simplify administrative paperwork.

• Combat waste, fraud, and abuse in health insurance and health care.

• Protect privacy and confidentiality regarding patient health care information.

HIPAAHIPAA: : WHAT IS “PROTECTED INFORMATION”WHAT IS “PROTECTED INFORMATION”

• Protected Information is any information on an individual that is generated through a health care provider, such as: doctor’s office, hospitals, pharmacist, physical and mental health care agencies.

• As of April 2003, all health care agencies must comply with HIPAA regulations. All protected health care information will be electronically filed into a Federal database.

FAMILY MEDICAL LEAVE ACT FAMILY MEDICAL LEAVE ACT (FMLA)(FMLA)

Established in 1993

12 Weeks of Unpaid Leave During Any 12-Month Period for:

personal serious medical conditioncare of spouse, child, parentbirthadoption

ACA (AFFORDABLE CARE ACT 2010)

• Children with special needs can no longer be denied care or coverage because of a pre-existing medical condition

• People with chronic conditions no longer have to worry about a lifetime cap on their insurance coverage

• Young adult children can stay on the family insurance plan until age 26

• New security knowing that insurance companies can no longer drop or rescind your coverage because you get sick.

MORE ON ACA – BY 2014Up to 7.2 million uninsured young adults will gain coverage through Medicaid expansions

No one can ever again be denied health insurance because of a pre-existing medical condition or charged more because of their health status or disability

Former foster children transitioning to adulthood can stay on stay on TennCare to age 26

Sliding scale advanced tax credits

ACA CONTINUEDThe TN Health Insurance Exchange will be

up and running to help uninsured individuals and small businesses shop for the best deal in private insurance.

Physicians and hospitals will have new incentives to work together to coordinate care in a patient-centered, evidence-based care model.

ACA IMPACT ON PREMIUMS Insurers must now dedicate at

least 80% of your premiums back to medical care, instead of administrative overhead and profit. For large group employer plans, it’s 85%.

NOTE: If they don’t meet this ratio, they owe their policyholders a rebate.

ACA SITESwww.healthcare.gov

http://www.irs.gov/newsroom/article/0,,id=220809,00.html

http://healthreform.kff.org/timeline.aspx

http://www.healthcare.gov/law/index.html http://www.amchp.org/Advocacy/health-reform/Do

cuments/CYSHCN-ACA-Fact-Sheet.pdf

Video http://www.youtube.com/watch?v=vmdbllWOOzs

TITLE V OF THE SOCIAL SECURITY ACT: TITLE V OF THE SOCIAL SECURITY ACT: “CHILDREN’S SPECIAL SERVICES”“CHILDREN’S SPECIAL SERVICES”

A federal program for “Children with Special Health Care Needs” (CSHCN)

Known as CSS in Tennessee; eligibility guidelines are set by the state

If a person (to age 21) does not qualify for TennCare, he or she may still qualify for CSS.

Apply through the local Health Department or Regional Health Office

CSS: WHO IS ELIGIBLE?CSS: WHO IS ELIGIBLE?

• Children under the age of 21.

• Children who meet Tennessee’s CSS Program diagnostic guidelines*.

• Children who meet the financial guidelines (200% FPL or below)

* TN Dept. of Health Rules: Chap. 1200-11-3

MORE ABOUT CSS ENROLLMENTMORE ABOUT CSS ENROLLMENT

• Applications for CSS may be made at any time.

• CSS is available across Tennessee.

• There is no waiting list for CSS.

respite home modifications personal assistance housing cost counseling

insurance homemaker services equipment transportation health related needs

STATE FAMILY SUPPORT PROGRAMSTATE FAMILY SUPPORT PROGRAM

Services are flexible and may include:

Purpose: To assist individuals with significant disabilities and their families.

FAMILY SUPPORT ELIGIBILITYFAMILY SUPPORT ELIGIBILITY

• Administered by local agencies contracted by the DIDD.

• Must live in Tennessee full-time.• Must have a severe disability that is likely to

continue for an indefinite amount of time. • Must have a disability that impairs 3 or more

areas of life function.• Must live in a community in an unsupported

setting to be eligible.

MORE ABOUT FAMILY SUPPORTMORE ABOUT FAMILY SUPPORT

• Family Support is one of the few programs that is not income based.

• Most counties currently have a waiting list for services.

• Local councils make the decisions regarding the money allocations of the program.

• Maximum annual benefit is $4,000 but could be less, if local council decides.

MEDICAID WAIVERMEDICAID WAIVER HOME AND COMMUNITY-BASED HOME AND COMMUNITY-BASED

SERVICESSERVICES• Serves all ages

• Must have diagnosis of mental retardation

• Individualized long term care services

• Administered by Regional Offices of the Department of Intellectual and Developmental Disabilities.

• Difficult to access

WAIVER PROGRAMSWAIVER PROGRAMS

Full Medicaid Waiver Services (“Statewide Waiver”)Will pay for residential services Independent Support Coordinator (ISC)Usually through a provider agency

Self-Determination Waiver ServicesSet limits on specified services “Participant management” is encouragedFamilies have control and choice

MEDICAID WAIVER MEDICAID WAIVER CATEGORIES OF NEEDCATEGORIES OF NEED

Crisis

Urgent Request

Active Request

Deferred Request

DIDD Application AccessDIDD Application Access

East Region: 1-888-531-9876 Middle Region: 1-800-654-4839 West Region: 1-800-308-2586

TEIS TEIS

TENNESSEE EARLY INTERVENTION TENNESSEE EARLY INTERVENTION SERVICESSERVICES

A voluntary educational program for families with children ages birth through two years of age with disabilities or developmental delays.

Offers information, referrals, and support to families of children with disabilities.

1-800-852-7157

TEIS: TEIS: Part C of IDEAPart C of IDEA Provides services for eligible children and families,

who may have or are at risk for developmental delays and other disabilities.

TEIS provides services in natural settings such as the home or childcare center.

TEIS works with many agencies to coordinate services.

http://www.tn.gov/education/teis/

TEISTEIS Services Services Services are determined by the development of

an Individualized Family Service Plan (IFSP).

The IFSP is a plan that determines the services or supports needed by the child and family. The IFSP helps the child reach his/her maximum abilities.

TEISTEIS helps the family: helps the family:

Make informed choices about the services or supports for their child.

Get information on how a child grows and learns. Find out what early intervention can do for a child

with special needs. Develop ideas to expand learning opportunities

for their child.

IDEAIDEA INDIVIDUALS WITH DISABILITIES INDIVIDUALS WITH DISABILITIES

EDUCATION ACTEDUCATION ACTFederal law that authorizes federal funding for special

education and related services to the states, and sets regulations for states who except these funds to follow.

FAPE (Free and Appropriate Public Education)

All students must have an IEP and the parent should be part of the team that develops the IEP.

“To the maximum extent appropriate” children will be taught along side of non-disabled peers.

Procedural safeguards such as mediation, due process, and administrative complaint.

FERPA FERPA FAMILY EDUCATIONAL RIGHTS FAMILY EDUCATIONAL RIGHTS

AND PRIVACY ACTAND PRIVACY ACT• A federal law that protects the

privacy of student education records.

• FERPA applies to ALL schools that receive funds from the U.S. Department of Education.

FERPAFERPA PROTECTIONS PROTECTIONS

• Right to inspect and review the student’s records.

• Right to request to amend the student’s record if you feel they are inaccurate.

• Right not to have “directory” information disclosed.

Rehabilitation Act of 1973Rehabilitation Act of 1973

Services focus on what the individual needs in order to succeed in adult life, such as:

post-secondary education employment independent living

Section 504Section 504Part of the Rehabilitation Act

Prohibits discrimination against individuals with disabilities.

Applies to entities that receive federal financial assistance, including schools and post secondary schools.

Covers anyone who meets the definition of disability.

Definition of DisabilityDefinition of Disability A person who has a physical or mental

impairment which substantially limits one or more major life activities.

A person who has a record of such an impairment.

Or is regarded as having such an impairment.

AMERICANS WITH DISABILITIES AMERICANS WITH DISABILITIES ACT OF 1990 (ADA)ACT OF 1990 (ADA)

• A federal civil rights law

• Provides protection against discrimination in the workplace

• Requires accommodations for accessibility by covered entities

THE ADATHE ADA

• Gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion.

• Guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services, and telecommunications.

LEGAL SERVICESLEGAL SERVICES

Access to TennCare / Medicaid or Families First:

Tennessee Justice Center: (877) 608-1009

The above plus SSA / Housing / Work / Immigration:

Tennessee Alliance for Legal Services: (615) 242-0438 <www.tals.org>

Disability Specific Services & Civil Rights:

Disability Law and Advocacy Center (800) 342-1660

PROCESS OF ADVOCACYPROCESS OF ADVOCACY

• Identify the need or problem.• Commit to doing something about it.• Gather information. • Identify a desirable solution.• Develop a strategy for attaining

the solution.• Take action.

WIN - WIN SOLUTIONWIN - WIN SOLUTION

What solution will have everyone walk away a winner?

Everyone will be more willing to work toward the goal if they have a vested interest.

WHERE TO BEGIN?What services does your family receive?

What services are you in need of?School related?Insurance related?Community services?

What services might your child need in the future?Need to sign up now?Meeting with future planners, or attorneys?

RESOURCESRESOURCES

TN Disability Info & Referral #

1-800-640-INFO1-800-640-INFO

www.familypathfinder.org

National Database:

www.DisabilityInfo.org

MORE RESOURCESMORE RESOURCES

Family Voices of TennesseeFamily Voices of TennesseeFamily-to-Family Health Information Center Family-to-Family Health Information Center

1-888-643-78111-888-643-7811www.tndisability.org/familyvoices

National: Family Voices, Inc.Family Voices, Inc.

1-888-835-56691-888-835-5669www.familyvoices.org

THINKING OUTSIDE THE BOX

Connect to your community for support (civic clubs, churches and other groups)

-UCP (United Cerebral Palsy of Middle TN) equipment exchange program.

Research online such as groups as

-United Healthcare grant

-http://uhccf.org/

-http://www.projectlifesaver.org/

Family Resource Specialists:Family Resource Specialists:West TN:West TN: Treva SeaseTreva Sease

treva_s@tndisability.org

Middle TN: Tonya BowmanMiddle TN: Tonya Bowmantonya_b@tndisability.org

East TN:East TN: Camille KeckCamille Keckcamille_k@tndisability.org

Family-to-Family Health Information Center Family-to-Family Health Information Center of Tennessee