ckhs community advocacy final
TRANSCRIPT
Presented by: •Crozer-Keystone Healthy Start’s Public Education Campaign Committee &•HELP: MLP a Medical-Legal Partnership between Crozer-Keystone Healthy Start &Widener University School of Law
Tuesday, May 21, 2013
Legal Rights for People who are Poor or have Disabilities
AgendaIntroduction
Joanne Craig, Project Director of Crozer-Keystone Healthy Start
Daniel Atkins, Co-Director of HELP: MLPThe Affordable Care Act: What it means for clients
Shannon Mace Heller, JD, MPHPennsylvania Welfare Sanction Policy
Laura Handel Schwartz, EsquireConsumer Law Basics: From mortgage
foreclosures to student loans Jordan Mickman, Esquire
SSI and SSDI: The basics of Social Security Disability Daniel Atkins, Esquire
WELCOME
Joanne CraigDaniel Atkins
HELP: MLPHealth, Education & Legal assistance Project: A Medical-Legal Partnership (HELP: MLP) is a collaboration between Crozer-Keystone Healthy Start, Crozer-Keystone Nurse Family Partnership and Widener University School of Law.
SHANNON MACE, JD, MPHHELP: MLP
PUBLIC HEALTH LAW SPECIALIST
The Affordable Care Act: What it means for clients
The Affordable Care Act: Agenda
Background of the Affordable Care Act (ACA)Major Provisions
Coverage Reform Quality/Payment Reform Individual Mandate Eligibility & Enrollment Health Insurance Marketplace
State Implementation Medicaid ExpansionTakeaways
Healthcare in the United States
Fragmented Complex Political
Expensive Unequal Reactive
The Promise of the ACA: The Triple Aim
Goals of the ACAIncreasing access to care for ALL individuals regardless of
race, ethnicity, gender/sexual identity, income or disability status
Using data to identify areas of need and drive improvement within the healthcare system
Providing comprehensive, holistic care to individuals that address unmet needs including those beyond the traditional treatment setting
Improving health information technology to reduce duplication of services, improve exchange of information, reduce errors and improve individuals’ access to information
Strengthening the healthcare workforce including, increasing diversity and capacity in underserved areas
Increasing access to prevention and health promotion services
ACA Timeline
The Affordable Care Act
Five major components:Coverage ReformQuality ReformPayment ReformInsurance
ReformHealth
Information Technology Reform
Coverage Reform
Many provisions are already in effect:Pre-existing condition coverage to age 19Family coverage to age 26No annual or lifetime limitsClosing the Medicare Donut HoleNo co-pays/deductibles for prevention/
promotion interventionsMedical loss ratio now at 85 and 80 %
Quality & Payment Reform: A Move to Integrated Care
Patient Centered Medical Homes (PCMH) and Health Homes
Accountable Care Organizations
Establishment of National Quality Measures
Established the Patient Centered Outcomes Research Institute (PCORI)
Innovation grant funding
Individual MandateMost controversial
provision of the ACARequires individuals to
obtain health insurance or pay a penalty
Penalties increase each year
Exemptions include: Religious Incarceration Undocumented
status
Year
Amount Owed
2014
$95 per adult; $47 per child ( up to $285 per family or 1.0% of family income)
2015
$325 per adult; $162. 50 per child (up to $975 or 2.0% family income)
2016
$695 per adult; $347.50 per child (up to $2085 per family or 2.5% of family income)
Eligibility & EnrollmentMajor changes to
eligibility & enrollment October 1, 2013 is open
enrollment for Marketplace
Elimination of income verification
Screened for multiple options through one application
Income calculation now “modified adjusted gross income” or MAGI
Enrollment Timeline
Health Insurance Marketplace
States must establish by January 2014 or default to the Federal government
Several requirements: User Friendly
Phone, In-person, and online services Language accessibility
Must screen and enroll public & private coverage Must establish “navigators” Transparency Self-financing by 2015
State Implementation The Affordable Care Act and the subsequent U.S. Supreme
Court Decision provides states considerable discretion in how it is implemented at the state level.
State decisions include: Whether to expand Medicaid eligibility to 138% of the
federal poverty level Whether to establish a state-based health insurance
marketplace*, a state-federal partnership marketplace or defer to the federally facilitated marketplace
Choosing the benchmark plan for the Essential Health Benefits package & the benchmark plan for the Medicaid alternative plan for newly eligible Medicaid enrollees
Participation in Health Home State Plan for individuals with chronic illnesses
Other funding opportunities (Bridge to Reform, Public Health & Prevention Fund grants, Centers for Medicare & Medicaid Innovation grants, etc.)
*Previously known as “health insurance exchange.”
Pennsylvania: Federally Facilitated Marketplace
Federally Facilitated Marketplace:Implementation Issues in PA
Infrastructure Pennsylvania returned Health Insurance Exchange
Establishment funding to the Federal governmentEducation and Outreach
896,000 eligible for tax subsidies through Marketplace in PAChanges to eligibility calculation
Movement to Modified Adjusted Gross Income (MAGI) $13 million in PA’s Dept. of Public Welfare (DPW) Budget
Qualified Health Plan (QHP) selection (HHS to decide) Supplementation of default benchmark plan
Medicaid determination State has the option of accepting federal determination as
binding or not
For Expansion Against ExpansionIncreased access to
coverage & careSignificant funding
source 100% FMAP 2014,
2015, 2016 90% 2020 and beyond
Job creator“The right thing to
do”
Too much reliance on public system
Increased costs due to administration & “woodwork effect”
Job killerPolitical ideology
Medicaid Expansion in PA: The Debate
PA Medicaid Expansion:Recent Activity
Governor Corbett met with Sec. Sebelius April 2nd
Considering alternative options like the Arkansas Plan
Will not move forward until “more information from HHS”
Legislation introduced in PA Senate
Issues without Expansion Opportunities with Expansion
Increase in individuals seeking services due to
Elimination of Disproportionate Share Hospital (DSH) payments could result in a loss of $8.1 billion over next 10 years
Coverage gap for individuals
Opportunity to expand insurance coverage to appx. 650,000 PA residents
Ensuring access to high quality health services
Maintaining efficiency
Medicaid Expansion
PA Coverage Gap
Source: PA Health Law Project, Medicaid Expansion in Pennsylvania Is Good For Families (2013).
Takeaways
The implementation of the ACA will take place over many years; however, major provisions take effect in 2014
Many individuals will need assistance navigating the new Health Insurance Marketplace
Individuals currently receiving Medical Assistance should not lose coverage
Many advocacy opportunities exist with regard to the implementation of the ACA
The promise of the ACA:
The Affordable Care Act has great potential to increase health equity within PennsylvaniaHowever, in order to fulfill that potential the state must implement fully in a meaningful way.
ACA ResourcesPhiladelphia Department of Behavioral Health &
Intellectual disABILITY Services, Health Reform & Health Equity Unit: http://dbhids.org/health-reform-health-equity-unit
www.Healthcare.gov Kaiser Health Reform Source: http://kff.org/health-
reform/ Health Reform GPS: www.healthreformgps.org CMS, Streamlined Application:
http://go.cms.gov/11SGmKFPA Health Law Project: http://www.phlp.org/home-
page/reformPA Health Access Network: http://pahealthaccess.org/
Thank you!
Questions?Contact information:
Shannon Mace Heller, JD, MPH
Phone: 215-685-5411
Email:[email protected]
Laura Handel Schwartz, EsquireHELP: MLP
Staff Attorney
Pennsylvania Welfare Sanction Policy
Welfare Sanction Policy: Agenda
What are sanctions?Reasons sanctions are issuedSanction issuesKey conceptsHow does the sanction process work?How will a recipient know she’s being
sanctioned?Importance of fighting sanctionsNew penaltiesHow to fight sanction threatsHow to prevent sanction threatsCounty Assistance Office information
What are sanctions? • Sanctions can affect recipients of cash assistance
benefits administered by the Department of Public Welfare (DPW) – i.e., recipients of Temporary Assistance for Needy Families (TANF).
• Sanctions are the denial of welfare benefits for which a person or family are eligible based on alleged noncompliance with welfare program rules
• Sanctions can be for employment-, child support-, personal responsibility- or fraud-related reasons.
• This training will focus on employment-related and support-related sanctions.
What are welfare “sanctions”?
If Temporary Assistance for Needy Family (TANF) recipients do not follow certain Department of Public Welfare (DPW) rules and do not have “good cause” or an exemption, they will be “sanctioned.”
The welfare office will “sanction” a noncompliant benefit recipient by reducing her monthly cash grant. Can reduce just her share or her whole family’s share. Reductions can be temporary or permanent. Repeated violations can lead to terminations of benefits
that are permanent for either just the noncompliant head of household or her children as well.
Why is this subject important now?
Sanctions are used as a strategy to reduce welfare benefit caseload – related to DPW philosophy and budget
New sanctions up 130% from January 2011 to current date
Sanctions that were in effect already now up 72%
Image from www.philly.com.
Another view: Growth in New Sanctions
New Sanctions Statewide Sanctions in effect Statewide
Reasons DPW issues sanctions
TANF recipients can be sanctioned for: Failing to cooperate with child support enforcement Failing to sign an Agreement of Mutual
Responsibility (AMR) Failing to cooperate with work or a “work-related
activity” requirement on an AMR Voluntarily quitting a job Voluntarily reducing earnings Failing to apply for work Failing to accept a bona fide offer for a job that the
recipient could do
Sanction Issues
IMPORTANT ISSUES TO BE AWARE OF:1. Sometimes a recipient does not even realize
that she has been, or is being, sanctioned.(a) The biggest clue that a recipient has been sanctioned
is if her welfare grant suddenly decreases, or is less than the maximum for her family size (unless she has earnings or other income that would explain why the grant is reduced)
2. Sometimes benefit recipients do realize that they are being sanctioned, but choose to accept the penalty without an appeal.(a)This is harmful. If you spot or hear about such a
situation, advise the recipient to appeal immediately.
Why do some recipients accept sanctions without appeal?
Confusion Difference between termination and sanction
Resignation “what can I do? I can’t win.”
Guilt “I did it so I should take my punishment.”
Belief (justified or not) that no attorneys or advocates available to help
“Legal Services probably won’t handle it.” “It’s only 30 days.”
Key concepts: Willful Noncompliance
Willful Noncompliance DPW may only sanction a recipient for
violating rules if “the noncompliance was willful and without good cause.” (CAH §135.712) Corollary: recipient cannot be sanctioned if she
had a good cause reason for why she did not follow a rule.
Key Concepts: Good Cause
Asking to be excused from TANF program requirements for reasons beyond the recipient’s control or because the requirements would endanger her or unfairly penalize her for hardship circumstances is called “requesting a waiver” or “claiming good cause.”
If good cause is established, no sanction should be imposed, and existing or past sanctions related to that good cause should be lifted or rescinded. An “exemption” or “good cause” can be established
AFTER a sanction is threatened or imposed, as well as before.
Key Concepts: Reasonable Accommodation
The welfare office is required to make a good faith effort to assist the client in overcoming whatever problems she had complying with work requirements (CAH §135.5) or for accommodating other hardship circumstances that may arise as a result of:
disability domestic violence, or substance abuse
How does the sanction process work?
Agreement of Mutual Responsibility (AMR)Alleged violationAdvanced notice (sanction threat)Compliance review
Determining good cause Opportunity for advocacy!
Fresh start vs. sanctionEnding the sanction or sending notice of
sanction
How will a recipient know if she’s being sanctioned?
For either a child support or a work-related sanction, DPW is required to send advance notice to the recipient, telling her she’s about to be sanctioned.
Recipient should APPEAL THIS NOTICE IMMEDIATELY, and ask for “aid paid pending.”
How will a recipient know if she’s being sanctioned?
For a work-related sanction, DPW must offer to conduct a “compliance review” before actually imposing the sanction. If DPW imposes a sanction without first offering a
compliance review, the sanction is illegal – appeal IMMEDIATELY!
If no notice of sanction is received, sanction has probably been imposed if the Cash Assistance grant is less than it should be for the family size/income level.
At the compliance review, the recipient can explain why she did or did not do something required of her.
How will a recipient know if she’s being sanctioned?
The CAO is required to make a good faith effort to assist the client in overcoming whatever problems she had complying with work requirements (CAH §135.5). As examples, DPW should: Reschedule appointments to better fit
recipient’s schedule Provide help with transportation Provide help with childcare Explore revising her AMR
The importance of fighting sanctions
Individuals and families are often sanctioned incorrectly, as a result of miscommunication, mental illness, domestic violence, disability, or other justifiable barriers to compliance.
Sanctions have harsh impacts in both the
short and the long term.Child Support-related sanctionsWork-related sanctions
The importance of fighting sanctions
Child Support-related sanctions: A TANF applicant/recipient is required to seek child
support and establish paternity unless she has good cause for not doing so.
If she does not cooperate with either requirement, the family’s grant will be reduced by at least 25%.
This benefit reduction will continue indefinitely, until the parent cooperates or establishes “good cause.”
The noncompliant parent stays on the TANF grant (even though her share of the cash is what’s technically being taken away), remains subject to the work requirements, and the benefits still count toward the five year time limit.
The importance of fighting sanctions
Work-related sanctions
IMPORTANT: with work-related sanctions, it’s a “three strikes and you’re out”-sanction scheme.
Note: these sanctions will affect Cash Assistance benefits, specifically; they should not affect SNAP or Medical Assistance benefits.
New penalties for First Sanction
First Sanction: individual cut off from cash benefits for 30 days
Sanction continues until individual demonstrates compliance for at least one week
After 90 days, if compliance not demonstrated, entire family ineligible until compliance demonstrated for at least one week
New penalties for Second Sanction
Second Sanction: individual cut off from cash benefits for 60 days
Sanction continues until in compliance for at least one week
After 60 days, if compliance not demonstrated, entire family ineligible until compliance demonstrated for at least one week
New penalties for Third Sanction
Third sanction now makes entire family permanently ineligible
Be sure to appeal any sanction notice!
Remember “good cause” -- including domestic violence
How to fight sanction threats
Appeal immediately, request “aid paid pending” outcome of appeal
Explore why non-compliant event occurred Common reasons: transportation issues, no child
care, domestic violence, illness, misunderstanding
Explore possibility of “good cause” waiver Special note: ANY circumstances beyond
recipient’s control can probably qualify as good cause; use common sense! If the reason was good and recipient is acting in good faith, there’s room to advocate successfully.
How to fight sanction threats
Examples of circumstances that qualify for “good cause” waiver of work requirements (55 PA Code § 165.51): Recipient tried to get care for a child or adult with disabilities,
but could not. Domestic violence. Homelessness. Transportation problems. Recipient or family member was ill. Job or job training was beyond recipient’s ability, and she is
willing to look for another job or do other training. Working conditions were substandard or unsafe, or wages paid
were below minimum wage or below the prevailing wage normally paid for that job.
Participation in drug or alcohol treatment can be “good cause” if the treatment program prevents recipient from working at the same time.
Other personal emergency.
How to fight sanction threats
A recipient with limited English proficiency cannot be sanctioned for failing to attend an activity or a meeting if she was given notice of it in a language she does not understand (Title VI of the Civil Rights Act of 1964)
DPW cannot sanction recipient for not doing something she only volunteered to do; may only sanction for failing to do something she was required to do (CAH § 135.261) Some items in the AMR are mandatory, some are
not; recipient (or her advocate) should always check to see what the AMR actually says!
How to fight sanction threats
“Benefit of the doubt” policy: DPW is supposed to give recipient the benefit of the doubt when deciding to approve or deny someone a waiver. DPW must consider
all facts and circumstances of the alleged violation, “especially if the transgression is relatively minor… or isolated in nature” (55 PA Code § 165.52(b))
How to fight current or past sanctions
For sanctions that have already been imposed: It is sometimes possible to get a sanction lifted
while it is in effect, or even retroactively, if the facts show that the recipient had good cause at the time of the violation.
This is important for two reasons: To get back the benefits that the recipient missed To get the “strike” removed from her record, if the
sanction was work-related, since these are subject to the “three strike” system that will result in permanent penalties.
How to prevent sanctions or sanction threats
Recipient should: Communicate any problems or potential problems to
caseworker in writing. Verify information and get copies of all documents,
especially her AMR! When possible, try to get written documentation of
problems that interfere with ability to comply with work requirements (i.e., illness of self or dependent child).
Talk to a supervisor if caseworker is unresponsive. Notify both CAO and welfare work program
contractor if an appointment must be missed for good cause reasons.
Notify both CAO and welfare work program contractor if she gets or loses a job.
DPW – local County Assistance Offices: Delaware County
Crosby District (also Delaware County Assistance Office Headquarters)701 Crosby Street Suite A, Chester, PA 19013-6099Phone: 610-447-5300 FAX: 610-447-5399
Darby District845 Main Street, Darby, PA 19023Phone: 610-461-3800 FAX: 610-461-3900
Delaware CAO Headquarters
DPW – local County Assistance Offices:Chester & Philadelphia Counties
Chester County Assistance Office100 James Buchanan Drive, Thorndale, PA 19372-1132Toll Free: 1-888-814-4698Phone: 610-466-1000FAX: 610-466-1130
Philadelphia County Assistance Office Headquarters801 Market Street,
Philadelphia, PA 19107Phone: 215-560-7226FAX: 215-560-3214
Philadelphia CAO Headquarters
Pennsylvania Welfare Sanction Policy
Disclaimer: the information in this presentation
is general legal information and is not intended
as legal advice to be applied to any particular
case.
Resources
DPW Cash Assistance Handbook: http://services.dpw.state.pa.us/oimpolicymanuals/manuals/bop/ca/
Legal Aid of SE PA = http://www.lasp.org/ or toll-free 1-877-429-5994
Thank You!
For more general information about this topic:
Laura Handel Schwartz, Esq.
E-mail: [email protected]
For legal assistance or to make a referral, please contact Legal Aid of Southeastern Pennsylvania (LASP) toll-free at:
1-877-429-5994
Questions?Referrals?
JORDAN MICKMAN, ESQUIREHELP: MLP
CONSUMER LAW FELLOW
Consumer Law Basics: From mortgage foreclosures to
student loans
Consumer Law Basics: Agenda
Prioritizing debtGarnishmentDebt collection harassmentBankruptcyCredit reportsFederal student loansMortgage foreclosure
Prioritizing Debt
Secured vs. Unsecured DebtAlways pay secured debt firstExamples:
Secured: Mortgages and Car loans Unsecured: Credit cards, legal and medical bills,
loans from friendsException:
Utility service (failure to pay cannot result in seizure of assets to satisfy arrears, but can result in adverse action)
Prioritizing Debt
Prioritizing Debt
Debt should not move up in priority based on creditor’s threats to sue
Do not pay when legal defenses available
Do not pay lower priority debts based on settlement offer if income is too limited to pay more important expenses
Garnishment in PAWages
Very limited circumstances Child/spousal
support Federal student
loans Unpaid rent Criminal
restitution Some taxes
Bank account Once judgment
obtained, bank accounts are fair game (with some exceptions)
Wages deposited into bank account are NOT protected
Exception: Social Security
payments deposited into bank account cannot be garnished
Debt Collection Harassment
I’ve stopped paying, but now they won’t leave me alone. Now what?
What debt collectors CAN do:Stop doing business with the consumerReport default to credit bureauSue in court
Just because they can, doesn’t mean they will Suing and winning a judgment are not the same
if the consumer shows up to defend
Debt Collection Harassment
What debt collectors CANNOT do: Abusive, deceptive, and harassing tactics Continue contacting consumer after:
Written request to cease & desist contacting consumer
Consumer disputes debt in writing Communicate with 3rd parties about a debt w/o
the consumer’s permission Exception: can request location info from 3rd parties
Call at known inconvenient times or places Generally before 8:00 a.m. or after 9:00 p.m.
Threaten arrest or wage garnishment
Avoiding Collection HarassmentCall the creditor first!
Possibly arrange deferment or repayment agreement before turned over to collection
Write a letter requesting the collector to stop collection efforts Explain why unable to pay now Explain expectations for repayment in the future Send by certified mail if possible
Dispute debt within 30 days of first written collection attempt
File complaint with Govt. agency (FTC, CFPB, AG) and send the complaint to the collector
Bankruptcy
Bankruptcy BasicsWhat bankruptcy
CAN do: Discharge most
debts Stop foreclosure and
provide chance to catch up on missed mortgage payments
Prevent repossession of car or other property
Stop collection harassment
Restore or prevent shut-off of utility
Bankruptcy Basics
What bankruptcy CANNOT do:Eliminate security interest of creditors Discharge: child support, alimony, most
student loans, criminal fines, certain taxesProtect co-signers (if only one co-signer
files, the other is left solely responsible)Discharge debts that arise after filingPrevent eviction after landlord has
judgment for possession
Bankruptcy Basics
Chapter 7 (straight bankruptcy) Discharge debts in exchange for giving up non-
exempt property.Chapter 11 (corporate reorganization)Chapter 12 (family famers)Chapter 13 (reorganization)
File a plan showing how the consumer will repay debts over a period of 3 to 5 years.
Can keep valuable property if consumer makes payments according to the plan Must prove to court that consumer has regular
income Payments usually go UP in chapter 13 plans
Credit ReportsType of info on the
report: Name, DOB, SSN,
current and former addresses
Employment info Payment history on
credit accounts List of creditors who
requested a copy of the report
Public records (bankruptcy, foreclosure, judgment)
Who can see it? Creditors Potential
employers Insurers Govt. agencies
trying to collect child support
Landlords
One Free Report Each Year (Experian, Equifax, & Transunion)
Getting a copy: Online at:
www.annualcreditreport.com
By phone: 877-322-8228
By mail: Annual Credit Report Request Service, P.O. Box 105281, Atlanta, GA, 30348-5281
Credit Reports
Federal Student Loans
Types of Federal Loans Subsidized
No interest while in school, grace period, or deferment Unsubsidized
Not based on financial need; interest charged at all times Plus
Pay for expenses up to the cost of attendance, minus other financial aidParent Plus (parent co-signs for dependant
children)Graduate Plus (no co-signer needed for graduate
school) Consolidation
Combine the above into a single loan
Federal Student LoansGrace Periods:
Subsidized & Unsubsidized 6 month grace
period Direct Plus
No “grace” period
But:6 month
automatic “deferment” for Graduate Plus and Parent Plus
Repaying Student Loans
Auto Payment = 0.25% reduction in interest rate
Delinquent vs. Default Delinquent: Payment not received by due
date Default: Payments not made for 9 months
Consequences of Default: Acceleration of loan debt Tax lien, garnishment, denial of professional
license, ineligible for new student loans
Repaying Student Loans
Solutions for Default Loan Rehabilitation
Borrower and Servicer agree on reasonable and affordable repayment plan
Make voluntary payments on the agreed-upon repayment plan (6-9 months usually)
Loan Consolidation First make several voluntary payments Then, consolidate defaulted loan Loan Consolidation = Paying off old loan,
and issuing new loan
Student Loan Repayment Plans
Student Loan Repayment Plans
Standard 10 year repayment plan Lowest interest charge
Graduated 10 year plan; payments grow over time
Extended Fixed or graduated payments up to 25 years
Income-BasedPay As You Earn
Income Based Repayment PlanMaximum monthly payment is 15% of
discretionary income Discretionary Income = AGI – 150% of
poverty guideline Up to 25 years repayment
Any balance after 25 years is forgiven Must have a partial financial hardship Examples:
Family Size of 1 with AGI of $45,000 has repayment of $353 per month
Family Size of 4 with AGI of $45,000 has repayment of $130 per month
Public Service Loan Forgiveness
Criteria: Make 120 on-time, full,
scheduled, monthly payments
Work full-time at qualifying public service org.
Payments made in qualifying repayment plan IBR or ICR Standard technically,
but after 10 years, no balance to be forgiven!
Forgiven, Cancelled, or Discharged
Total and Permanent Disability DischargeUnable to engage in substantial gainful
activity by reason of medically determinable physical or mental impairment that: Expected to result in death Has lasted, for continuous period of no less than 60
months Can be expected to last for 60 months, or Unemployable due to service-connected disability
(as determined by VA)
Forgiven, Cancelled, or Discharged
Death Discharge If the borrower dies, the loan will be discharged Parent Plus: If the Parent or the Student dies,
the loan will be dischargedClosed School Discharge
School closes while you’re enrolled and unable to complete program
School closes within 90 days after you withdrawTeacher Loan ForgivenessPublic Service Loan Forgiveness
Mortgage ForeclosureHousing Counselors!
Loan Modification / HEMAPAct 6 (Right to Cure)
Before filing in court, lender must give at least 30 days notice of intention to foreclose
Act 6 notice must tell homeowner the amount needed to repay in order to prevent court filing
Act 91 (HEMAP)Emergency mortgage assistance program to
non-FHA borrowers who fall behind through no fault of their own (unemployment, divorce, medical)
Resources
Consumer Complaints CFPB:
http://www.consumerfinance.gov/complaint/ FTC: https://www.ftccomplaintassistant.gov/ PA Attorney General:
http://www.attorneygeneral.gov/complaints.aspx?id=451
Delaware County: http://www.co.delaware.pa.us/consumeraffairs/consumer.html
Thank you!
Contact information:Jordan Mickman, Esq.
Phone: 610-497-7395
Email: [email protected]
Questions?
DANIEL ATKINS, ESQUIREHELP: MLP
CO-DIRECTOR
SSI and SSDI: The basics of Social Security Disability
Basics of Social Security Disability: Agenda
Differences between SSI and SSDIncome eligibilityBenefit amountsEligibility criteria & determination
Non-Citizens Children Adults
Appeals processSpecial circumstancesWhat to look forOverpaymentsRepresentative Payee
Supplemental Security Income Social Security Disability
A means-tested public benefit for people who are poor and disabled
Health Insurance: Medicaid
Insurance for people who have worked or children of disabled/deceased workers.
Health Insurance: Medicare after two year waiting period. Waiting period starts
with month of entitlement (5 months after the onset date).
Basics of SSI/SSD
Income eligibilityTo qualify for SSI you must have little or no income and
few resources. This means that the value of the things you own must be less than $2,000 if you are single or less than $3,000 if you are married. Child support counts. The value of your home does not count. Usually, the value of your car does not count up to $4,500. And the value of certain other resources, such as a burial plot, may not count either.
In-kind income and support counts so if family member providing or paying for food or shelter, that amount will be subtracted from monthly SSI amount. Pay for cell phone or cable directly to vendor. Money to recipient is considered income.
Benefit Amounts
SSI $710 federal benefit amount. No earlier than
application date.
SSD Amount of cash benefit varies. Can go back to onset date but can’t be paid more
than one year prior to the application date. Five month waiting period from onset to date of
entitlement.
Eligibility for Non-Citizens
If you are not a U.S. citizen, but you are a resident, you still may be able to get SSI.
A non-citizen qualifies if he or she is lawfully admitted for permanent residence in the U.S. and:
is a refugee or asylee in his/her first 5 years of U.S. residency; or
is an active duty member of, or an honorably discharged veteran of, the U.S. Armed Forces, or is the spouse or unmarried dependent minor child of such a person; or
has worked and earned 40 quarters of credit (10 years) under Social Security;
Disability Eligibility
Evaluation the same for adult SSI and SSD Onset differences: SSI can be no earlier
than application date. SSD can go back to onset date, but no pay more than one year prior to application date.
5 month waiting period for SSDIf dual application, can get SSI and
Medicaid during waiting periodDifferent for adults and children
Child Disability Standard: 3 Step Analysis
Functional Equivalence “Marked” in two
domains of functioning.
“Marked” means interferes seriously with child’s ability to independently initiate, sustain or complete activities.
Extreme in one domain .
“Extreme” = seriously interfere . . .
6 Domains of Functioning
Adult Disability Standard: 5 Step Analysis
1. SGA- Substantial Gainful Activity in 2013 > 1040
If No, proceed. If Yes, lose.
2. Severe Medically Determinable Impairment?
Severe if significantly limits ability to do basic work
Not severe if slight abnormality with no more than minimal effect on ability to do basic work.
If Yes, proceed to step 3. If No, lose.
3. Meet or equal a listing? And expected to last 12 months.
If Yes, win. If No, proceed to 4.
4. If don’t meet a listing– can do past work?
If Yes, lose. If No, proceed to 5.
5. Can you do any other work?
If Yes, lose. If No, win.
SSA Appeals Process
Ineligibility While IncarceratedSSD and SSI not payable for months
confined to a jail or prison or another public institution.
No benefits for any month in which you violate a condition of probation or parole.
Children receiving benefits on your account can receive benefits when you are in prison.
Upon release, request benefits to re-start by providing SSA with copy of release documents.
Protecting SSI Eligibility if Windfall
If client going to come into money– perhaps a settlement from a lawsuit, for instance– refer to a lawyer for advice on how to set up a trust to protect eligibility for Medicaid/SSI.
Windfalls don’t impact SSD.
What to Look For
Anyone in special educationChild failing in schoolChild struggling socially or at homeAny child or adult who has been in-patient
for mental health problems. Any adult with a serious impairment who
has been out of work for a long time. Any child with a serious impairment who
has missed school. Chronic homelessness.
Questions to Ask
How is your child doing in school?How is your child doing socially? At home? Were you in special education? How far
did you go in school? Where did you go to school?
How long have you been out of work? Are you receiving treatment for your
mental health condition? Have you ever applied for SSI/SSD before?
Overpayments
Work or other income not reported properly.
No longer disabled or eligible. SSA recovers by withholding of benefits. Request Waiver if without fault of
beneficiary and hardship to repay. For SSI recipients, hardship automatic.
Request Reconsideration if overpayment.
Representative Payees
If beneficiary cannot manage own money.
SSA must approve. To change to own payee, doctor must
submit letter supporting ability to manage money.
Mental illness does not necessarily mean recipient needs a payee.
Summary
SSI SSD
Medical Insurance MedicaidMedicare two years after five months
after onset
Financial CriteriaYes – must meet income/resource
testsNo, but work
history required
Disability Criteria Sequential Evaluation
Sequential Evaluation
Benefit Amount $710 retroactive to date of application
Depends on how much claimant paid
in and starts five months after onset
Observations
Don’t SaveDon’t work too
muchDon’t expect much Don’t expect the
process to be quick and painless.
ResourcesSocial Security Administration Bluebook (disability
listings): http://www.ssa.gov/disability/professionals/bluebook/
Social Security Administration Forms page: http://www.ssa.gov/online/forms.html
Social Security Administration POMS (sub regulatory materials): http://policy.ssa.gov/poms.nsf/aboutpoms
National Association of Social Security Claimants Representatives (NOSSCR): http://www.nosscr.org/
Thank you!
Contact information:
Daniel Atkins, Esq.
Phone: 484-557-0171Email: [email protected]
Questions?
VISIT US ON THE WEB: WWW.HELPMLP.ORG
Thank you!
http://on.fb.me/10OTObX
@HELPmlp