New Horizons Un-Limited Inc.

Editorials

Legislation: Finances

Disabled Adult Child and Title 19 Medical Assistance

Under a little-publicized law, a Disabled Adult Child (DAC) who loses Supplementary Security Income (SSI) continues to be eligible for Medicaid (MA) if his/her assets are under $2,000 and if his/her SSI benefits were lost solely because of an increase in Social Security benefits.

According to law, a Disabled Adult Child shall be considered for Medicaid purposes as being on SSI - and all Social Security payments which caused him/her to lose SSI eligibility are to be disregarded.

However, this is NOT automatically occurring.

Disabled Adult Children are incorrectly losing Medicaid coverage or receiving the wrong type of Medicaid coverage.

As a result, a Disabled Adult Child can face an impossible situation which includes: an administration and staff unfamiliar with the DAC law; multiple levels of government; multiple agencies within each level; private for-profit corporations; lengthy, confusing and endless notices; multiple hearings; and great difficulty in obtaining needed information.

Medicaid is a federal and state program with the Federal Government paying 50% to 80% of the cost (percentage varies between states).

Congress needs to ensure that this law is properly implemented.

A Disabled Adult Child (DAC) is one who is: · At least 18 years old. · Classified by the Social Security Administration (SSA) as disabled before age 22. · Receives an Old Age Survivors Disability Insurance (OASDI) payment that is based on the earnings of a parent, who is disabled, retired or deceased. · Was receiving SSI, but lost SSI eligibility because the OASDI (DAC) payment exceeded the SSI income limits.

An increase in SSA payments can occur for a DAC receiving Social Security benefits under the Family Maximum Benefit (FMB). For example, the SSA benefits of a family comprised of a retired worker, spouse and disabled children will be pro-rated, with the spouse and disabled children each receiving less than the standard benefit.

When a spouse or sibling dies, the individual benefits are to be recalculated, resulting in increased payments for the remaining family members. This increased payment can push the income of a DAC over the SSI limit, resulting in a loss of SSI benefits. Since Medicaid coverage is tied to SSI, Medicaid coverage could be lost also if DAC are not aware of the DAC law.

Although, according to law, increased payment in Social Security benefits for DAC shall be disregarded, and for Medicaid purposes, the DAC shall be considered as still receiving SSI.

DO NOT ASSUME MEDICAID WILL AUTOMATICALLY CONTINUE. Quite the contrary.

You can be incorrectly pulled into a web of programs from which it is nearly impossible to extricate oneself.

You may well have to:

• Fill out a 20-page application form received from the Department of Workforce Development (DWD) which comes with an unsigned letter from the state Department of Health and Family Services (DHFS) in an envelope bearing the return address of a private corporation.
• Educate oneself on the law with very little information readily available to the public. In one large city, there was only one reference copy of the Medicaid Manual in the entire public library system. There were no circulating copies.
• Incur costs to research the law.
• Acquaint people running the program with the DAC law.
• Attempt to explain, without alienating the caseworker, that questions they are asking are irrelevant.
• Deal with a maze of private corporations and multiple government agencies on federal, state and county levels.
• Try to interpret endless computer generated Notices of Decision (NOD) which are lengthy, unclear and include decisions on numerous programs which were neither requested nor wanted.
• Find it impossible to obtain a written response to a request for needed clarification.
• Live with the impossible situation in which costly computer programs were not designed to handle the DAC law.
• Question dollar amounts that are incorrect.
• Request a hearing before an administrative law judge.
• Delay obtaining medical care while awaiting the results of the appeal as one is liable for all medical expenses if the appeal is lost (this wait can last up to 90 days for each appeal).
• Live with hearing decisions not entered on the record, and have to start the hearing process all over again.
• Deal with the consequences (both to the DAC and the taxpayer) of not being informed of a new determination, thereby making a hearing unnecessary.
• Spend days and days in preparation for each hearing.
• Incur needless costs for long distance calls, faxes, photocopies, hearing tapes, parking meters, telephone loops, etc.
• Discover that a lengthy hearing was not taped.
• Question incorrect and changing dollar amounts on NODs (and figures subtracted instead of added).
• Challenge being placed into an incorrect category of Medicaid which would require sizeable out-of-pocket payments of medical expenses before Medicaid would cover anything.
• Face, in disbelief, the receipt within 30 days after a hearing decision, of a new notice advising that an eligibility review is to be scheduled within the next month.
• Receive a solicitation from a Health Maintenance Organization (HMO).

The list goes on and on - there is so much more! But mostly, it is the time stolen from the lives of those who cannot afford additional stress - stress that frequently exacerbates a disability. Time loss compounds the problems of individuals with disabilities and their families who, despite their additional time needs, must struggle to survive in a world with the same allotment of time as those without disabilities. Particularly, for parents in their 70s and 80s who have provided care for 50 or more years and are trying to find a humane solution for the DAC's future, time stolen seems criminal.

There are those who would have you believe that failures to properly administer the DAC law are isolated incidents. Not true! That is, in effect, saying that parents and siblings of disabled adult children never die.

I suggest the following recommendations:

• There is a great need for this law to be better published and available to the public.
• There is a great need for this law to meet the Social Security requirements of simplicity and the best interests of applicants or recipients (Title 42, Part 435, Subpart J, Section 435.902).
• There is a great need for this law to be better understood by administration and staff.
• There is a great need to save taxpayers the money spent on needless multiple hearings and to spare families this ordeal.

Since the Federal Government, through the Social Security office already handles Medicaid coverage to SSI recipients, since the DAC law applies only to those individuals who have lost their SSI benefits due to increases in Social Security benefits, and since Medicaid coverage for DAC is a federal mandate, IT WOULD SEEM LOGICAL AND CERTAINLY LESS COSTLY TO SIMPLY HAVE THE FEDERAL GOVERNMENT CONTINUE TO HANDLE MEDICAID COVERAGE FOR DISABLED ADULT CHILDREN.

It could save the taxpayers millions, and it would meet the SSA requirements of simplicity and the best interests of applicants or recipients.

- Signed "An Aging Caregiver of Disabled Adult Children"

Legislation and the Law

	Home  / Disability News  / NHU Quarterly Newsletter
	Share Your Knowledge!  / NHU Community Forum  / Contact Us
	About NHU  / Announcements and Features  / Contribute  /  What's New?  /  Site Plan