Patti Hackett, MEd HRTW National Center, Natick, MA 9 th AZ Transition Conference

1. Making the Paperwork Work: Expediting Program Eligibility Celebrate the Paperwork: It Means You Are Alive! Patti Hackett, MEd HRTW National Center, Natick, MA 9th AZ Transition Conference September 2009

4. Today’s Outcomes By the end of 1 hour success will look, sound and feel like: • New knowledge of how to draft disability documentation • Ways to increase family involvement in their own care • Energized by working in a brain compatible learning environment that you can model in your work

5. O V E R V I E W • About You & Me • About HRTW • Entitlement-Eligibility • Essential Paperwork • Just the Facts • Resources

6. You, Me, Looking for ? • Affirm • Ah ha! • Squirm • Disagree Who You Are? Experts in the Room About me!

7. Growing Up Ready to try new things!

8. Transition to Adulthood

9. www.hrtw.org

11. Prepare for the Difference: Entitlement to Eligibility • So many different definitions of disability. • Who is considered disabled ? • Who is not? • And why does it matter? • What is the difference between disabled and special health care needs? Methods

12. Expediting Eligibility: Definition, Criteria & Rules • Adult Programs, Services & Benefits • Definition of disability • Each agency is different • Learn their rules/definitions • Documenting Disability - LEGAL RESOURCES • http://www.hrtw.org/tools/dis_info.html • - ADA • - DEVELOPMENTAL DISABILITY • - EDUCATION: IDEA/IDEIA • - HEALTH • - REHABILTATION ACT 1973, Section 504 • - SEVERE DISABILITY • - SOCIAL SECURITY • WORK Methods

13. Making the Paperwork Work! • Concise Documentation • Review takes less time when • application and documentation is complete! • Faster decision. • Less stress for YOU! • Evidence matches “rules” • Medical • Functional: Social, physical, behavior, cognitive, • and decision making • Other Methods

14. Take Home Messages • Paperwork is a reality no positives in whining 2. Identify the shortcuts put energy on solutions 3. Draft the paragraph, create the one pager Trim down the care notebook 4. Families NEED to learn this they get the denials and the stress

15. Disability Criteria 3 2 1

16. D I S C U S S I O N

17. Disability Criteria

18. Just the Facts: Accessing Adult ServicesIt’s Moving from Entitlement to Eligibility format • Dispelling the Myths (SSI, VR, health insurance) • The Intent of the Service • Roles: Teachers, • Physicians, Care Coordinators Families & Youth

19. Just the Facts: SSI The Myth: All applications get denied first time around. The Intent: • Supplemental Security Income (SSI) 1972 Federal funded by general tax revenues (not Social Security taxes) Designed to help aged, blind, and disabled people, who have little or no income; and Provides cash to meet basic needs for food, clothing, and shelter (assets $2,000 single/$3,000 couple)

20. Just the Facts: SSI Insider Info: • Applications will receive a timely impartial review IF the complete paperwork is received. • Medical and other evidence is not complete. • Documentation doesn’t follow disability criteria. * SSA staff receive raises in part based on paperwork flow.

21. Just the Facts: SSI – Disability Criteria An individual is "disabled" if he or she has a medically determinable physical or mental impairment • Can be expected to result in death • Has lasted or can be expected to last for a continuous period of not less than 12 months • Child - Marked & severe functional limitations • Adults -Inability to engage in any substantial gainful activity(2007-$900/mo)

22. Just the Facts: SSI - Listings www.ssa.gov search BLUE BOOK • Musculoskeletal System • Special Senses and Speech • Respiratory System • Cardiovascular System • Digestive System • Genito-Urinary System • Hemic and Lymphatic System • Skin • Endocrine System • Multiple Body Systems • Neurological • Mental Disorders • Neoplastic Diseases Malignant • Immune System

23. Just the Facts: SSI 111.07 Cerebral palsywith: A. Motor dysfunction meeting the requirements of 101.02 or 111.06; or B. Less severe motor dysfunction (but more than slight) and 1 of the following: 1. IQ of 70 or less; or 2. Seizure disorder, with at least one major motor seizure in the year prior to application; or 3. Significant interference with communication due to speech, hearing, or visual defect; or 4. Significant emotional disorder

24. Just the Facts: SSI Disability Criteria for Children: Domains - Acquiring and Using Information; - Attending and Completing Tasks; - Interacting and Relating with Others; - Moving About and Manipulating Objects; - Caring for Yourself; and - Health and Physical Well-being

25. Just the Facts: SSI CHILDREN - Meets or Equals Functionally = "listed impairment” • Marked limitations in 2 of these domains interferes seriously with the child's ability to independently initiate, sustain, or complete activities. • Extreme limitation in 1 domain, interferes very seriously with these abilities.

26. Just the Facts: SSI Disability Criteria for Adults • Meets the Listing - one of the Listings by comparing it to the specific requirements in the Listings. • Meets or Equals - impairment(s) is equal in severity and duration to a listed impairment. • Residual Functional Capacity - disability is severe, but does not meet or equal a listed impairment

27. TIPS: Navigating & Documenting 1. Prepare the medical and other evidence 2. Know the eligibility requirement 3. Prepare the application - Ask for review by others before submitting 4. Come ready (paperwork completed) the day of “intake”

28. D I S C U S S I O N

29. Just the Facts: Vocational Rehabilitation The Myth: - They purposely delay applications. - They only serve people who are easy to place. The Intent: To assist and empower eligible individuals with disabilities to achieve and maintain meaningful employment

30. Just the Facts: VR TRAINING • Supported Employment • Short-Term, Vocational Training • College or University-based education EMPLOYMENT SUPPORT • Job Coaching • On-the-Job Training

31. Just the Facts: VR Physicians, Care Coordinators • Help gather medical & other evidence for disability determination Families & Youth • Portable Medical Summary-ICD9 codes • 1st appt have ALL paperwork completed. • Be part of the solution, be proactive.

32. Handouts: VR Documenting Disability • Sample Letter from Physician • Families need to learn how to draft letter • Medical Team reviews/edits • Youth learn the rules and regs.

33. TIPS: Navigating & Documenting 1. Prepare the medical and other evidence 2. Know the eligibility requirement 3. Prepare the application - Ask for review by others before submitting 4. Come ready (paperwork completed) the day of “intake”

34. D I S C U S S I O N

35. Just the Facts: Private Health Insurance The Myth: • My disabled child will not age out of my health care insurance. • All young adults are covered by Medicaid so why should we continue the private coverage The Intent: • It’s a state mandated benefit.

36. Maintaining Health Insurance

37. Extended Coverage – Family Plan CONTINUATION OF COVERAGE POST 18 (18 states ) with/without disabilities. Unmarried, childless young adult, most require student status Up to age 24 — DE, IN, SD* Up to age 25 — CO, ID, ME, MD, MT, NM, RI, TX, VA , WA, WV Up to age 26 — CT, MA, NH, UT Up to age 30 — FL, NJ, SD *employer option PA - Students in National Guard called to duty, maintain coverage until education is completed regardless of age

38. Extended Coverage – Family Plan Adult Disabled Dependent Child state mandate (40 states) AZ, AR, CA, CT, FT, GA, HI, ID, IL, IN, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI and WY

39. Handouts: Private Health Insurance Adult Disabled Dependent • AZ Rev. Stat. Ann. Sections 20-826 (F) - 1342.01, -1407) • Coverage for dependent children cannot be terminated while a person is incapable of self-sustaining employment due to mental retardation or physical handicap and chiefly dependent on the insured.

40. Handouts: Private Health Insurance - 411 Extension of Policy for Dependent Child with a Disability Employee 1. FORM - continuation of coverage 2. FORM - Attending physician statement of mental retardation or physical handicap. 3. Both forms submitted to the employer for review and signature before forwarding to the claim office.

41. Just the Facts: Private Health Insurance Physicians, Care Coordinators • More than letter from God • Discuss before age 17, 26 Families & Youth • Transition of Care Notebook to concise thin files and sample documentation - Don’t wait to be informed – get the forms early

42. TIPS: Navigating & Documenting 1. Prepare the medical and other evidence 2. Know the eligibility requirement 3. Prepare the application - Ask for review by others before submitting 4. Come ready (paperwork completed) the day of “intake”

43. TIPS: Creative Health Insurance Ex #2 ex #1, 3rd wife

44. D I S C U S S I O N

45. SKILLS FOR YOUTH • Practice filling in forms (Home & School) 2. Cheat sheet: portable medical summary 3. Tracking to avoid forgetting

47. D I S C U S S I O N

48. Survival Tips: Why NOT try some • No is just the first answer until additional information is provided 2. Speak their language, terms Compliment, address by name 3. Scheduled stress day-deal w/ forms, bills. - Open mail on the 15th - Take action on 17thprep relax bath 4. Three way call

49. TIPS: Navigating & Documenting 1. Prepare the medical and other evidence 2. Know the eligibility requirement 3. Prepare the application - Ask for review by others before submitting 4. Come ready (paperwork completed) the day of “intake”