Navigating the Maze:

1. NavigatingtheMaze: An Overview of Services and Laws Impacting Children with Disabilities

2. 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

3. Session Overview • Eligibility factors • SSI...Medicaid…TennCare • Workplace benefits and rights • ACA (Affordable Care Act) • Title V – Children’s Special Services • State Family Support Program • Medicaid HCBS waiver • TEIS (IDEA Part C, Early Intervention) • Special Ed. (IDEA Part B)...FERPA • Vocational Rehab Act…Section 504 • ADA…DD Act • Legal Services...Advocacy tips • Resources

4. EligibilityFactors • Eligibility requirements for the particular service or program, such as: • Disability label or diagnosis • Age requirement • Income guidelines • State participation: Is it mandatory? • Available funds for the program • Availability of program and/or service provider in your geographic area.

5. SSI 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

6. 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).

7. Enrollment Considerations • 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.

8. Enrollment Considerations • 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.

9. Medicaid TennCare • Criteria • 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

10. 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

11. 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

12. Applying for TennCare Apply 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

13. 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)

14. 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.

15. 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

16. Health Insurance Laws at Work and Related Rights • COBRA • HIPAA • Family Medical Leave Act www.dol.gov/pwba/health.htm

17. COBRA:Consolidated Omnibus Budget Reconciliation Act • 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.

18. COBRA Coverage Periods

19. HIPAA: Health Insurance Portability 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.

20. HIPAA: 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.

21. Family Medical Leave Act (FMLA) • Established in 1993 • 12 Weeks of Unpaid Leave During Any 12-Month Period for: • personal serious medical condition • care of spouse, child, parent • birth • adoption

22. 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.

23. More on ACA – By 2014 • Up 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

24. ACA continued • The 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.

25. 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.

26. ACA sites • www.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/Documents/CYSHCN-ACA-Fact-Sheet.pdf • Video http://www.youtube.com/watch?v=vmdbllWOOzs

27. Title V of the Social Security Act: “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

28. 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

29. More About CSS Enrollment • Applications for CSS may be made at any time. • CSS is available across Tennessee. • There is no waiting list for CSS.

30. State Family Support Program • Purpose: To assist individuals with significant disabilities and their families. • respite • home modifications • personal assistance • housing cost • counseling • insurance • homemaker services • equipment • transportation • health related needs • Services are flexible and may include:

31. Family 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.

32. More 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.

33. Medicaid WaiverHome and Community-Based Services • 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

34. Waiver Programs • Full Medicaid Waiver Services (“Statewide Waiver”) • Will pay for residential services • Independent Support Coordinator (ISC) • Usually through a provider agency • Self-Determination Waiver Services • Set limits on specified services • “Participant management” is encouraged • Families have control and choice

35. Medicaid Waiver Categories of Need • Crisis • Urgent Request • Active Request • Deferred Request DIDD Application Access • East Region: 1-888-531-9876 • Middle Region: 1-800-654-4839 • West Region: 1-800-308-2586

36. TEIS Tennessee Early Intervention Services • 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

37. TEIS: Part 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/

38. TEIS 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.

39. TEIS 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.

40. IDEAIndividuals with Disabilities Education Act • Federal 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.

41. FERPA Family Educational Rights and 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.

42. FERPA 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.

43. Rehabilitation 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

44. Section 504 • Part 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.

45. Definition 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.

46. Americans with Disabilities Act of 1990 (ADA) • A federal civil rights law • Provides protection against discrimination in the workplace • Requires accommodations for accessibility by covered entities

47. The 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.

48. Legal 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

49. Process 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.

50. WIN - 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.