ODMH Expedited SSI and Medicaid Application ProceduresTraining Program Conducted by the Social Security Administration and the Ohio Bureau of Disability Determination

Social Security AdministrationSocial Security Administration

Disability Programs

Disability Programs

Types of Disability Programs

Social Security benefits for workers

Social Security benefits foradults disabled since

childhood

Social Security benefits for disabled widows

Supplemental Security Income

(SSI) for children and adults

To qualify, the disabled person must have a recent

work history

Special rules apply to younger persons who need

less work to qualify

Social Security Disability Insurance

The amount of work you need depends on your age at the time disability starts

Before age 24— 1-1/2 years of work in a three-year

period before becoming disabled

Age 24-31— work during half the time between age

21 and the time the disability began

Age 31 or older— work during five out of the 10 years before the disability began

Social Security Disability Insurance Work Requirements

Work CreditsIn 2009 it takes $1,090 to earn 1 work credit

— $2,180 earns 2 work credits

— $3,270 earns 3 work credits

— $4,360 earns 4 work credits(maximum number of credits in 1 year)

Amount of earnings needed to earn a work credit changes every year

Social Security Disability Insurance

Amount of Benefits

Benefits are calculated based on your entire

work history

If your Social Security benefit amount is lower

than the full SSI payment,

you may be eligible to receive both Social

Security and SSI

Social Security Disability Insurance

Benefits can be paid on the record of a disabled,

retired or deceased parent to an unmarried child of any

age if the child became

disabled before the age of 22

Social Security Benefits for Adults Disabled Since Childhood

Social Security Benefits for Adults Disabled Since Childhood

Who Is a Child?

Natural Legitimate Child Stepchild Legally Adopted Child Illegitimate Child Other

Social Security Benefits for Disabled Widows

Requirements for Entitlement

• Legal Spouse of Deceased Worker• Surviving Divorced Spouse Married 10 Years• Age 50 But Not Yet 60• Disabled Within 7 Years of Workers Death• Unmarried or remarriage occurred after age 50

and onset of disability

Medicare Coverage

Automatic enrollment in Medicare after being entitled to disability benefits for

24 monthsInformation about Medicare is sent several

months before coverage starts NOTE: People who have permanent kidney failure requiring dialysis or a transplant

or have amyotrophic lateral sclerosis (Lou Gehrig’s disease) may qualify for

Medicare almost immediately

Spouse, if he or she is 62 or older Spouse, at any age if he or she is caring for a child of worker who is

younger than age 16 or disabled Unmarried child, including an adopted child, or, in some cases, a stepchild

or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time

Unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of

disability for adults) A divorced spouse if he or she was married to worker for at least 10 years,

is not currently married and is at least age 62

NOTE: The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children

Benefits for Family Members

Family members may be eligible for Social Security benefits

Who Can Get SSI?

People with limited income and resources who are:

Supplemental Security Income (SSI)

• disabled, at any age; or

• blind, at any age; or

• age 65 or older

Resource limits— $2,000 for individual

— $3,000 for couple

We count— bank accounts (CDs, IRAs)

— second car

— stocks and bonds, 401Ks

— liquid assets

— property other than where you live

SSI Benefits for Adults

SSI Benefits for Adults

We don’t count as resources— home in which you live

— first car

— burial plots

— some resources set aside for burial

Disability for All Adults (Over Age 18) Both Social Security and SSI

Must have a physical or mental impairment (or combination

of conditions)Inability to perform substantial

work activityDisability must be expected to

last 12 consecutive months or result in death

We consider age, education and past work activity

The Application Process - Current

A paperless process

Application and disability report completed online at www.socialsecurity.gov, or during office/phone interview

SSA creates Electronic Folder (EF) to house all forms and medical evidence

EF transferred from SSA office to Ohio Bureau of Disability Determination (OBDD) for medical decision

The Application Process - Current

OBDD requests medical evidence from providers

Provider has paper records Scans records to make them electronic Using barcode fax records to BDD to convert to

electronic Mail per instructions on BDD request letter

Provider has electronic records Send records by uploading to Electronic Records

Express secure website (ERE)

The Application Process – ProjectOverview

SSA applications, forms and questionnaires submitted with medical evidence to local SSA

office as a complete package (Refer to “Checklist”)

Local office creates EF and adds all forms and evidence, begins development of non-medical eligibility factors, transfers EF to OBDD for

medical decision

OBDD requests any additional medical evidence from mental health provider

The Application Process – Project Overview

Mental health provider submits evidence via fax gateway using barcode (866 755-6629) or ERE website

OBDD makes medical eligibility determination

SSA effectuates decision

If approved SSA may contact mental health provider for any needed non-medical evidence

The Application Process – Project First Steps

Initial contact between local SSA office and mental health provider to establish working relationship; then case by case…

Applicant often unaware of status with SSA

Obtain SSA-1696 at screening – allows for release of information

Contact local SSA liaison to discuss current entitlement and potential eligibility

SSA establishes protective filing for benefits based on contact

What You Can Complete Online

Social Security Disability Benefits

Complete the Internet Disability Application (SSA-16) online at:

http://www.socialsecurity.gov/applyfordisability/

Complete the Adult Disability and Work History Report-PRO (Form SSA-3368)

online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html

What You Can Complete Online

Supplemental Security Income (SSI)

Complete the Adult Disability and Work History Report-PRO (Form SSA-3368) online at: https://secure.ssa.gov/apps6z/i3368PRO/main.html

Application for SSI (Form SSA-8000-BK)

must be completed as a paper form

Visit Our Website

www.socialsecurity.gov

Visit Our Website

www.socialsecurity.gov

ODMH Expedited Pilot Project

Forms Needed

Application for SSI (SSA-8000-BK)

Pays benefits to disabled adults and children who have limited income and resources.

Also pays benefits to people 65 and older without disabilities who meet financial limits

Authorization to Disclose Information (SSA-827)

Used to obtain medical and other information needed to determine whether or not a claimant is disabled.

Disability Report (SSA-3368BK)

Provide information about claimant and their medical condition, healthcare providers, medications, education, and job skills.

If completed online, indicate date of completion and confirmation #

Work History (SSA-3369)

Needed for the disability determination.

Work experience is a vocational factor that helps determine what jobs an individual can do.

If completed online, indicate date of completion and confirmation #

Online Disability Report (i3368 PRO)

The iPRO gathers all of the same information you’re used to putting on a paper 3368 and 3369

Appointment of Authorized Representative (SSA-1696-U4)

A representative can help with:

completing forms; going with you to your local

Social Security office; interpreting for you;

gathering and giving information;

taking you to medical examinations, tests, or to your local Social Security office;

receiving mail for you at his or her address.

Physician/Medical Statement (SSA-787)

This form is used to determine if we should pay this person directly or if he or she needs a representative payee to handle the funds

Mental Status Questionnaire

Appearance and Behavior Flow of Conversation and Thought Affect and Mood Anxiety Issues Substance Abuse History Mental Content Bodily Concerns Sensory and Cognitive Functioning Intellectual and Memory Functioning Insight and Judgment

Daily Activities Questionnaires

Living Arrangements Sleeping Habits Personal Care Meals/Eating Habits Shopping Social Contacts Concentration and Memory Treatment (Medications)

Medical Records and Other Pertinent Information

Psychiatric Assessments Psychiatric/Nursing Notes Progress Notes Hospitalization/Crisis Shelter information IEP Claimant’s Statement Other Pertinent Information

Additional Forms

Request for Representative Payee

provides financial management for the Social Security and SSI payments of our beneficiaries who are incapable of managing their Social Security or SSI payments. Generally, we look for family or friends to serve in this capacity.

When friends and family are not able to serve as payee, Social Security looks for qualified organizations to be a representative payee.

Additional Forms (cont.)

Advance Notice of Representative Payee

Bureau of Disability DeterminationFatimata Kamara 614-438-1839 fatimata.kamara@ssa.govDarlynn Nero 614-438-1709 darlynn.nero@ssa.gov

Definition of Disability

Inability to engage in Substantial Gainful Activity (work)

Due to a Medically Determinable Impairment (mental/physical)

Expected to or having lasted for no less than 12 months or

Expected to result in death

Application filed at SSA-FO Forwarded to DDS for Medical

Development & Decision

Assigned to DCA – Primary Point of Contact

Obtains & analyzes supporting medical & non-medical evidence

Sequential Evaluation5 Step Evaluation Process

SGA

Severe Impairment

Meets/Medically Equals Listing Severity

Return to Past Work

Ability to Perform Other Work

Listing of Impairments

Medical evaluation criteria ensures program consistency

May be accessed at: www.socialsecurity.gov/disability/professionals/bluebook

MENTAL LISTINGS

12.02 Organic Mental Disorders 12.03 Schizophrenia, other

Psychotic Disorders 12.04 Affective Disorders 12.05 Mental Retardation

MENTAL LISTINGS

12.06 Anxiety Related Disorders 12.07 Somatoform Disorders 12.08 Personality Disorders 12.09 Substance Addiction Disorders 12.10 Autism and other PDD

Drug and Alcohol Use

Details of Drug and Alcohol use are needed, including: Frequency of use When last use occurred Periods of sobriety Functional limitations when using Functional limitations when sober

A Criteria--Substantiates the particular mental disorder. It contains a composite of the medical criteria usually used to establish the presence of that impairment.

LISTING STRUCTURE

Examples of A Criteria

Medically documented persistence, either continuous or intermittent, of one/more of the criteria in the listings, examples include:

Delusions/Hallucinations

Incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with the following:

Blunt, Flat, or Inappropriate affect

Emotional withdrawal and/or isolation

LISTING STRUCTURE

B Criteria--Assesses the severity of the impairment. It is expressed in terms of functional limitations

THE B &C CRITERIA

1. Activities of Daily Living2. Social Functioning3. Concentration, Persistence or

Pace4. Episodes of Decompensation

• Document episodes of decompensation, including duration

THE FIVE CONTEXTS USED TO

1. Effectiveness or Quality

2. Independence

3. Appropriateness

4. Sustainability

5. Longitudinal History

EVALUATE B1 AND B2

Effects of Medication

Effects of a Structured SettingEffects of a Structured Setting

Acceptable Medical Sources

Psychiatrists

Licensed Clinical Psychologists

School Psychologists for Mental Retardation and Other Learning Disorders

Other Good Sources of Information

MH Counselors/Therapists Hospitals/ Clinics Rehabilitation Centers Schools

GENERAL DOCUMENTATION REQUIREMENTS FOR MENTAL CLAIMS

1. History2. Mental Status Exam

7. Capability

3. ADL’s

4. Social Functioning

5. Concentration, Persistence, Pace

6. Deterioration and Decompensation

Completing ODMH forms

Mental Status Questionnaire Ensure all information is consistent with

the medical evidence in file If inconsistencies exist, explain them

Daily Activities Questionnaire Ensure that the claimant’s day to day

functioning is fully described Where problems exist in functioning, be

sure to describe problems in detail

ODMH Checklist

In addition to SSA forms BDD needs as much medical and

functional evidence as possible to make a fair and accurate decision. Evidence can be given to the SSA office upon

filing Evidence can be faxed to BDD using a

barcode after the case is transferred from SSA to BDD.

Final Determination

Adjudicator must consult with and have decision signed by physician/

psychologist prior to finalizing

Notification By Mail

Appeal Rights

DDS Accountability