Education + Advocacy = Change

Click a topic below for an index of articles:

New Material

Home

Help us Win the Fight!

Alternative Treatments

Depression

Financial or Socio-Economic Issues

Health Insurance

Help us Win the Fight

Hepatitis

HIV/AIDS

Institutional Issues

International Reports

Legal Concerns

Math Models or Methods to Predict Trends

Medical Issues

Our Sponsors

Occupational Concerns

Our Board

Projects

Religion and infectious diseases

State Governments

Stigma or Discrimination Issues

If you would like to submit an article to this website, email us your paper to info@heart-intl.net


 

~

any words all words
Results per page:

“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Social Security Insurance

 

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

 

Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

 

 

 

"The Social Security Administration administers two programs that provide benefits based on disability: the Social Security disability program (Title II) and the supplemental security income program (Title XVI). Title II provides benefits to individuals who are insured under the Act by virtue of their contributions to the Social Security trust fund through tax on their earnings. Title XVI provides payments to individuals who are disabled and have limited income and resources.

What follows is a linked outline to legal resources organized under the Office of Hearings and Appeals five-step sequential evaluation process for reviewing social security disability claims, as set out in 20 CFR 404.1520. The rules under Title II and XVI are identical in most cases, so only Title II rules are linked below.

Social Security Ruling 86-8: THE SEQUENTIAL EVALUATION PROCESS. The regulations state that a sequential evaluation process is followed whereby current work activity, severity and duration of the impairment(s), ability to do past work and vocational factors are considered in that order." Health Hippo: Evaluations of Social Security Disability

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /Type**

2007-Coverage through the “Doughnut Hole” Unlike most forms of insurance, the Medicare Part D prescription drug program has a hole in its middle. This coverage gap, colloquially known as the “doughnut hole,” is perhaps the most bizarre and troublesome aspect of the Part D drug program. After beneficiaries reach their initial limit of total drug expenses ($2,250 in 2006), they have no prescription drug coverage until their total drug expenses reach a catastrophic threshold for the year ($5,100 in 2006). While beneficiaries are in the doughnut hole, they must continue to pay their monthly premiums, although they do not receive any drug benefits. Only after they have spent thousands of dollars of their own money to get out of the hole ($2,850 in 2006), in addition to their monthly premiums, does their coverage resume. Pdf 534 kb
A History of the Disability Listings In order to facilitate the process, the Social Security Administration created a list of diseases and conditions which were felt to be incompatible with substantial gainful activity (gainful employment). Persons who were not engaged in substantial gainful activity, and whose conditions met the requirements of one or more of the listed conditions, were considered disabled. Called the listings, the criteria proved so useful that they were retained and revised periodically, and have been kept in continuous use ever since. Pdf 248 kb
Compassionate Allowances Under titles II and XVI of the Social Security Act (the Act), we pay benefits to individuals who meet our rules for entitlement and have medically determinable physical or mental impairments that are severe enough to meet the definition of disability in the Act. The rules for determining disability can be very complicated, but some individuals have such serious medical conditions that their conditions obviously meet our disability standards. Pdf 53 kb
A CONSUMER’S GUIDE TO HEALTH INSURANCE This booklet, developed by the Vermont Department of Banking, Insurance, Securities and Health Care Administration, helps you understand health insurance and how it works.  It explains the different types of insurance policies available to you and what to expect once you have health insurance.  With a little knowledge, you can choose the right kind of coverage for you and your family.   
Childhood-Disability Evaluation Under Social Security-2003 Rules and regulations of claiming disability as a child 502 kb pdf
COURT CLARIFIES STANDARDS FOR DENIAL OF DISABILITY BENEFITS Judges must approach medical disability and health insurance disputes with a skeptical eye when they involve insurance companies that both evaluate and pay employee claims.  

DETERMINING MEDICAL EQUIVALENCE IN CHILDHOOD DISABILITY CLAIMS
WHEN A CHILD HAS MARKED LIMITATIONS IN COGNITION AND SPEECH

 To provide a policy interpretation that children who have a "marked" limitation in cognitive functioning and a "marked" limitation in speech have an impairment or combination of impairments that medically equals Listing 2.09. Also, to provide guidance for determining when a child has a "marked" or an "extreme" limitation in each of these areas.

 

Disability Evaluation Under Social Security
This edition of Disability Evaluation Under Social Security has 
been specially prepared to provide physicians and other health
 professionals with an understanding of the disability programs 
administered by the Social Security Administration.  It explains 
how each program works, and the kinds of information a health 
professional can furnish to help ensure sound and 
prompt decisions on disability claims
903 kb pdf
Disability Evaluation Under Social Security-Listing of Impairments—Part A Complete listing of impairments-2003 644 kb pdf
DUAL-ELIGIBLE BENEFICIARIES WITH RETIREE DRUG COVERAGE: What Retiree Plan Sponsors Should Know About the Risks and Choices Facing Retirees, Spouses & Dependents, and What They Can Do to Help Based on the best available data, several tens of thousands of dually eligible individuals also receive retiree drug coverage from an employer or union plan sponsor.  While this number is not large compared with the total number of Medicare-eligible retirees, it is large enough that many retiree plans will cover one or more affected retirees.  Because the consequences for an affected retiree are so significant, it is important that every employer and union plan sponsor be aware of these issues and consider taking steps to reduce the risk to and adverse impact on affected retirees. This document provides an overview of the choices faced by these retirees and outlines best practices employer and union plan sponsors can adopt  
Guilty until proven innocent-Dealing with a flawed SSDI Application process The Social Security Disability Insurance system, which is supposed to protect workers from suddenly losing all sources of income with an unexpected disability, is seriously flawed and becoming more so. There's a widespread national myth that people are "faking it". I understand that Connecticut spent over a million dollars to unroot all those fakers in their system, and only found 6  

Handbook for SSI Guidelines

Provided by SSA

8,144 kb pdf

Health Hippo: Evaluations of Social Security Disability part 1

(Large report-increased down-load time)

The Social Security Administration administers two programs that provide benefits based on disability: the Social Security disability program and the supplemental security income program .

 

Health Hippo: Evaluations of Social Security Disability part 2 

(Large report-increased down-load time)

The Social Security Administration administers two programs that provide benefits based on disability: the Social Security disability program and the supplemental security income program  
Health Hippo: Evaluations of Social Security Disability part 3 

(Large report-increased down-load time)

The Social Security Administration administers two programs that provide benefits based on disability: the Social Security disability program  and the supplemental security income program  

Helping your Social Security Claim through the system

The majority of people who file for Social Security Disability benefits, either SSDI or SSI, complete the requested paperwork, submit it—then they wait. Sometimes for months without hearing a word.

 

Hepatitis C and Social Security Disability Benefits

Rules for applying

445 kb pdf

HIV and Public Benefits: Your Legal Rights-Jan. 2002 Many people who need to apply for public benefits, like Social Security, Food Stamps or a Medicaid card, have no idea where to begin.  And once they start the process, they often find it extremely confusing and frustrating.  This booklet is designed to make that process easier to understand, and to provide the information you need to get the benefits you are entitled to. 110 kb pdf
HIV Testing, Confidentiality, and Discrimination: An Outline of Legal Protections for Persons with HIV in Connecticut Informational booklet 94 kb pdf
Home-care use and Expenditures among Medicaid Beneficiaries with AIDS This article compares the use and cost of home-care services among traditional Medicaid recipients with AIDS and among participants in a statewide HIV-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data 62 kb pdg
HUD-Homeless Management Information Systems

(Large file-please allow extra time for download)

This program requires organizations providing services to the homeless to collect certain data and report that data to HUD for use in a federal database.  Although the exact terms of use of the database vary by region, at a minimum the data will be accessible to other service providers within the same region.  The stated purposes of the program include allowing HUD to get an unduplicated count of homeless persons and to encourage coordination among different providers.  The collection of this information, however, poses some very serious privacy concerns.  Particularly troubling is that service providers are encouraged/required to report HIV status, medical treatment, and mental health status (among other information) in a format that does nothing to protect the privacy of the individuals involved - their names, social security numbers and other identifying information will also be available in the database.  Whether a person sought treatment from an HIV-related care provider would also be included in the database.  While HUD has encouraged the use of certain security protections for the data, we are also concerned that the required protections do not appear to go far enough to protect the confidentiality of this information.  1006 kb pdf
Law and Treatment Access Power Point presentation-Feb. 2003 197 kb

New Therapies Pose Quandary for Medicare

The federal Medicare program is expected to decide this week whether to pay for an aggressive and expensive lung operation that could offer a lifeline to tens of thousands of elderly patients.

 

Obtaining Social Security Benefits for Patients with Liver Disease

Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For most people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering with Hepatitis C and liver disease, the requirements of the Act can appear overwhelming.

 

MEDICAID AND PERSONS WITH DISABILITIES Special Medicaid Eligibility Provisions for Persons with Disabilities for New York Pdf 163 kb
Medicare Stand-Alone Prescription Drug Plans By state  
MSP PROGRAMS OFFER $88.50 MORE IN SOCIAL SECURITY CHECKS, PRESCRIPTIONS WITH SMALL CO-PAYS AND EVEN---FOR MANY-- COVERAGE OF MEDICARE DEDUCTIBLES AND CO-PAYMENTS

The little-known Medical Savings Programs (MSPs) can mean an extra $88.50 monthly in Social Security checks in 2006 and extra medical and prescription drug benefits for disabled and elderly persons who are on Medicare but are not also on SSI or Medicaid already.

 

 
Pulling away the safety nets The Safety Net She Believed In Was Pulled Away When She Fell Debra Potter made a good living selling disability coverage. But like many working Americans, she learned the hard way that federal law now favors insurers.  
Proposed Rules Revising Medical Criteria for Evaluating Immune System Disorders Set forth below are comments on the Proposed Rules revising the criteria in the Listing of Impairments used by the Social Security Administration to evaluate claims involving Immune system disorders Pdf 1391 kb
Sample Disability Policies The following sample policy statements are for various types of disability policies.  Generally, disability leaves are granted with pay, or with pay provided through an insurance plan, and without loss of credit for the employee’s length of service with the company for short-term disability.  The following samples are for illustration purposes only.  The policy terms and conditions available from your insurer could be quite different from the terms set out in these policies.  These policies, however, should be useful in giving you a sense of how a disability policy is structured and the types of issues you’ll need to discuss with your insurer.  
SHOULD NEEDY FAMILIES BE REQUIRED TO TAKE DRUG TESTS TO RECEIVE AID?

Sen. David Vitter (R-LA) introduced a bill that would amend the Social Security Act to require States to implement a drug testing program for applicants for and recipients of assistance under the Temporary Assistance for Needy Families (TANF) program. 

If an applicant fails a drug test, or was convicted of a drug related crime they can be denied aid. Also, states would be allowed to require random or set time drug tests.  A person can be permanently denied aid if they fail three drug tests or receive three drug related convictions.
 
Social Security findings should play key role ''As long as the worker can engage in 'substantial gainful activity,' he is not disabled even if the only work that he is capable of doing is only part time. E.g., Brewer v. Chater, 103 F.3d 1384, 1391-92 (7th Cir. 1997); 20 C.F.R. §404.1572(a). Of course, the work must not be so meager as not to be substantial and gainful. See 20 C.F.R. §§404.1573(e), 404.1574(a), (b). But the same, it turns out, is true under ITT's disability plan  
STATE ELIGIBILITY POLICIES WHICH DISCRIMINATE AGAINST THE DISABLED IN THE MEDICAID, MEDICAID WAIVER EXPANSION, CHIP, AND STATE-FUNDED HEALTH & PHARMACY ASSISTANCE PROGRAMS Some state Medicaid, Medicaid waiver expansion, Child Health Insurance (CHIP), state-funded health assistance and state pharmacy assistance programs (SPAPs) have rules that deny eligibility, coverage, equal income levels or benefits to disabled and aged persons.  
State Medicaid Actions—2005: What the States Said, Did and Plan to Do States faced gaping budget deficits that required lawmakers to cut program spending, including that for higher education, social services and health care.  During this period the states reduced spending by $236 billion due to shortfalls in revenue. 1675 kb pdf
State Pharmaceutical Assistance Program (SPAP) Legislation & Policy Changes To Coordinate With & Supplement Part D: Issues, Possibilities & Challenges for HIV, Disabled & Other Patients Several states passed legislation and/or regulations creating, altering or--in once case-- abolishing SPAPs in response to the coming implementation of Medicare Part D, especially to coordinating with and supplement drug coverage for those Low Income Subsidy (LIS)/”Extra Help” patients with incomes under 150% FPL.   SPAPs can cover drugs not on individual Part D plans’ formularies; pay LIS/Extra Help patients’ co-pays, coinsurance, deductibles and premiums; do likewise for slightly “richer’ limited income patients (as some newly-created or adapted SPAPs will do); and---if they meet CMS standards—have such drug payments count toward True Out Of Pocket (‘TrOOP”) credit for moving patients over 150% FPL through and out of the donut hole and into Part D’s catastrophic coverage.  

The Language Of Disability: Problems Of Politics And Practice

Language. . .has as much to do with the philosophical and political conditioning of a society as geography or climate. . .people do not realise the extent to which their attitudes have been conditioned since early childhood by the power of words to ennoble or condemn, augment or detract, glorify or demean.

 

TIICA-Glossary of Wonky Medicaid, Medicare, VA, Health & Other Related Program Terms: Definitions used by the US Government concerning Medicaid, Medicare, VA, Health and other related programs  
Widening State Pharmacy Assistance Programs (SPAPs) for the Aged Only to Cover the Disabled Too While state Medicaid programs appear to be prohibited by the new law in most, if not all, cases from offering secondary, "wraparound" drug coverage to "dual eligibles" [those Medicare patients who are also poor enough to be on Medicaid too] this is not so for SPAPs. They're allowed to be secondary, "wraparound" payers if they choose to do so. Given state budget problems, some may propose terminating SPAP programs to save state funds, on the [disingenuous] grounds that the new Medicare drug benefit makes the state program unnecessary. But either way, enactment of the Medicare Part D  drug benefit means enormous savings to SPAPs---in addition to the savings states will get from Part D displacing some state Medicaid drug expenses.  For example, Pennsylvania was predicted to save $150 million just from the preliminary Medicare interim $600 drug discount card program; New Jersey’s savings were to be $90 million; Connecticut’s were to be $15 million; and all SPAPs will save proportionately at least as much when the full, permanent Part D program becomes primary payer in 2006.    

** In order to view PDF files, you must have Adobe Acrobat Reader installed on your computer. Many computers already have this software; however, if you need it, a free copy is available for download at this site: Click here to get Adobe Acrobat Reader.