State by State Analyisis of Medicaid

There is a link to the July 1, 2009 edition of the MEDICAID WATCH under the “what’s new” tab here:

Note that notable and recent state developments and proposals that expand access and eligibility appear in blue, while notable and recent state developments and proposals that cut access and eligibility are printed in red. The last page contains a regularly-updated listing of sources and resources on state health coverage, with the most recent items highlighted in yellow.

The MEDICAID WATCH not only covers state-level Medicaid eligibility and access news; it also reports on other state health assistance programs, including:

* the State Children’s Health Insurance Programs (SCHIP);
*states’ own non-federally-funded medical assistance programs;
*State Pharmacy Assistance Programs (SPAPs);
*State AIDS Drug Assistance Programs (ADAPs);
*state-subsidized or -sponsored health insurance programs for limited income persons;
*state-subsidized high risk health insurance pools (including premium discounts given by some risk pools
to those with incomes under state-set levels); and
*safety-net hospitals offering free or discounted care to the indigent.

For each state, we now note, as percentages of the annual Federal Poverty Levels (FPL), the most recently-tabulated income eligibility levels for aged/disabled and parental Medicaid; medical assistance for childless, non-disabled adults (if they get Medicaid via an eligibility expansion waiver or other public Medicaid-like coverage in their state); SCHIP; ADAPs; SPAPs; state-subsidized or -sponsored health insurance; states’ Medicare Savings Program (MSP) eligibility liberalizations; and any risk pool low income premium discount programs. The 2009 FPL, for your convenience, is noted on page 13 of this edition— as is the 2008 FPL (since it was that year’s level which was used to tabulate state Medicaid parental levels in the most recent national survey used here as a source).

Details on state income and asset levels, their income disregards, a “2009 VA Health…Benefits” guide and a helpful Glossary appear in those documents below “From the Community Access National Network (CANN)” among “Other Organizations’ Materials” under the “Library” icon at www.healthlaw.org .

Please do share this with your colleagues and affiliates at the state and local level. We welcome your comments, news items and corrections; email me at tomxix@ix.netcom.com .

Thomas P. McCormack
Editor, MEDICAID WATCH
&
Public Benefits Policy Consultant
Community Access National Network (TIICANN)
www.tiicann.org
Washington, DC
(202) 479-2543

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Wall Street Journal Recognizes Difficulty of Application Process

Today’s Wall Street Journal has a thoughtful article on the travails of obtaining disability payments from Social Security, specifically about how people underestimate the difficulty of the process. We frequently find clients who express amazement at this: they have always assumed these benefits they have paid for will be readily available in time of need.

“Workers who contribute part of their earnings to Social Security often underestimate what it takes to tap the benefits if they become permanently disabled. The process can be tricky and more time-consuming than people expect, and the weak economy appears to be contributing to a surge in applications.

“Applications for Social Security disability benefits rose more than 17% in the first quarter. There are 7.4 million people receiving disability benefits that average $1,063 a month.

“Those numbers are expected to rise as baby boomers age, so it can pay to know the claims process. Here are seven common errors to avoid:

First, Misdefining disability

Many people erroneously think they can collect benefits as long as they are unable to do their regular job. A person must be unable to perform any substantial work and have a medical condition that has lasted or is expected to last at least a year or to result in death. It’s not only what you can do or have been doing but anything they think you’re suited for. Others include wating too long to apply,being disorganized, failing to get help, making financial errors. Read full article here:

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Medical Facilities Exchange Electronic Records with SSA, Decisions Issued Faster

From the American Medical Association News today: The Social Security Administration says it has already demonstrated the business value of a national health information exchange through the test run it’s doing in collaboration with MedVirginia, a regional health information exchange in central Virginia.

The two started exchanging data in February to expedite disability benefit approvals. By using the data exchange to receive medical records that can help determine eligibility for disability benefits, the SSA says the approval process has been reduced to an average of 32 days from 83 days.

A handful of cases were determined within a day of being received, said Jim Borland, special adviser for health IT for the SSA.

“That just doesn’t happen,” he said. See more here

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Still On Hold with Social Security? Stand By.

From today’s Atlanta Journal Constitution: The Social Security Administration has reduced its staffing by more than 5 percent since 2003, to about 60,000.

That means seniors such as Early Graham of Raleigh, N.C., have dealt with long hold times and promises of return calls that never come.tn_vibe11

“I had to call three different numbers before I got anyone on the phone,” Graham said.

Brian Simpson, a spokesman at the Social Security office in Raleigh, said he hears similar complaints all the time.

Trying to handle customer demand with fewer employees, the agency has shifted some workers away from phone lines to front desks to assist walk-in clients.See Full story here:

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How to Improve Your Wait Time for Benefits

While Social Security predicts a substantial reduction in waits for hearings by 2012, many claimants need a more immediate fix. This article discusses the reasons and some remedies for hearing delays:

“Many people are denied disability benefits at the first two levels (Application for benefits and Request for Reconsideration). The third step in the process is the Request for Hearing before an Administrative Law Judge. At this stage, most claims have the greatest chance of being approved. The problem is that the greatest delays occur at this level.
The Administration has been confronted by a significant backlog on
cases pending decision and dispositions.thumbnailca0r1ypi
In FY 2007, SSA’s National Hearings Average Processing Time was 512
days for all dispositions. (see
http://www.ssa.gov/oig/ADOBEPDF/A-12-08-28036.pdf for a thorough
discussions of the whys and wherefores)”…
a href=”http://www.examiner.com/x-13746-Tampa-Social-Security-Disability-Examiner~y2009m6d11-How-to-avoid-delays-in-obtaining-Social-Security-disability-benefits-at-the-Hearing-level”>
See entire article here:

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Hearing Request Backlog: Improvement is Minimal

Charles Hall’s blog today nicely supplies graphics for the delays at the Social Security Hearing office, by city. These were orginally published in the newsletter of NOSSCR (National Organization of Social Security Claimants’ Representatives) The worst is well over 600 days wait, the “best” hearing office has a wait of 200+ days. (Click on the images in Mr. Halls blog to enlarge.)

Not much progress has been made in spite of a variety of measures to speed up service delivery - claims are simply coming in faster than they are being resolved. Overall, between January 1007 and April 2009, the average wait for a hearing has just been reduced from 508 to 505 days. Keep in mind that this wait is AFTER denials on initial and reconsideration aspects of the claim, which can take more than a year.

Compare the average processing time as it has changed over time:

January 25, 2007 — 508 days
May 25, 2007 — 523 days
July 28, 2007 — 528 days
August 31, 2007 — 523 days
November 30, 2007 — 500 days
February 29, 2008 — 511 days
May 30, 2008 — 523 days
June 27, 2008 — 529 days
July 31, 2008 — 530 days

September 3, 2008 — 532 days
November 5, 2008 — 476 days

December 3, 2008 — 480 days
March 8, 2009 — 499 days
April 24, 2009 — 505 days

See Mr. Hall’s blog for the list of cities and their respective waiting times:

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Psychiatrist Sets Out Way to Evaluate Disability for Social Security Claim

In Psychiatric Times today, noted Vanderbilt clincal professor Samuel O. Okpaku MD, PhD notes that about 20% of adults who receive Social Security disability benefits have psychiatric disability. Psychiatric disability accounts for a significant proportion of private long-term disability claims and payments.Advances in technology that have had an impact on physical disabilities have not had a corresponding effect on psychiatric disability.

This article is based on the United States Social Security Administration (SSA) model of disability assessments for psychiatric impairment. Since its inception in 1935, there have been several amendments and rul-ings that have attempted to expand and refine the Disability Act. Despite these efforts, the reliability and validity of the disability determination process have been impaired by several factors:

• The inherent difficulty of objectifying psychiatric signs and symptoms

• The fluctuating nature of psychiatric disorders

• Problems with language and communication (central to the collection of data from patients), which may be compromised by the disease process

In addition, many individuals who apply for disability on the basis of physical illness also have comorbid mental disorders.

See remainder of article here:

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Newspaper Receives Award for Investigative Reporting of Social Security Backlogs

Over the past year, the newspaper The Oregonian, Portland and Oregon’s local paper, has been running a series carefully documenting the devastating delays at the Social Security hearing offices, putting a human face on this non-comedy of errors and underfunding. Brent Walth and Bryan Denson of The Oregonian have just won the prestigious Bruce Baer Award for Investigative Reporting, for uncovering the enormous backlog of disability claims in the Social Security system. The articles showed that while claims management is a nationwide problem, Social Security Administration’s Portland office has one of the slowest case-completion rates in the country. The reporters found several cases in which claimants died while waiting for a benefits determination from the office: On average, it takes nearly two years for the Portland office to handle the appeal of a case.

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Social Security’s Stimulus Checks Should be Arriving by June 4

The Philadelphia Inquirer today notes that “if you or a loved one is on Social Security or Supplemental Security Income and that $250 stimulus payment for each beneficiary has not arrived by check or direct deposit, visit socialsecurity.gov online or call 800-772-1213. Start inquiring on June 4.

Medicaid patients in nursing homes may keep their $250, which will not be counted as income for Medicaid purposes. Hang up on anyone calling to help you get the payment. Don’t spend it all in one place.

Second, you may have heard that the government has decided inflation is so low that for the first time there will be no Cost of Living Adjustment or COLA (increase) in Social Security benefits for the next two years. Former Deputy Social Security Commissioner Andrew Biggs says this news is not all bad because benefits will remain the same while the cost of living is less, which means many beneficiaries will still be ahead. However, many retirement experts have suggested the cost-of-living index for older people should be higher than the rest of the population, in large part because of out-of-pocket medical and drug costs.

Barbara Kennelly of the National Committee to Preserve Social Security and Medicare says that “zero COLAS would also mean no Medicare Part B premium increases” for most beneficiaries, for, by law, Social Security benefits may not decrease for current beneficiaries. However, new and affluent beneficiaries will be subject to the higher Part B premiums. And Part D premiums, which are expected to rise by 11 percent, she said, will continue to shred the already-tattered budgets of many older Americans.” Link to story here:

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Benefit Applications Soar in First Quarter

From the web site UPI.com comes this news: The recession-driven safety net of government benefits is at a record high, as $1 of every $6 of U.S. income is a government payment, an analysis showed.

The Bureau of Economic Analysis said benefits such as Social Security, food stamps, unemployment insurance and healthcare accounted for 16.2 percent of personal income during the first quarter of this year, the highest since the government began compiling records in 1929, USA Today reported Thursday.

Federal data indicate government spending on benefits will top $2 trillion in 2009, averaging $17,000 provided to each U.S. household. Benefits rose at a 19 percent annual rate in the first quarter of 2009 compared to the last three months of 2008. Full detail of story here:

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