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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
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SSA rules:
We explain when vocational factors must be considered along with
the medical evidence, discuss the role of residual functional capacity
in evaluating your ability to work, discuss the vocational factors
of age, education, and work experience, describe what we mean by
work which exists in the national economy, discuss the amount of
exertion and the type of skill required for work, describe and tell
how to use the Medical-Vocational Guidelines in appendix 2 of this
subpart, and explain when, for purposes of applying the guidelines
in appendix 2, we consider the limitations or restrictions imposed
by your impairment(s) and related symptoms to be exertional, nonexertional,
or a combination of both. A decision by any nongovernmental agency
or any other governmental agency about whether you are disabled
or blind is based on its rules and is not our decision about whether
you are disabled or blind. We must make a disability or blindness
determination based on social security law. Therefore, a determination
made by another agency that you are disabled or blind is not binding
on us. The law defines disability as the inability to do any substantial
gainful activity by reason of any medically determinable physical
or mental impairment that can be expected to result in death or
which has lasted or can be expected to last for a continuous period
of not less than 12 months. To meet this definition, you must have
a severe impairment, which makes you unable to do your previous
work or any other substantial gainful activity that exists in the
national economy. To determine whether you are able to do any other
work, we consider your residual functional capacity and your age,
education, and work experience.
There are specific rules and requirements that must be met before
even the consideration of coverage under SSA will even regard as
viable before a determination will be made: income, the ability
to work (or is there some other type of work the claimant can perform),
education or lack or (can the claimant work at a lower scale if
able to), gifts to the claimant, etc. This must be met or the claim
may to rejected as unsound.
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Document Name & Link to Document
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Description
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File Size /Type
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2005 Medicaid and Medicare Cutbacks |
Federal
legislation & state responses to Hurricanes Katrina & Rita
were still pending on 9/30 & aren’t addressed in this
issue. |
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2005-06 State Medicaid Cuts & Expansions:
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Proposed
cuts in funding & Enacted draft # 1, January 1, 2006 |
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Medicaid Watch: State Medicaid and
Health Cuts & Expansions 4-07 |
Cuts in Medicaid within the US |
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A CONSUMER’S GUIDE TO HEALTH INSURANCE
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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. |
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Childhood-Disability Evaluation Under Social Security-2003 |
Rules and regulations for childhood disability |
502 kb pdf |
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Disability
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Hepatitis and Social Security Disability Benefits-What
you need to know
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PDF / 445 KB
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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
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903 kb pdf |
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Disability Evaluation Under Social Security-Listing of
Impairments—Part A |
Complete
listing of impairments-2003 |
644 kb pdf |
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Disparities in State Health Coverage: A Matter of Policy or
Fortune?
(Large
Report-Increase Download Time) |
This paper explores the reasons why states differ in their
Medicaid coverage of the at-risk population, focusing in particular
on the large disparities in Medicaid spending associated
with these differences.
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3378 kb pdf |
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Guilty until proven innocent-Dealing with a flawed SSDI
Application process
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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 |
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Handbook
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SSA Handbook on obtaining benefits
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PDF / 8,144 KB
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HEALTH AND
DISABILITY INSURANCE, and SOCIAL SECURITY DISABILITY: A HANDBOOK
FOR IBD PATIENTS,
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Patients
with chronic illnesses unfortunately must advocate for
themselves, whether it be with a doctor or an insurance company.
Knowing your rights will help. If you have internet access, you
have access to the best research tool in the world. |
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Hepatitis
C & Disability
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Social Security disability benefits are often
the ultimate safety net for
persons suffering from medical impairments which make it impossible
for them
to work
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Hepatitis
C-Information
on Disability
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Links to agency’s
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Health Hippo:
Evaluations of Social Security Disability Part ONE
(Large report-increased
download time)
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HIPPA regulations
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Health Hippo:
Evaluations of Social Security Disability Part
TWO
(Large report-increased
download time) |
HIPPA regulations
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Health Hippo:
Evaluations of Social Security Disability Part THREE
(Large report-increased
download time) |
HIPPA regulations
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House Committee on Ways and Means
Statement of Linda Fullerton, Social Security Disability
Coalition, Rochester, New York
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Since my organization primarily consists of SSDI/SSI
claimants, I have to question what sorts of “stakeholders”
the Commissioner met with. Seems like her main concern is
to meet with “stakeholders” who stand to make the most money
from a claimant’s problems with the SSDI/SSI program rather
than the claimant’s themselves who are most affected by
those problems. This is further evidenced by the list of
“stakeholders” referenced in the aforementioned GAO
testimony. Again proof of the Federal Government catering
to special interest groups. While many of these “claimant
representatives” may have good intentions, unless they
personally experience what it is actually like to live
through the process of applying for these benefits, and have
their lives permanently altered as a result of it, they can
never accurately convey to anyone what the problems with
dealing with a severely broken system is like for us. If
this system is ever to be reformed properly, it is crucial
that before any changes to this program are implemented,
that the majority of input/involvement in any phase of
change be with a team of actual SSDI/SSI claimants and the
SSA workers themselves who must implement any proposed
changes. |
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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. |
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The Language
of Disability
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Language. . .has as much to do with the philosophical
and political conditioning of a society as geography or climate.
. .people do not realize 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.
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Legislative Survey of State
Confidentiality Laws, with Specific Emphasis on HIV and
Immunization
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This report examines current state and federal law
protecting the confidentiality of health information. It
focuses on four specific areas: public health information
held by government, privately held health care information,
HIV and AIDS-related information, and immunization
information. The ways in which our modern medical and public
health systems collect, store, and use personally
identifiable information have increased both the potential
benefits from access to such information and the possible
harms from improper uses and disclosures. The report
examines the importance of both the collection of health
information and the protection of its privacy. The
collection and use of health information involves two
important goals, yet sometimes competing goals: 1) gathering
and disseminating accurate and timely information on the
incidence and prevalence of disease, health information
necessary for health care of individuals, assessment of
health care and public health needs and evaluation of
programs, services, institutions and providers; and 2)
protecting that information from uses or disclosures that
cause harm to individuals to whom the information pertains.
The report reviews the current privacy safeguards under both
state and federal law in order to determine whether they are
adequate to protect the privacy of individuals and are
consistent with effective health policy |
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Medicaid Watch: State Medicaid and
Health Cuts & Expansions=March 2007 |
Cuts in Medicare and Medicaid Benefits throughout the United
States |
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Medicare Audits Show Problems in
Private Plans |
Many of the marketing abuses occurred in sales of the
fastest-growing type of Medicare Advantage product, known as
private fee-for-service plans. In June, the government
announced that seven of the leading companies in this
market, including UnitedHealth, Humana and Coventry, had
agreed to suspend marketing of these plans. Medicare
recently allowed them to resume marketing after they took
steps to monitor their sales agents more closely. |
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Medicare To Deny Reimbursement For
Medical Errors: The Blame Game |
Robert Pear of the
NYT reports that CMS is going to cease reimbursing
hospitals for services that are provided as a result of
errors, such as hospital-acquired infections and decubitus
ulcers (commonly known as bed sores)…In a significant policy
change, Bush administration officials say that Medicare will
no longer pay the extra costs of treating preventable
errors, injuries and infections that occur in hospitals, a
move they say could save lives and millions of dollars. |
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Painless, Cost-Free Ways For States
With Budget Shortfalls To Preserve and Even Increase
Medicaid, S-CHIP, Other Health, SSI State Supplement and
Food Program Funding (Without Cutting Eligibility or
Benefits)
by Thomas P. McCormack |
Changes in the laws |
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REDDICK v CHATER |
This case
involves a claim for Social Security disability benefits by
Susan Reddick ("Claimant") who was diagnosed with Chronic
Fatigue Syndrome ("CFS"). The Administrative Law Judge ("ALJ")
found that Claimant suffered from CFS but that she was not
disabled because the disease did not undermine her ability to
perform substantial gainful work. The district court concluded
that the ALJ's decision was supported by substantial evidence
and granted summary judgment for the Commissioner. A principal
issue in this case is whether the ALJ was justified in
discounting the testimony of Claimant, her treating doctor,
and an examining doctor concerning her disability from
fatigue, and instead relying upon the testimony of two
consultative examiners who concluded that she was not
disabled. |
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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. |
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Social Security Bulletin-2005 |
Current
information about SSI benefits as of 2005 |
1300 kb
pdf |
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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 |
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SOCIAL SECURITY DISABILITY NIGHTMARE –
IT COULD HAPPEN TO YOU!!!
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The Social Security Disability System is set up to suck the life
out of it’s applicants, in hope that they die in the process, so
they don’t have to pay out benefits to them. After filling out
several pages of paperwork which I was told was greatly reduced
from which it had originally been, and submitting a huge stack
of medical records supporting my claim, I was told it would take
4-6 months to go through the process. I was shocked and asked
what I was supposed to live on, and I was told to apply for
Social Services (Medicaid, food stamps and cash assistance)
while my claim was being reviewed. I did just that, and was
denied any sort of help based on the cash value of a life
insurance policy that is not even enough to bury me when I die.
Due to all my illnesses if I cashed in that policy I would never
be able to get insurance again! That process and paperwork was
very difficult and humiliating and then to be denied that help
too, just added even more to my stress and misery. Since many
SSD applicants are forced into poverty while waiting for their
claims to be processed (many years in some cases), they have to
apply for state programs in addition to SSD such as Medicaid,
food stamps, cash assistance and other state funded programs |
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SSA
ISSUES RULES IMPORTANT TO BENEFICIARIES IF SSA DECIDES THAT
THEIR CONDITIONS ARE NO LONG DISABLING |
For over two
decades, federal law has required that the Social Security
Administration continue payment of disability benefits to a
person whom SSA has determined if SSA determines that the person
is participating in a vocational rehabilitation program and
there is a likelihood that completing the program will make it
less likely that the person will need to resume receipt of
Social Security or Supplemental Security Income disability
benefits in the future...The purpose of this paper is to explain
the new regulations and to alert people with disabilities, their
families, schools, service providers, and advocates that these
regulations will take effect on July 25, 2005 and will be of
significant benefit to some individuals who otherwise would lose
their benefits when SSA decides that they currently are no
longer disabled |
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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. |
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State Medicaid Eligibility Cutbacks & Exclusions-Proposed &
Recently-Enacted, 2001-04 |
Nonetheless, many states dropped coverage of legal
aliens; cut eligibility and benefits for, or even dropped,
state-only medical assistance for the federally-unmatchable
poor; added or raised premiums and copays and cut "optional"
services in S-CHIP and Medicaid; raised Medicaid drug copays;
added preferred formularies, generics requirements and monthly
number limits for Medicaid drugs; stopped “presumptive”
eligibility for pregnant women (a clever back-door way to bar
otherwise-federally-mandated coverage of citizen-to-be fetuses
of poor illegal alien mothers) and curtailed services and
enrollment in expensive home and community-based (HCB)
waivers. |
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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 |
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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. |
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