Documenting Disability for Medi-Cal and Social Security. Joe Hennen Vocational Rehabilitation Services Chris A. Douglas Legal Aid Society of San Mateo County. Outline of Training. Primer of Disability Benefits SSI and SSDI Medi-Cal and Medicare Application Process
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Documenting Disability for Medi-Cal and Social Security
Vocational Rehabilitation Services
Chris A. Douglas
Legal Aid Society of San Mateo County
SSA administers 2 disability programs:
Social Security Disability Insurance (SSDI)
Supplemental Security Income (SSI)
Call SSA at 1-800-772-1213 or file claim online to establish Protective Filing Date
Complete Application and Disability Report
SSA Determines Non-Medical Eligibility
SSA Sends Medical Information & Releases to State DDS, Where A Disability Analyst Is Assigned
DDS Processes & Makes Disability Determination
Claimant’s Folder Is Returned To Local SSA Office
SSA Notifies Claimant of Decision By Letter
“The inability to do any substantial
gainful activity by reason of any medically determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of not less than 12 months or result in death.”
Is the claimant engaged in substantial gainful activity?
If yes, not disabled. If no, proceed to step 2.
Does the claimant have a severe impairment?
If no, not disabled. If yes, proceed to step 3.
Does the claimant have an impairment that meets or equals a listed impairment?
If yes, disabled. Process stops, you win! If no, proceed to step 4.
Can the claimant return to his or her past relevant work?
If yes, not disabled. If no, proceed to step 5.
Can the individual do any type of work that exists in significant numbers in the national economy?
If yes, not disabled. If no, disabled. You win!
5-Step Disability Evaluation Process
Behavioral or physical changes associated with regular substance use that affects the central nervous system.
The required level of severity is met when the requirements of any of the following (A through I) are satisfied:
A. Organic mental disorders - 12.02
B. Depressive syndrome – 12.04
C. Anxiety disorders – 12.06
D. Personality disorders – 12.08
E. Peripheral neuropathies – 11.14
F. Liver damage – 5.05
G. Gastritis – 5.00
H. Pancreatitis – 5.08
I. Seizures – 11.02 or 11.03
The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.
A. Medically documented persistence, either continuous or intermittent, of one of the following:
1.Depressive syndrome characterized by at least four of the following:
B.Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration; or
C. Medically documented history of a chronic affective disorder of at least 2 years’ duration that has caused more than a minimal limitation of ability to basic work activities, with symptoms and signs currently attenuated by medications or psychological support, and one of the following:
1. Repeated episodes of de-compensation, each of the extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
Understanding, Remembering, and Carrying Out Simple Instructions
Making Simple Work-Related Decisions
Responding Appropriately to the ordinary stress of a work-day or work-week
Interacting Appropriately with Supervisors, Co-workers, or the public
Keeping Regular Attendance
Dealing with Changes
Can Patients Meet the Basic Mental Demands of Work?
550 Quarry Road, San Carlos, CA
(650) 802-6578; 802-6486
1515 S. El Camino, CA 94402
5th Ave, San Mateo, CA 94402