Benefits and Community Supports for Persons with Developmental Disabilities and Mental Illnesses September 9, 2009

1. Ann Carrellas, LMSWVice President/Director of Family Resource CenterWashtenaw Association for Community Advocacy1100 N. Main Street, Suite 205 Ann Arbor MI 48104734-662-1256 Benefits and Community Supports for Persons with Developmental Disabilities and Mental Illnesses September 9, 2009

2. What we will talk about today Applying for Social Security Disability benefits Other financial programs How to effectively advocate for appropriate mental health services

3. What I want to leave knowing Please take a moment and think about one or two things you hope to understand about Social Security Disability programs and other supports. If I don’t answer your questions during the presentation, please ask.

4. Social Security Disability Application Process • Don’t Forget • Always tell the truth • Focus on what’s difficult for you to do in daily life and on the job

5. Marsha’s Laws of Surviving Bureaucratic Balderdash: Save everything you receive from any state or federal agency. Copy everything you give to them. Don’t look for logic.

6. Supplemental Security Income (SSI) Based on need (income and resource limits). Check arrives on the 1st of the month. Benefit amount varies with living arrangement. Medicaid included in Michigan. Asset and resource limitations are: $2,000 for individual, $3,000 for a couple Payment rate is about 75% of poverty. For 2009, $674/month for an individual($1,011 for couple) for independent rate.

7. Social Security Benefits(Old Age/Retirement, Survivors, Disability (SSDI, Title II) No resource limits, no limit on unearned income. Check arrives on 3rd or another assigned day. Benefit amount depends on work record, age when benefits begin, # of people receiving. Medicare after 24 months of eligibility. Substantial Gainful Activity applies

8. Concurrent Recipient Receives both SSI and SSDI in two checks. Total of benefits is $20 more than SSI alone.

9. The Law The Social Security Act and current amendments (applies at Administrative Law Judge level) Code of Federal Regulations--CFR 20, parts 400-499 applies at Administrative Law Judge level) Program Operations Manual (POMS)-day to day policy used by SSA District office staff. All the above are on line at www.ssa.gov, search program rules.

10. The 14 Adult Listings Musculoskeletal System Special Senses and Speech Respiratory System Cardiovascular System Digestive System Genitourinary System Hematological Disorders Skin Disorders Endocrine System Impairments that Affect Mulitple Body Systems Neurological Mental Disorders Malignant Neoplastic Disorders Immune System Disorders

11. The 6 reasons you could be found not disabled: Earning SGA. Do not have a medically determinable impairment. Have an impairment that does not significantly limit the physical or mental ability to do “basic work activities”. Fail to meet the duration requirement. Be capable of past relevant work. Be capable of other work.

12. Basic Work Abilities Think about some of the problems a person with a developmental disability or mental illness might have in terms of basic mental and social abilities needed to work as we go through the next few slides.

13. Basic Work activities defined: Remember work like procedures. Understand, remember and carry out very short and simple instructions. Maintain attention for two hour segments. Maintain regular attendance and be punctual within the customary, usually strict tolerances. Sustain and ordinary routine without special supervision. Work in coordination with or proximity to others without being unduly distracted.

14. Basic Work activities defined: Make simple work related decisions. Complete a normal work day and work week without interruptions form psychologically based symptoms. Perform at a consistent pace without an unreasonable number and length of rest periods. Ask simple questions and request assistance Accept instructions and respond appropriately to criticism form supervisors.

15. The process: Step one Call your local SSA office, or 1-800-772-1213 to request an application OR Apply on line at www.ssa.gov This activity assures your “protected filing date (the date benefits will go back to when you are approved).

16. A little known, but important fact about the process The claimant is responsible for making sure that their medical evidence reaches SSA and therefore, DDS. DDS and SSA make a minimal effort (that is why we sign all those releases) but you are the person with the most at stake - take an active role! Your active participation in this, will make a HUGE difference in whether or not you are awarded benefits on first application.

17. Step two Fill out all the paperwork in detail. Write as if you are drawing a picture of yourself and your disability for the examiner (who will never meet you). The forms can be intimidating - take a break, ask for help.

18. Step three Call the DDS examiner every 10 days to check on your case. Find out what they have for medical evidence. If there are medical reports that will help the examiner make a decision and recognize your disability, get copies of them to DDS. Have your treating MD’s fill out supporting medical evidence paperwork.

19. Step four Go to consultative examinations. If you do not have or have not had health insurance, make sure you let people know this at SSA in your forms and at your appointments.

20. If the doctor who treats you will fill out forms, have him or her do so - their opinion means a lot.

21. Approval or Denial If approved, you will get a letter stating this. You will need to go to SSA to begin receiving benefits. If denied, you need to decide within 60 days whether or not you want to appeal. If you decide to appeal, go to SSA and file the appeal forms. (Appeals take 18-24 months from the date you file).

22. Questions?? Do I need a lawyer to appeal? No, you can do it yourself or get a non-attorney representative. I heard everyone is denied the first time they apply, Why is that? Actually a significant number of people are approved. Generally, it seems that the main reason people are denied is because there is not enough medical evidence.

23. Other Financial Resource Programs Apply for these programs through your local Dept. of Human Services State Disability Assistance ($264 a month) Food Assistance (food stamps) State Emergency Assistance Childcare assistance Financial assistance to families with dependent children

24. Other Financial Resource Programs • Affordable housing such as: • Section 8 vouchers-sometimes persons with disabilities go to the top of the list • Subsidy based housing in a congregate site-- contains accessible units • Public housing • Michigan State Housing and Development Authority specialized home ownership programs for persons with disabilities

25. Accessing Community Mental Health Services • Each Community Health Board has the same general definitions of developmental disabilities and mental illness. • How they interpret those definitions in terms of who they serve is somewhat up for grabs. • There are different services for folks who have Medicaid and different entitlements if you have a developmental disability versus a mental illness.

26. Developmental Disabilities • Michigan defines as: • “Developmental disability” means either of the following: • (a) If applied to an individual older than 5 years, a severe, chronic condition that meets all of the following • requirements: • (i) Is attributable to a mental or physical impairment or a combination of mental and physical impairments. • (ii) Is manifested before the individual is 22 years old. • (iii) Is likely to continue indefinitely. • (iv) Results in substantial functional limitations in 3 or more of the following areas of major life activity:

27. Developmental Disabilities (cont.) A) Self-care. (B) Receptive and expressive language. (C) Learning. (D) Mobility. (E) Self-direction. (F) Capacity for independent living. (G) Economic self-sufficiency. (v) Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated. Michigan Mental Health Code

28. Mental illness eligibility • Qualifying diagnosis and one of the following: • Significant functional disability • Certain prior service utilization • Sufficient duration of illness Or Non-qualifying diagnosis and all the above

29. Qualifying Diagnoses • Schizophrenic Disorders • Major Depression • Psychosis NOS • Dementia with delusions, depressed mood and/or behavioral disturbance • Personality Disorder

30. Unqualifying Diagnoses • Partial list: • Panic Disorder with or without agoraphobia • Generalized Anxiety Disorder • Dissociative fugue or amneisa • Obsessive Compulsive Disorder • Dysthymic Disorder • Anorexia Nervosa • Post Traumatic Stress Disorder

31. Functional Degree of Disability • Personal hygiene and self care • Self Direction • Activities of daily living • Learning and recreation • Social transactions and interpersonal relationships

32. Duration--will or has lasted 6 months or prior history of mental illness • Prior service utilization--two or more admissions or inpatient hospitalization exceeding 30 days or state hospital admission or 20 or more outpatient mental health visits in a calendar year

33. How can I effectively advocate for someone to receive appropriate mental health services? • Educate yourself about the policies and procedures that impact eligibility in your local area • Advocate for the right interpretation of the rules • Work with the person, their family, other social workers to define how the person meets the functional limitations criteria

34. Effective Advocacy • Prepare a packet including a letter that outlines why you think this person meets criteria and back it up with psychological assessments, school records, statements from family and friends. Send it in before the intake phone call or meeting. • Call in with the person for the first contact and ask if you can also offer information. Refer to the packet you have submitted. • If the person is denied, file an appeal and help them through the process.

35. Questions? Thank you for your time.