Wednesday, July 20, 2016

Denying Children Medicaid Benefits

Parents who learn that their child has been diagnosed with a debilitating mental health disorder are often times at a loss as to how to proceed. Those who live with mental health conditions often require intensive therapies to mitigate the impact the problem has on their life. Such treatments, while effective, are both time consuming and expensive—costing tens of thousands of dollars. Most hardworking Americans cannot afford to pay for behavioral therapies out-of-pocket, so they will typically turn to private or state health insurance coverage to offset the costs.

State assistance is typically the favored course, and many children who have a disability qualify for Supplemental Security Income (SSI). Through SSI children with disabilities may also qualify for Medicaid, as well. According to the Social Security Administration (SSA), those eligible for SSI for children benefits must be either blind or disabled. The criteria for which are as follows:
  • If under 18, whether or not married or head of household, the child has a medically determinable physical or mental impairment or impairments which result in marked and severe functional limitations.
  • The impairment(s) has lasted or can be expected to last for a continuous period of at least 12 months or be expected to result in death.
  • If the child is blind, he or she meets the same definition of “blind” as applies for adults. Unlike the requirement for SSI disability benefits, there is no duration requirement for SSI blindness benefits.
SSI benefits are a crucial resource for covering the costs of the evidence based treatments available, therapies which could greatly improve one’s quality of life down the road. It is often recommended that a child who is diagnosed with autism undergo what is known as applied behavior analysis (ABA). A therapy which could go on for years and is extremely costly. Fortunately, in 2014 the federal Centers for Medicare & Medicaid Services (CMS) mandated that all states cover all medically necessary care for Medicaid-eligible children with autism up to age 21.

In California and a number of other states, the CMS mandates have allowed for many children with autism to get ABA treatment, saving parents thousands of dollars each year. Unfortunately, some states have not been so eager to follow the directive. In Texas, for instance, children with autism who have qualified for Medicaid and have been given ABA recommendations, are being denied coverage, Disability Scoop reports. This has forced some parents to get private insurance plans for the children, coverage which carry outrageous deductibles.

While both speech and occupational therapy are covered under the Texas Medicaid program, ABA is not currently a defined benefit. ABA claims are denied despite the fact that research has shown that the therapy can greatly improve the life of a person with autism.

“ABA is based on scientific research,” said Dan Unumb, executive director of the Legal Resource Center at Autism Speaks, a national advocacy group for families. “For many kids it takes upwards of 30 hours a week of intensive therapy to achieve desired results. That sounds like a lot, but when you’re looking at a lifetime of consequence, and at the dramatic difference it can make, it makes sense to comply with the law.” 

Stephanie Merritt Driscoll is an attorney in Southern California who focuses her practice as a Social Security Disability advocate.

Wednesday, July 6, 2016

ABLE Act Moves Forward

While college is worth the time and hard work, it is also very expensive—more so today than just a few years ago. Parents have the ability to open what are called 529 plans for their child, which is a tax-advantaged savings plan designed to encourage saving for future college costs. By the time their child matures to college age, there will hopefully be a significant amount of funds available to offset the costs of higher learning.

Using 529 as a model, in 2014 President Barack Obama signed the Achieving a Better Life Experience (ABLE) Act. The legislation allows for a tax free savings plan for American’s with disabilities. The ABLE Act will allow certain individuals with disabilities and their families to set up a tax-exempt savings account. The funds are to be used for:
  • Medical Expenses
  • Maintaining Independence
  • Improving Quality of Life
The ABLE Act mandates each state independently establish and implement ABLE accounts. Now, almost two years later, states are preparing to launch ABLE programs. Nebraska was the first state to offer their version of the program, according to the ABLE National Resource Center. On June 30th, the state began offering ENABLE accounts, people with disabilities can save up to $14,000 a year without having to worry about it affecting their Social Security, other benefits and they can keep their Medicaid cards.

At the moment ENABLE, ABLE TN, and the Ohio STABLE Account program are programs available in the country, but other states are expected to launch their version of ABLE in the coming months. People are signing up for ABLE accounts using online portals.

Leading up to the passing of the ABLE Act, Sara Wolff who lives with Down syndrome wrote an op-ed for Change, she said:

"When the ABLE Act passes into law this year, it will change my life forever. I lost my mother this past year, Connie, to a sudden, rapid illness. With my whole life ahead of me, I need an ABLE account to plan for my future. And, I am not alone, like most individuals with disabilities, people with Down syndrome and other conditions are out living their parents. "

Please take a moment to watch a short video:

If you are having trouble watching the video, please click here. And information about the State of California's upcoming ABLE Act can be found here.

Stephanie Merritt Driscoll is an attorney in Southern California who focuses her practice as a Social Security Disability advocate.