Need opinions - SSI eligibility question

Discussion in 'The Watercooler' started by flutterby, Jun 25, 2013.

  1. flutterby

    flutterby Fly away!

    I'm just looking for opinions from any of you who have done this process for either yourself or your kids.

    difficult child has applied for SSI. Technically, I am applying for her - as in, I'm filling out all of the paperwork, etc, but since she is chronologically 18 years old the SSA sees it as difficult child applying. And, it's not SSI. It's Adult Child with a Disability. Since she draws a child benefit from my SSDI, and because they are counting child support that I received as her income (they also count it as mine, so they are counting it twice, but whatever), her income is too high for SSI. From my understanding, it's the same eligibility process, however if she were to apply for SSI later - such as when child support stops - they don't have to use the medical decision that is determined under Adult Child with a Disability, but they can. They really make this stuff way too complicated.

    Anyway, I got a call today from someone from Social Security who wanted to know if difficult child would consent to a "state paid exam". At least, he said he was from Social Security. The paperwork that we received to complete after filling everything out online and having an appointment came from the Bureau of Vocational Rehab or something. Like I said, they make this too complicated with too many names and programs that all essentially do the same thing. Anywayyyyyy...I was in the car and difficult child wasn't with me, so she has to call back. This is strange to me because I wasn't given an option to consent when my claim was being considered - I was told where and when to show up. I just assumed that it's a pysch exam because that is why she is filing, but I didn't have the presence of mind to ask specifically what type of exam. I will ask. My concern is that for my SSDI, they took the recommendation of a doctor who spent 15 minutes with me over 10 hours of neuropsychologist testing, medical records, etc. Until it went to court, anyway. I don't know what happens if she were to not consent. I'm really tired and didn't think to ask that, either. And I'm kind of afraid to. I don't want to give them reason to think it's not a legitimate claim, her psychiatrist and therapist are the ones who insisted that I file this for her, but no one's going to see the issues with difficult child in 15 minutes.

    So, my question is this - if she can opt out, would you? Does not consenting means automatic denial?
  2. DDD

    DDD Well-Known Member

    I am not an expert. difficult child#2 was on disability for about eighteen months. He has a variety of MH issues that were well documented by experts when he lived with me. He was not given an option but was given an appointment to meet with a therapist for "review". The therapist was the one I used when difficult child#2 was in elementary/middle school and frankly I found him to ge a pleasant but not very swift professional.

    I drove difficult child#2 to his appointment and when the therapist came out to get him he asked difficult child "would you like to come in alone or would you like your Grandmother to come with you?" difficult child opted to go alone as he was happy to see a familiar face. He lost his disablity status (a letter came in a few weeks). It is not possible to id his disabilities in a brief visit. He is a good looking kid, polite AND gives upbeat responses (that often have no validity). "How are you doing difficult child?" "Great!" "Do you have any friends?" "Yes...I have alot of friends!" "Do you have a job?" "I am going to the community college next semester to become a Nurse." "That's great, difficult child".

    I appealed with-o success. The appelate SS officer told me "I really understand what you are dealing with but there is not enough evidence that he is unable to work. I will recommend he reamain covered but frankly I doubt he will be." It has been three years or so. difficult child does not live with me. He has been hired by McD's and couldn't take the stress of multi tasking. Recently he was hired to become a Correctional Officer for the State. That career ended on the third day he began training.

    In answer to your question I do not think you can say No. I know that they want "current" evaluations that prove disability. As an adult your difficult child will be alone to answer questions. I wish you well. Hugs DDD
  3. Hound dog

    Hound dog Nana's are Beautiful

    Flutter, you should have asked what type of exam............physical or mental.

    I'm not expert, all I can do is tell you what they did when Travis applied. (and from what I've learned from others.........seems the process is basically the same)

    He had a "physical exam". In other words, he had a very brief check over by a MD (chosen by SS ), after which I sat there for 20 mins giving the background information. doctor was fine with that since Travis both wanted me there and admitted he could not give doctor the background info........there is just too much to remember. I've been quoting it so often over the years it just comes out automatic. lol

    He had a vision exam because one of the things he listed was the legally blind thing. (chosen by SS) Run of the mill optometrist . Here I thought they'd have him see a specialist because his visual issues are more neuro related than "disease".

    He had a psychiatric exam. If you could call it that. According to Travis and others I've spoken with it is basically a memory exam with some psychiatric questions tossed in for good measure. Not a clue of the testers qualifications but it was a mighty simplified exam.

    He didn't see one specialist. Katie's biomom didn't see one specialist. Several of my friends never saw specialist. Seems like it is basic categories and what is not obvious is going to be based on doctor reports ect.

    I'm not sure if that is helpful or not.
  4. flutterby

    flutterby Fly away!

    She sees a therapist weekly and a psychiatrist monthly. I would think those would be current enough, and would prefer they use their evaluations. I was thrown by this because they can't even schedule the appointment until she gives consent for the exam. Like with your difficult child#2, I wasn't given a choice either. I hate this stuff.
  5. ctmom05

    ctmom05 Member

    When I applied for my son to get SSI he was 7 years old and already had a documented treatment history. The powers that be at SS decided we needed to see "their" doctor, in other words a professional of their choosing. If we did not consent to this the claim would be denied. We could fight it, however. I did not see the appointment as optional.

    When we went to the SS doctor he said "I don't know why they put you thru this. Your son is very clearly disabled." SS was granted.

    Your experience and my own may be vastly different, but I don't think the doctor exam is purely optional. You can say no, but the other road is probably a much more difficult one to take.
    Last edited: Jun 26, 2013
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I would not turn it down but I would also not fret about it. I am probably the only person in history who got into an argument with the SS psychiatric That was because he wanted to argue with me over the year the first shuttle exploded. He said it was 85 and I knew without a shadow of a doubt it was January 86. I knew it was because it was after my birthday and I was pregnant and I had Cory in 86 so it had to be 86 if it was in January because 86 had just begun on the first day of January! I think I remembered it more clearly because I had more events in my life to make it unforgettable. He just wanted to argue with me...lmao.

    Now Buck just went through his application and saw two doctor's referred by SS - a shrink and a general practitioner - and he was approved on the first try. I do think that was because of his age, his occupation and lack of education along with what his disability is.
  7. Hound dog

    Hound dog Nana's are Beautiful

    I also would not fret it as SS choice of docs don't seem to be anywhere near "top notch". At least in our area. I had a notion, not sure where I got it from, that SS docs were out to do their best to prevent someone from claiming the benefit. I certainly have not seen this to be the case.

    M was turned down flat. But then I knew he would be. Katie tried to get it on the old "bad back" thing. Now he may or may not have back issues. But SS was so scammed in that area in the past that it is almost an automatic refusal. It didn't help him that he walks a mile one way to work. If your back is bad enough you can't work you'd not be able to do that. (and stand for 8 hrs) If she had attempted on his low IQ or some other area, most likely he'd been accepted. I haven't told her this, however. lol Nor do I think M's pride would let her file it that way.

    In our area, most people file through Chillicothe. So far M is the only person I've ever seen be turned down. I dunno if they're more lenient or what. I DO know they tend to be much more helpful with the process.

    While this topic is here............I don't want to high jack your thread but I have a question.

    When we re-applied for our food stamps the CW noted Travis' income.........that he was paying a step down for medicare, which of course took a large chunk of his income right off the top. She said now that we re-applied for the food stamps, the state would take over as his insurance. It would take a while, but once it did he would have no more step down payment and his disability would go back to the normal amount. But at that point the state would only cover 80 of his bills. I'm still trying to figure out where they think that 20 percent of his share is going to come from. They certainly don't give him much of anything and he is helping me pay bills. I'm trying to motivate him to get his rear to the doctor, because he is in serious need of treatment for the blood disorder (he needs phlebotomy really bad). His blood pressure is through the roof and I'm afraid he's going to stroke again before I can convince him. He refuses because he knows what the bills are, knows where what little money he has needs to go, and knows there is none left over for either the step down or the 80 percent. ugh

    I'm confused. I know others that the state took over and they're paying the step down PLUS only are 80 percent covered. (they're also not being treated because they can't afford it) I don't have the brightest CW in the world. She can't explain to me why the state insist on giving a menopausal woman birth control coverage. lol
  8. DDD

    DDD Well-Known Member

    Forgot to mention that I was told that soon after adulthood they had to reevaluate as adult and childhood disability claims are handled differently. My difficult child#2 has no physical disabilities and presents very well. It's all MH stuff that blends into a mess, sigh. I would guess that your difficult child will have no problems as both therapist and psychiatrist are completely involved on a scheduled basis. It is a pain to jump thru the hoops, I know. DDD
  9. flutterby

    flutterby Fly away!

    Lisa, I have no idea. I don't understand any of your question. LOL! I've never heard of step down for Medicare - my Medicare is $105 a month that comes out of my SSDI. Even though my income is pitiful - my monthly SSDI is the equivalent of what I made in working a week and a half 6 years ago - I don't qualify for food stamps or medicaid. My copay for specialists is $40, and a specialist is anyone other than a GP. Because I have so many that I'm supposed to see - cardiologist, rheumatologist, orthopedist, therapist, and now Occupational Therapist (OT) for my hands - I have to pick and choose how often I can go to the doctor based on what is most pressing.

    What I suggest is that you see if your hospital or any doctor's office affiliated with the hospital has a program for low income patients. OhioHealth which is big in the Columbus area, and which also owns a lot of doctor's offices (my cardiologist group, and my former GP for example) will treat anyone regardless of ability to pay. I'm supposed to have Occupational Therapist (OT) done at Grady Hospital in Delaware which is owned by OhioHealth and so I'm going to check into that program. I certainly qualify based on income, and I know I qualify for inpatient stays, but am not sure how it works for something like Occupational Therapist (OT). I know I'm not making much sense. Flaring hard - mind is scrambled.

    DDD, difficult child is already an adult, so there won't be that issue. However, if we decide to apply for SSI when child support goes away and her income drops below the threshold, then they may accept this decision (if she's found to be disabled), or they may decide to do the process all over again.

    Thanks everyone. psychiatrist and therapist did get a records request from Vocational Rehab which is somehow who this process is through, even though you apply at the Social Security office, so I feel better. When I first applied for SSDI, they didn't request records from anyone. They used the copies of records that I happened to have, which was a mish mash and not at all complete. It wasn't until I got an attorney involved and he got copies of the records and sent them to Social Security that they had them. I think that's why I'm so apprehensive - because in my case they used a 15 minute joke of an appointment and didn't bother to get my medical records.
  10. Hound dog

    Hound dog Nana's are Beautiful

    I re-read what I wrote in that last reply........... and that is what I get for typing with a severe headache before the tylenol kicks in. LOL But I'm not sure if I can explain it better because I've never been quite sure I understand it myself.

    Travis gets SSDI. Last year he was notified that he would pay 124.00 per month out of his SSDI for medicare. He was getting 700.00 and something.......step down took effect he dropped to 600.00 and something. (yes, that hurt too) I wasn't too pleased, as one of the big reasons we opted for disability was to get the kid into treatment for the blood disorder again.

    CW said that the state will take over Travis' medicare. (I have no clue what she means by that I have a moron for a CW) Once the state takes over his SSDI will return to the normal amount. But the state version (?) will only cover 80 percent of his medical anything, which means Travis would have to cover 20 percent himself. Laughable as when you don't have it I dunno where they think it's going to come from.

    I can further confuse the issue. Katie's biomom also gets SSDI. She has the 124.00 "step down" only hers is like a deductible. Any month she has a doctor appointment or picks up medications she has to go to family services and pay the step down fee BEFORE she can be seen by the doctor or whatever, so they cover the cost of the visit. So she does her best to see every doctor she can in the same month and make sure they all write scripts that last several months. That one has me totally baffled. Maybe I should ask Katie if she has biomom as a dependent or has her helping pay the bills. Maybe that makes the difference?

    I dunno. This junk is so confusing I don't even think the govt workers know what their doing. ugh
  11. flutterby

    flutterby Fly away!

    I still don't know about the step-down, or why his Medicare is $124 a month. Medicare should be $105 a month for everyone, I thought. What the state is doing is picking up what he pays for Medicare every month - paying his medicare premium. The 80/20 is probably just how straight Medicare covers. I don't have straight Medicare. I have an Advantage plan, so I have copays. Some things are percentages, such as ambulance, but most things are copays. I don't know when Travis got Medicare, but you have 3 months from the time you receive it to select an Advantage plan (go to Other than that, you have to wait until open enrollment which is October or November - or maybe October and November.

    He should also qualify for Extra Help with Prescriptions which is through Social Security. Call your local office or the main 800 number about that. If he qualifies for Extra Help with prescriptions (I don't pay more than $6 for a brand name prescription), then you can sign up for and switch Advantage plans anytime - you don't have to wait for open enrollment. I was automatically enrolled when I received SSDI and Medicare. You have to recertify every year.

    You need a doctorate to understand this stuff. it turns out, everyone is always supposed to give consent before being seen by a SS doctor. Apparently, most caseworkers just don't do it. I asked the guy today about it since I was thrown by difficult child needing to give consent. And it's a psychiatric exam, too.
  12. flutterby

    flutterby Fly away!

  13. Hound dog

    Hound dog Nana's are Beautiful

    Thanks Flutter. :)

    They start talking this stuff and they might as well be speaking another language as far as I'm concerned. I'll check it out. He needs treatment and one of us needs to at least "somewhat" understand this junk.

    They had Travis sign one consent form...............and that was for me to act in his we're sort of in it together. I'm allowed to help him since they have his consent for it on file. That was prior to any doctor appointments, so perhaps they felt it applied there as well.
  14. flutterby

    flutterby Fly away!

    Was this prior to his claim being accepted or after? I'd like to have that consent form. difficult child doesn't understand any of this at all.
  15. Hound dog

    Hound dog Nana's are Beautiful

    It was prior, right after we started the process. That I remember clearly because Travis refuses to talk on the phone unless given absolutely no other alternative. I knew they'd be calling often... ect.

    Once the consent was filed all Travis did was go and do what I told him as per the phone calls/ letters. Oh, and make sure you get gas vouchers if you can too.
  16. flutterby

    flutterby Fly away!

    difficult child refuses to talk on the phone unless absolutely forced. I have to put it on speaker and basically tell her what to say. She won't even talk to her brother or Nana on the phone unless it's an emergency. I'm going to ask about that consent form.
  17. DammitJanet

    DammitJanet Well-Known Member Staff Member

    ok...wait, something is wrong here. I need to look up your income levels for medicaid in OH. Something doesnt sound right here.

    For example, and NC is poor state and in the south which is normally not known for having any great programs better than other states, I now get 800 a month after all the cost of living raises since I started at 737 in 2007. Back then the cut off for medicaid for single person with disability wast 800. Now it has been raised to 850. It has slowly been raised also with the cost of living.

    What this means is that medicaid picks up my $105 charge for having medicare, the $200 that you have to pay each year before medicare kicks in and the 20% of all medicare charges. It also picks up all copays and pays for my medicare part D payment up to a certain amount and it pays a certain amount on those medications. I have either a $1 or $3 copay on my medications.

    Let me look up your medicaid cut off amounts. Hold on. Well I will be darned. I think you guys have some sort of system I cant even figure out. At least at this hour of the morning. It makes no sense to me. It appears to me the cut off is extremely low but that you can somehow buy in by doing things not very hard. One thing I think might be an issue is that they may think Travis may still be working. Not sure. There is something to do with blind that I cant figure out for the life of me. I dont know. You may also have to say he is an heir to the house. I would do that if it gets more stamps. Whatever. Darned if I can figure the stupid regulations out. One thing it looked like to me was it said that they were denying any more disability claims. Interesting.