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July 5, 2013

Opening Mental Health Care To More Individuals




By the end of 2011, there were 11.7 million individuals receiving Social Security Disability (SSD) benefits. Out of those, there were "more than 1.4 million Americans on the federal disability rolls for mood disorders." Historically, people have been reluctant to seek help due to the societal stigma surrounding mental illness. As science and medicine have expanded our knowledge of the brain, though, this old idea has been proven to be false. Now with the expansion of health insurance through Obamacare, there are concerns about out of control increases in mental health care.

Economic Costs of Mental Illness

Mental illness is treated through drugs, therapy, hospitalizations and other medical applications that total about $150 billion per year. Beyond these direct medical costs, there are other economic costs as well. According to a 2008 study published in The American Journal of Psychiatry "people with serious mental illness earn, on average, $16,000 less than their mentally well counterparts, totaling about $193 billion annually in lost earning."

Those with mental illness have higher rates of absenteeism and tend to be less productive when they are at work. These problems tend to reduce an individual's earnings. With low productivity and high absenteeism, individuals who are mentally ill can easily lose their jobs and wind up relying on "public safety-net services like food stamps and subsidized housing."

Cost Controls

Policy makers are trying to come up with ideas to keep costs from skyrocketing when Obamacare fully goes into effect. But experts are suggesting that in order to save money in the long run, there should be a greater expenditure to treat individuals up front. The Journal of the American Medical Association (JAMA) published a study in 2007 that put depressed employees into one of two groups during a randomized controlled trial. "Some of them received telephone outreach, care management and optional psychotherapy, while others received their usual care. The employees in the 'enhanced care' group not only worked longer weeks than those in the other group, but also demonstrated greater job retention." This "enhanced care" translated into, on average, an additional $1,800 annual value per worker to the company.

Even with positive findings from studies like the JAMA study, spending additional funds is not a popular political move. There is also the traditional stigma regarding mental illness that appears to prevent individuals from seeking help. "Even though tens of millions of people will get more coverage, estimates suggest that only 1.15 million new users will take advantage of mental-health services." For those taking advantage of expanded mental health coverage, they may not get the right type of treatment for their problems. The economics reporter for the New York Times is promoting comparative-effectiveness research to address this dilemma. Comparative-effectiveness means "pitting health care options head to head to see which works best for which patients and under what circumstances." This approach poses two problems: 1) it is highly expensive and, 2) Americans object to "government telling doctors and patients what to do."

Even without this proposed research, the expansion will allow many more individuals to seek help for their mental health issues outside of and within SSD. If you are seeking SSD benefits, contact our experienced attorney to assist you with the application process.

November 3, 2010

Disabled and Uninsured? Low Cost Healthcare Options




Low-Cost Healthcare Options for the Uninsured

Due to the exorbitant cost of healthcare in the United States, most people applying for Social Security Disability benefits are uninsured. The consequences of remaining uninsured can be devastating, however. Uninsured individuals are four times more likely to avoid seeing a doctor for preventative or urgent care, and advanced stage diseases are diagnosed 30-50% more often in the uninsured. If you find yourself uninsured and unable to afford healthcare services, look into the following low-cost healthcare options:

Community Health Centers

At community health centers, fees are based on your income, so you only pay what you can afford. Community health centers are regulated by the federal government and are located all over the country.

Free Clinics

Free clinics provide healthcare and prescription medication for free or at a low cost to uninsured individuals. Some have pharmacies on site, some rely on pharmaceutical company samples, and some have an arrangement with local pharmacies.

Hospitals

You may be able to receive free or low cost care at public hospitals or private nonprofit hospitals. Contact your state's health department to find out if any of these types of facilities are located in your area.

Social Service Agencies

Social service agencies or religious groups in your local area may have emergency funds available to help you with medication purchases in times of crisis. Contact a local church, United Way, Salvation Army, or Goodwill for more information.

Financial Assistance from Government Programs and Nonprofit Organizations

If you have a specific disease, look for government programs and nonprofit organizations that advocate for people with specific chronic diseases. The National Institutes of Health website features links to organizations that provide financial assistance to people with certain conditions.

Medicare

If you are elderly or disabled and have limited income, you may qualify for Medicare, a federal health insurance program that covers the costs of medical care and hospital stays.

Medicaid

Medicaid is a health and medical services program for low-income individuals and families. Each state sets its own Medicaid eligibility guidelines and makes the final decision about what their Medicaid programs provide. Services that all states are required to provide in their Medicaid programs include inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, and more.

Migrant, Rural, and Indian Clinics

Migrant health clinics provide healthcare to migrant laborers. Rural clinics are located in rural areas and typically serve Medicare and Medicaid patients. Indian Healthcare Services clinics are tribally-administered and provide healthcare services to Native Americans.

For more information about low-cost healthcare services, check out this list of resourc

October 19, 2010

Uninsured and Disabled? The New Healthcare Law May Help




Many people who apply for social security disability benefits have no health insurance, and many of these people need long term care.

More than 10 million Americans need long-term care and over 60% of them are 65 or older. Long-term care, which includes receiving help with bathing, dressing, eating, using the toilet, and getting in and out of bed, is a necessity for anyone - old or young - who becomes disabled. Unfortunately, few people are prepared to cover the cost of long-term care.

On March 23, 2010, the President signed the Patient Protection and Affordable Care Act, establishing a national, voluntary insurance program for purchasing community living services and supports. This program, which is known as the Community Living Assistance Services and Supports program (CLASS), is designed to offset the cost of long-term care services for aging populations and people with disabilities. Individuals are enrolled in the program automatically but have the choice to opt out. Monthly premiums are automatically deducted from workers' accounts.

How Much Are the Monthly Deductions?

Enrollees will have an average of $150 to $240 deducted from their paychecks each month. The amount of the deduction is based on the enrollee's age and salary.

Who Is Eligible for Benefits?

Adults who have multiple functional limitations or cognitive impairments are eligible for benefits if they have paid the monthly premiums for at least five years and have been employed for at least three of those five years. The CLASS act does not require the screening of patients for health problems, so even those who do not qualify for private health insurance programs may enroll.

What Are the Benefits?

Enrollees in the CLASS program receive a cash benefit averaging no less than $50 per day that can be used to offset the cost of long-term care services. The amount of the cash benefit is based on the degree of the impairment or disability. The cash benefit can be used to purchase non-medical services and supports. It can also be used towards payments for institutional care. Although the CLASS program is not designed to cover the entire cost of long-term care, it lifts much of the burden.

Beneficiaries can choose the kind of care that best suits their needs, whether that means adaptations to their home, assistance from a home care aide, or participation in an adult day program. Supporters of the CLASS program claim that it will help people with disabilities stay in their homes instead of enter nursing homes.

What Are Critics Saying about the CLASS Act?

Critics say that people who have existing health problems will sign up for the CLASS program in droves, paying such low premiums that the program would eventually collapse. They argue that the program will not have enough money in it to cover problems several years down the line.

Both critics and supporters of the program agree that there have to be enough healthy people in the program in order for it to work because otherwise, the premiums would become so expensive that the program would not be an attractive option for anyone. Eventually, the premiums will have to be based on the number of people enrolled in the program if it is to sustain itself.

August 13, 2010

Social Security Disability and Medicare/Medicaid




For disabled folks who struggle to pay hospital bills, Medicare and Medicaid can help cut back the costs of hospital stays, physician visits, and necessary prescription drugs. A disabled person's eligibility for either program is dependent on the type of disability benefits that they receive.

Medicare is a program run by the federal government that provides health insurance for citizens over the age of 65. In addition to the over 65 set, Medicare covers those that have been receiving Social Security disability benefits (under title II) for two years or more.

Beneficiaries are automatically enrolled in Medicare (Part A only, which covers hospitalization; most beneficiaries will need to sign up for further coverage during the enrollment period) 24 months after their date of entitlement. The date of entitlement is five months after the established date of onset. In simpler terms, disabled beneficiaries are eligible for Medicare 29 months after the determined start date of the disability. Those with specific conditions, including renal failure, kidney transplant, ALS, or Lou Gehrig's disease, may be eligible for Medicare much sooner.

Medicare coverage is complex, but is generally broken down into four categories of coverage:

Part A - Hospital Insurance. A basic insurance that covers hospital stays as well as some hospice and home medical care.
Part B - Medical Insurance. A more comprehensive insurance, requires an additional monthly fee and covers hospital stays, physician visits, laboratory services, home medical care, surgical services.
Part C - Medicare Advantage. Private insurance plans through Medicare contracted companies. Plans are wide ranging and can cover a variation of the services and care covered by Part A or Part B.
Part D - Prescription Drug Plans. Private prescription drug plans, approved by Medicare, that assist with the costs of medications.

Those who receive supplemental security income under title 16, on the other hand, could be eligible for Medicaid. Medicaid is a state and local run program that helps patients with medical expenditures. Eligibility is based on several factors, but a limited income is one of the main prerequisites. Medicaid pays some or all of the medical expenses for qualifying individuals.

Some individuals receive both disability benefits under title II as well as supplemental security income under title 16. In these instances, it is best to consult the Social Security Administration to determine whether you qualify for Medicaid or Medicare.


April 19, 2010

Affordable Healthcare for Social Security Disability Applicants




Many of my social security disability clients express their frustration at not being able to afford medical treatment. Besides not getting the healthcare that they need, their chances of winning their social security disability claim are greatly diminished.
Indeed, one of the most important factors the Social Security Administration (SSA) takes into consideration in deciding disability claims is the Claimant's medical treatment history. If someone is alleging disability but is not seeing a doctor on a regular basis, SSA may conclude that the person is not "truly" disabled. However, many disabled people have no health insurance and no money to pay for a doctor to give them the medical care they need.
I recommend to anyone who needs access to affordable health care to locate a "Community Health Center" in their area. These clinics are usually staffed with nurses, physician's assistants, and medical doctors who will evaluate and treat patients. How much do they charge? It depends on the financial means of the patient to pay. Typically the patient will be charged on a sliding fee scale based on income. While the treatment at these clinics may not be "free," the fees charged are usually much less than what would be charged at a traditional doctor's office.
These Community Health Centers receive state and federal funding, as well as contributions from individuals and private entities. The new healthcare reform bill signed into law by President Obama (the "Patient Protection and Affordable Care Act") will add approximately $10 billion in new federal funding for these Community Health Centers.
To find a Community Health Center near you, go to http://findahealthcenter.hrsa.gov/.