Erin Bui and Marc Ang discuss the basics of government funding for special needs, around Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Medicare and Medicaid.
The deep love for a child will make a parent, family member, or a non-family loved one do anything, walk over broken glass, to provide the child they love with the best care they can get.
A family with a special needs child has an even greater need to give their child a comfortable life. However, to achieve a stable life for their child with the right care, the entire family unit needs to be financially stable. Thankfully, one of the “legs” of the proverbial special needs financial planning stool involves crucial government benefits that go a long way to helping special needs family.
Thankfully, we are in 2017, where the needs of the special needs community (whether it’s autism, down’s syndrome, cerebral palsy, epilepsy or mental disorders) are generally understood by the greater society. The government has made a commitment in the way of supportive legislation, taxation and dedicated funding for special needs families.
Most parents have become advocates for their children, successfully working with school districts, regional centers and health insurance (usually landing speech therapy, occupational therapy and behavioral therapy hours and support).
Here at Mangus Finance, we help special needs families navigate through the process of government funding for special needs, especially when it comes to Medicaid, Medicare and Social Security Disability benefits or Supplemental Security Income (SSI).
There are many nuances depending on where the child (or adult) is on the spectrum, and how independent they are. Other nuances, especially for special needs seniors, include the quality of care and facility if you choose the Medicare-Medicaid (Medi-Medi) route and opt for assisted living versus going the private long term care route. This is worth another discussion, but it is best to set some time to consult with us in person as there is far from a one-size-fits-all solution in the special needs community. We take the time to understand your situation in its entirety.
We want to provide you with basic information if you are a special needs parent who is overwhelmed with the list of to-do items. Our scope will be around the Social Security, which includes Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), Medicare (federal) and Medicaid (state) options. Hopefully this helps give your family a better understanding of the jargon out there:
What is the difference between Supplemental Security Income and Social Security Disability Insurance?
SSDI is Social Security Disability Insurance. If you have worked and have earned enough credits, then you should be entitled to Social Security Disability Insurance. For some people who have a later-onset disability, this makes a lot of sense. You now have income for the rest of your life that is based on objective earnings while you were an adult.
However, what happens if you haven’t built enough of a work history? Or if you’ve had a disability since childhood and you are now an adult with no working history? This is where SSI (Supplemental Security Income) comes in. This also covers certain disabled adults who don’t have enough of a working history, or whose benefit is just too small to live on. These days, Supplemental Security Income maxes out at around $730-800/month, depending on which state you live in. If you collect Social Security Disability Insurance and Supplemental Security Income, the combination never exceed the SSI maximum.
What is Medicare?
- Medicare is usually only available to those who are 65 and over. However, if you have SSDI, you can get Medicare after you’ve had SSDI for 2 years. Another exception is if you have a chronic renal disease and need a kidney transplant or maintenance dialysis, or if you have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis.
- If you have SSI, you don’t get Medicare but you get Medicaid (discussed next), After you get Medicare, Medicare’s premiums will be paid by Medicaid. However, you will not get Medicare automatically.
What is Medicaid?
- Medicaid is a state health insurance program (jointly funded on the federal level) for low-income individuals that need the government help. It usually covers children, seniors, the blind, disabled and more.
What are the Centers for Medicare and Medicaid Services (CMS)?
- Thanks to the ability now to self direct your care, there is a lot more flexibility with how you use Medicaid dollars. This is done through HCBS, Medicaid Home and Community Based Services Waivers. States have a lot of flexibility in designing these programs.
What the process to apply for Supplemental Security Income or Social Security Disability Insurance?
- You need to first be knowledgeable on the requirements for physical conditions and mental conditions before you apply. It is best to consult knowledgeable professionals, as there is a subjective component to whether Social Security deems how “severe” the impairment is.
- Social Security will use the “Blue Book” (aka “Disability Evaluation Under Social Security”) which is an impairment listing manual to determine if a claim is eligible to receive social security disability benefits.
- The condition that an individual has must interfere with the ability of the individual to work.
- Once you have satisfied the requirements for SSDI, you can submit an initial application over the phone, online, or in person at any Social Security Administration (SSA) office.
- You will need to bring a disability report and medical evidence
- It is important that the doctor is familiar with the criteria when submitting a statement on behalf of the individual.
- It is good to explain to the doctor your condition and how it limits you on your daily activities, so the doctor can include the information in the medical records. The evaluators judge the severity of a condition by how many ADLs (Activities of Daily Living) are impaired.
Disability Benefits Contact Information:
- Toll free telephone number 1-800-772-1213
- If you are deaf or have a hearing problem, call them at 1-800-325-0778
- Online: https://www.ssa.gov/applyfordisability/
- Visit in person
- Call and make an appointment at the your local social security office before you go.
Part of the Mangus service is to help you through this sometimes daunting process. Our team of professionals is here to guide you every step of the way, connecting you with professionals with the highest of integrity, and overseeing the journey.