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Federal/State Benefits

Information about supplemental security income (SSI) social security disability insurance program (SSDI), Medicare, Medicaid, Veterans Benefits and Victim Crime Compensation Boards.

1. Benefits Check-Up

1.1. Complete a Benefits Check-up

BenefitsCheckUp includes more than 1,650 public and private benefits programs from all 50 states and the District of Columbia, such as:

 

  • Prescription drugs
  • Nutrition (including Supplemental Nutrition Assistance (SNAP)/Food Stamps)
  • Energy assistance
  • Financial
  • Legal
  • Health care
  • Social Security
  • Housing
  • In-home services
  • Tax relief
  • Transportation
  • Educational assistance
  • Employment
  • Volunteer services

 

Since 2001, millions of people have used BenefitsCheckUp to find benefits programs that help them pay for prescription drugs, health care, rent, utilities, and other needs. Find benefits now!

2. CLASS - ABLE Acts

2.1. ABLE Act-State Programs

See the state-by-state ABLE Act program listings

The ABLE National Resource Center (ANRC) is a collaborative that brings together the investment, support
and resources of some of the country's largest and most influential national disability organizations in
an effort to accelerate the design and availability of ABLE accounts to meet the needs of individuals
with disabilities and their families. Founded and managed by National Disability Institute (NDI), the
ANRC's goal is to provide consistent, reliable information concerning the benefits of an ABLE account.
In addition, the ANRC aims to educate individuals with disabilities and their families, state government
and legislatures, financial service companies and financial planners and attorneys - who focus on trust
and estate planning - about ABLE's potential positive impact on the lives of millions of Americans with
disabilities.

Five Areas of Collective Impact

1) Serve as a facilitator between the disability sector, government, and financial service comapnies to
accelerate the effective design and availability of ABLE accounts nationwide.

2) Educate the disability community about the available opportunities to save and plan for a better
economic future and quality of life experience through the establishment of ABLE accounts.

3) Educate government at the federal and state levels about consumer needs and challenges in establishing
and/or managing an ABLE account.

4) Inform financial service companies about the needs and interests of the disability community to offer
investment products for use with ABLE account resources.

5) Educate the public, policy makers and other relevant stakeholders about the positive impact of ABLE
accounts at an individual and systems level and any needed changes for further policy development.

 

2.2. ABLE Act Guidance from CMS-Is Medicaid Impacted?

CMS recently released guidance on how funds in an ABLE account may or may not interfere with eligibility for the Medicaid program.  This webinar aims to explore that guidance and help people better understand intersection between Medicaid and ABLE.  I encourage you to register if you are available and to please help spread the word.  Also, the following link can be shared via social media:  http://www.ablenrc.org/events/medicaid-and-able-look-recently-released-cms-guidance

 

2.3. Advanced CLASS-A New Era of Independence and Choice

Advanced CLASS, Inc. is THE national advocacy organization dedicated EXCLUSIVELY to the implementation of a strong and vital long-term services and supports program. The group is an independent 501(c)(3) organization, comprised of prominent national organizations who serve the most vulnerable in both the aging and disability communities. This "big tent" group is eager to expand, further, and include a variety of stakeholders including diverse providers of care, and companies who specialize in delivery of crucial services.

3. Disability Benefits (SSDI & SSI)

3.1. NEW: Social Security by smartphone

Social Secirty Adminitstration announces (May 2013) a new mobile optimized website, specifically aimed at smartphone users.  Mobile phone users will be able to  access all of the FAQ and other services available on the Social Security website. 

3.2. NEW-Non-Medical Appeals on--line

As of December 10, 2016, an applicant now has the ability to file non-medical denial and adverse action appeals online.  You can appeal a wide range of decisions, including denial of benefits, date of entitlement, and overpayment.

Online appeals applications allow a customer to complete and submit the Request for Reconsideration and Request for Hearing by Administrative Law Judge to Social Security online.   

The application incorporates appeals of non-medical denial decisions with features already available, including uploading supporting documents online.  In addition, people living outside the United States can also utilize this new service.

This expansion will reduce the need for travel to a field office, as well as lessen the time to process non-medical appeals and associate the supporting documents.

3.3. Allsup

Allsup - Social Security disability representation and Medicare plan selection service

Throughout their history, Allsup has positively influenced how the SSA serves its applicants. They educate their customers on the Social Security disability process, making it less confusing, less intimidating and more convenient for people with disabilities. And provide the SSA with a well developed claim that allows its staff to issue an informed decision. 

In addition, in 2008 Allsup began expanding the True Help® it provides to those with disabilities, providing access to a broad range of financial and healthcare information and services that help customers live lives that are as financially secure and as healthy as possible.

3.4. What are Disability Benefits and am I eligible?

Learn more about disabilitiy benefits and how to apply for them.

The Social Security Disability Insurance (DI) program provides modest but vital benefits to workers who become unable to perform substantial work on account of a serious medical impairment. READ HERE about approval rates for SSDI

SEE SSDI vs SSI video in our VIDEO RESOURSE ROOM referenced below

3.5. Disability Benefits (Questions and Answers)

Read frequently asked questions and answers about disability benefits.

 

How Social Security Disability and Medicare Benefits Work Together

September 16, 2014

You can get financial help from Social Security and Medicare if you're permanently disabled or if you have Lou Gehrig's disease or kidney failure. To be considered "permanently disabled," your doctor must confirm that you are unable to work for at least 12 consecutive months. Being "unable to work" means you cannot perform your job functions because of the disability, and you cannot find a new line of work because of age, education, or impairment. You must follow your doctor's prescribed treatment plan to continue to qualify. It's a good idea to keep up-to-date medical records.

Qualified disabled individuals can apply for Social Security Disability or Railroad Retirement Board (RRB) disability to recover lost wages. Once you qualify for Social Security Disability or RRB benefits, you can also apply for Medicare Disability benefits to cover your hospital, medical, and/or prescription drug expenses.

3.6. Direct Deposit/Go Direct

A Department of the Treasury rule with a fast approaching deadline requires most Federal benefit payments be made electronically instead of by paper check.  With a few exceptions, this March 1, 2013 mandate includes Social Security, Supplemental Security Income (SSI), .......  and other non-tax payments.

People still getting paper checks have the option of direct deposit to a financial institution account of their choice or Treasury's Direct Express® debit card program. Learn more about the advantages of receiving benefits electronically, and sign-up today at www.godirect.org.    updated 10/19/12

Disaster planning:  Additionally, as people prepare for the threat of a natural disaster, which could disrupt mail delivery and force people to evacuate, they should sign up for Direct Deposit of their payments from Social Security. With Direct Deposit, the payment will be in their account on time no matter what happens, and immediately available for use from anywhere.

3.7. Guide to Disability Benefits

Guide to Disability Benefits at Disability.gov provides a broad range of resources about Social Security disability benefits and assistance programs and services for people with disabilities, seniors and their families. In addition, we have developed this guide to connect you to programs, services, and government agencies that provide disability benefits for people with disabilities, including children and Veterans.

3.8. Social Security Financial Planning Tool

Access and view your Social Security benefit and earnings information in a convenient and secure manner. Obtain an official benefit verification letter instantly.  The benefit verification letter serves as proof of income to secure loans, mortgages and other housing, and state or local benefits. Additionally, people use the letter to prove current Medicare health insurance coverage, retirement or disability status, and age.  People can print or save a customized letter.

In announcing this new tool, the Social Security Commission Astrue said: "Our new online Social Security Statement is simple, easy-to-use and provides people with estimates they can use to plan for their retirement.  The online Statement also provides estimates for disability and survivors benefits, making the Statement an important financial planning tool.  People should get in the habit of checking their online Statement each year, around their birthday, for example."

See My Social Security to set up a personal social security account.

3.9. Compassionate allowances (for SSDI determination)

Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.

Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information.

List of Compassionate Allowances conditions

3.10. Social Security Fast Tracks Disability Processing

Effective November 12, 2010, Social Security has improved the procedure for processing claims for persons with complex determinations.  Read Social Security Fast Tracks Disability Claims

3.11. Social Security Homepage

Social Security Homepage has just been simplified and redesigned for easier consumer access.  There are quick links to many of the services and needs that you will have.  Updated 5.9.11

3.12. www.segurosocial.gov-- Información en español

www.segurosocial.gov  Social Security benefits available in Spanish

Información sobre beneficios del Seguro Social en español

3.13. The Center for Section 504 Compliance

The Social Security Administration has announced the creation of the new Center for Section 504 Compliance.  Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against individuals with disabilities, and requires the federal government to provide individuals with meaningful access to government facilities, programs, and services. 

Individuals may report issues and make suggestions regarding meaningful access.  The toll-free number is 1-844-881-9061.  The business hours are Monday through Friday from 8:00am - 4:00pm Eastern Time (except federal holidays).  

4. Medicaid & Medicare

4.1. Medicare Claims and Appeals

Your Right to a Fast Appeal- This section of the Medicare website provides information on initiating a fast appeal in hospital and non-hospital settings. 

4.2. Who is eligible and how to do I apply?

Visit the Centers for Medicaid and Medicare Services online for information about both Medicaid and Medicare.

4.3. Private Medicare Plans

A private Medicare plan is health care benefits offered by a private insurance company. These are often used to replace or to subsidize Medicare benefits. Most often private Medicare plans aren't the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Private Medicare Plans vary in how and where services can be obtained. You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. Not all providers will. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.

Some plans contract with a network of providers who agree to always treat you even if you've never seen them before. Out-of-network doctors, hospitals, and other providers may decide not to treat you even if you've seen them before. For each service you get, make sure your doctors, hospitals, and other providers agree to treat you under the plan, and accept the plan's payment terms. In an emergency, doctors, hospitals, and other providers must treat you. Show your plan membership ID card each time you visit a health care provider. Your provider can choose at every visit, whether to accept your plan's terms and conditions of payment.

You can't use your red, white, and blue Medicare card to get health care because Original Medicare won't pay for your health care while you're in the Medicare PFFS Plan. Keep your Medicare card in a safe place in case you return to Original Medicare in the future. You only need to pay the copayment or coinsurance amount allowed by the plan for the type(s) of service you get at the time of the service.

Types of Private Medicare Plans

Medicare Special Needs Plans (SNP)
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network (except emergency or urgent care, such as care you get for a sudden illness or injury that needs medical care right away, or if you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis). Medicare SNPs typically have specialists in the diseases or conditions that affect their members. Find out who can join a Medicare SNP.

Health Maintenance Organization (HMO) Plan
In HMO Plans, you can't get your health care from any doctor, other health care provider, or hospital. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option. Find and compare HMO Plans in your area

Preferred Provider Organization (PPO) Plans
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network. Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren't on the plan's list, but it will usually cost more. A PPO Plan isn't the same as Original Medicare or a Medicare Supplement Insurance (Medigap) policy. PPO Plans usually offer extra benefits than Original Medicare, but you may have to pay extra for these benefits.

Private Fee-for-Service (PFFS) Plans
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren't the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.

4.4. Contacting Medicare

Contacting Medicare can often be a daunting and sometimes frustrating task. Finding an accurate answer however is often dependent on you. You will need to have certain information so that you can clearly communicate your question.

Before contacting Medicare be sure to have your information and thoughts together:

  • Are you calling on your behalf or on behalf of another person?
  • Is the question a general one related to the benefits provided by Medicare and how to obtain them?
  • Is your question more specific and related to provision of services/benefits or payment and claims for services that you have received?
  • Be sure to have your information on hand. This may include information regarding your enrollment, the benefit/service you are inquiring about, past communications with Medicare, payment and claim information that are in question.

Medicare Inquiries


General Medicare Questions 

For general questions regarding enrollment, available benefits, eligibility for benefits/services, and how to obtain benefits and services:

Phone: 1-800-MEDICARE (1-800-633-4227) | TTY: 1-877-486-2048

Mailing Address:
Centers for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD 21244-1850

Specific Medicare Questions

If you have questions that are specific to you such as specific billing questions and questions about your claims, medical records, or expenses, you will have to login to MyMedicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

Medicare Inquiries On Behalf Of Another Person
If you want someone to be able to call 1-800-MEDICARE on your behalf or you want Medicare to give your personal information to someone other than you, you will need to fill out a "Medicare Authorization to Disclose Personal Health Information."

Medicare Help Resources

Medicare Rights Center
The Medicare Rights Center is a non-profit organization dedicated to helping older Americans understand their Medicare rights and benefits, navigate the Medicare system and get quality health care.

State Health Insurance Assistance Program
Understanding your Medicare plan and making sure your loved one gets quality care that you can afford can be an overwhelming process. It can also be an isolating experience if you don't know where to get help. If you have questions about your coverage or about how to enroll in Medicare and Medicaid plans, you can contact a local State Health Insurance Assistance Program to get personalized help from one of its counselors.

Senior Medicare Patrol
If your Medicare question involves a suspected error, fraud, or abuse of Medicare, the Senior Medicare Patrol is a resource you may want to look into. They specialize in those areas of Medicare.

State-specific Medicare information
There is significant variation from one state to another in terms of availability, pricing, and regulation of private Medicare plans. Medicare beneficiaries in different areas often make different choices about their coverage based on availability. This is a state by state listing from MedicareResources.org offering state-specific Medicare information.

5. Medicare Updates and Helpful Pages

5.1. Medicare and You

Medicare and You

This official government booklet tells you:

Summary of Medicare benefits, coverage decisions, rights and protections, and answers to the most frequently asked questions about Medicare.

5.2. Medicare Helpful Contacts

This Helpful Contacts tool will provide you with contact information for specific organizations or help you get answers to your Medicare related questions.

5.3. Physician and Healthcare Provider Directory

Locate a provider.

5.4. Medicare Options Compare

Find and Compare Medicare Health Plans.

5.5. Medicare Prescription Drug Plan Finder

Find and Compare Medicare Plans that Cover Drugs.

5.6. Extra help with prescription drug cost

Extra help for prescription drug costs is now available as the result of a new law that became effective January 2010.  To learn more and find out if you qualify see:  Prescription help  (EN ESPANOL)

5.7. Nursing Home Compare

This tool has detailed information, including a checklist of important selection features, about every Medicare and Medicaid-certified nursing home in the country. This site also provides a link that will help you or your family member explore other long-term care choices like community-based services, home care, or assisted living.

SEE 'Long Term Care in Housing Knowledge Book (linked below on this page)

5.8. Home Health Compare-Agency Search

This tool gives detailed information about Medicare-certified home health agencies. New home health agencies may not appear for several months after being approved by Medicare.

5.9. Dialysis Facilities

Dialysis Facility Compare

This website provides important information and resources for patients and family members who want to learn more about chronic kidney disease and dialysis.

Look at the information on Dialysis Facility Compare carefully. Use it with other information as you compare facilities and decide where to get dialysis. You should also:

  • Visit facilities that interest you,
  • Talk to dialysis facility staff and patients,
  • Talk to your doctor and,
  • Contact kidney disease groups. The phone numbers and website for some of the kidney disease groups are found in the Resources section of this website.

Print out information you will find useful on this website and bring it with you when you visit facilities or talk with doctors, staff, other patients, or kidney disease groups.

5.10. Supplier Directory

The primary purpose of this tool is to provide names, addresses, and contact information for suppliers that provide services or products under the Medicare program.

5.11. Medicare Ombudsman

Your Medicare Ombudsman receives and provides help regarding complaints, grievances, and requests for information from people with Medicare

6. Veterans Benefits

6.1. What are Veterans entitled to?

Visit the Veterans Administration for a list of the different benefits Veterans are entitled to.

6.2. Social Security Website for Wounded Warriors

Social Security now makes it easy for Wounded Warriors to learn about benefits available to them at Social Security-Wounded Warriors

7. Crime Victims Compensation Programs

7.1. Victim of a crime?

Below is a list maintained by the National Association of Crime Victim Compensation Boards of links to the Websites of state crime victim compensation programs. You can find out specific information about each program's benefits, requirements, and procedures from clicking on the links.

In addition, you can click here for a link to the National Association of VOCA Assistance Administrators (NAVAA) aggregate listing of websites in all states for many types of victim-service-related programs.

8. Government Benefits, Grants and Financial Aid

8.1. "5 Questions You & Your Family Are Asking About the FMLA"

"5 Questions You & Your Family Are Asking About the FMLA"

Though it is undeniably taxing to live with a spinal cord injury (SCI), it's also important not to disregard the physical and emotional demands of caring for a loved one with spinal trauma. This is especially a concern immediately after the trauma occurs or if complications arise. Attending work every day can seem nearly impossible on top of the additional aid of an injured or ill family member. Those caring for a loved one can take time to learn how to balance workplace and medical demands by opting for FMLA leave. Read the following FMLA guidelines to learn about provisions and employee privileges.

1. What is the FMLA?

The Wage and Hour Division, administered by The U.S. Department of Labor, describes the Family and Medical Leave Act (FMLA) as entitlement for eligible employees to take unpaid, job-protected leave for family and medical reasons. The premise of FMLA is an employee may be incapable of performing basic job functions because of the health condition or needs of a sick or injured loved one. Under a covered employer, the employee can take 12 unpaid workweeks of leave during a period of 12 months to care for family member who has suffered an SCI or other debilitating medical setback. The employee's group health insurance coverage will continue without changing terms or conditions.

2. What is the purpose of FMLA?

The act is intended to help families respond to a family member's injury or medical needs while balancing home and work responsibilities. The act provides job security and contributes to economic stability for family members that take unpaid leave, thus preserving the integrity of our nation's families.

3. Do I qualify?

Employees are eligible for FMLA if they're employed by a public agency or a private sector organization that has employed 50 or more workers for at least 20 workweeks in the last year. Employees must work at the location or within 75 miles of it. Public and local education agencies are also covered. An eligible employee will have worked for the employer for 12 months minimum and put in at least 1,250 hours during that 12-month period.

For example, if you live with chronic back pain, and you are considering undergoing a minimally invasive back surgery at one of Laser Spine Institute's five country-wide locations, you could possibly qualify for FMLA and get the relief you need while guaranteeing an equivalent job with equivalent pay is still there upon your return.

4. How do I apply?

Speak with your company's HR representative, and expect to provide appropriate medical information and health insurance certification for requesting leave. Typically, you'll have to request leave 30 days in advance or as soon as possible during an emergency. The U.S. Department of Labor advises that first-time employees requesting leave don't have to mention the FMLA, even if the reason qualifies under FMLA guidelines.

5. What else do I need to know?

SCI patients should keep the following in mind when seeking FMLA employment leave:

  • Qualified employees taking FMLA leave shouldn't experience employer retaliation, job loss, benefits denial or discrimination. If so, take legal action.

  • If you're taking leave to care for an "immediate family member," federal law dictates that immediate family members are parents, spouses and children. Check your state's labor laws and HR to see if a sibling or domestic partner, for example, qualifies as an immediate family member.

  • You may want to or be required to take paid leave first. Paid leave time is excluded from the amount of time you'll take with FMLA leave.

8.2. Article- What you need to know about FMLA

Article from (http://www.rehabilitation-center.org/whitepapers/fmla/)

Despite the fact that many have taken advantage of the Family and Medical Leave Act (FMLA) in the past, others continue to overlook what it can do for them.

In short, this act is in place to provide up to 12 weeks of job protected, unpaid leave from employment. It is important to note that this is only available to eligible, covered employees for one of the following three reasons:

  • To take care of a serious health condition
  • To take care of an immediate family member – such as a spouse, child, or parent – who is suffering from a serious health condition
  • To give birth and care for a child

During FMLA leave, the law requires that the person's group health insurance be maintained, despite the fact that he or she is not currently being paid.

What You Need to Know

There are several things you need to know about FMLA, including the following:

    • Not all employees are eligible. Just because you have a job does not mean you are protected under this act. To be eligible, you must have worked for the company for at least 12 months before requesting the leave.
    • Your employer has the right to request that you use paid leave first. If you have vacation days stashed away, for example, you may have to use these before FMLA kicks in. This differs from one employer to the next, so check with the HR department.
    • Your employer may request proof. For example, if you are seeking a leave due to a personal health problem, you may have to obtain certification from a health care professional. Even though it may be a sensitive issue, your employer has the right to request verification.
    • You will have a job when you come back, but it does not have to be the same one. Although most companies attempt to move you back into the same position, this is not always guaranteed. The Department of Labor notes the following: "an employee must be restored to the employee's original job, or to an equivalent job with equivalent pay, benefits, and other terms and conditions of employment."
    • The Family and Medical Leave Act is administered by the Employment Standards Administration's Wage and Hour Division within the U.S. Department of Labor.

If you have any questions or concerns regarding the Family and Medical Leave Act, contact your employer's HR department.

8.3. Government Resources

Visit to see a list of all Government Benefits, Grants and Financial Aid.

Here is your One-Stop Shop for over 1,000 government assistance and loans.

8.4. Pre-existing Condition Insurance Plan

If you have been uninsured for six months and have had difficulty obtaining health insurance due to a health condition, this program may benefit you:  Pre-existing Condition Insurance Plan