Social Security Disability and Medicaid for Disabled Adults

Here's a recent question that was left by a commenter:

I have a ?? I cant find the answer to and hope u can help. I applied for SSI and was denied,I filed a appeal and hired a attorney. I also filed for medicaid and recieved notice recently that I am going to be recieving medicaid .I read SS and Medicaid have the same guidelines on determination and wondered why would I be denied SSI and awarded medicaid for a disability. Im also wondering if winning the medical portion will help my SSI case?


Hi Kimberly,

I used to be a disability examiner for disability determination services, the state-level agency that renders determinations on disability claims for SSA. However, I am also a former caseworker. I worked in nearly every program, including taking MAD applications at a Department of Social services. MAD basically means medicaid for adults who are disabled. As you yourself stated, an individual can apply for medicaid for disabled adults separately from an SSI or social security disability claim that is filed with the social security administration.

This is how it works with MAD. The application is taken at social services. However, just as with a social security disability or SSI disability claim that is taken at a social security office, the medicaid claim is not processed at social services. Instead, it is sent to the state agency that is responsible for rendering disability determinations. In most states, this agency is called DDS, disability determination services.

Social Security disability and SSI disability claims that are taken at social security field offices are sent to processing units at DDS and are assigned to disability examiners to be evaluated and decided.

Medicaid claims for disabled adults, that are taken at social services, are also sent to the state disability agency (DDS, or a name very similar to this, depending on the particular state).

However, medicaid claims are sent to different kinds of units. They are sent to medicaid units that, at the risk of being repetitive, only process medicaid claims for disabled adults.

So, if you filed for SSI disability and also filed for medicaid for disabled adults, those two claims were sent to the same agency, but were sent to two separate processing units and were worked on by two different kinds of disability examiners. Which is why you received two separate decisions.

Sometimes, if an SSD (or SSI) claim has been decided, the medicaid application can simply "adopt" the decision that was made on that case.

But---if there is no SSD or SSI decision to adopt, then the medicaid claim will be subject to the processing deadline that the county caseworker has to adhere to----meaning that the medicaid case has to be returned to the county caseworker who actually took the medicaid application by the disability examiner (this can be confusing) before the deadline expires...even if it means halting ongoing work on the medicaid claim.

Of course, this is an example of government gone wrong. The processing deadline for disability-medicaid claims was instituted to "help" medicaid claimants get a "speedy decision". But, in actuality, it has often meant that many applicants for disability-medicaid have had their claims denied simply because processing a case can take longer than a silly artificial 90 day deadline.

Yes, if they--the DDS medicaid unit--can't get the case done by the 90th day deadline, they are forced to send ti back to the county department of social services which will summarily deny it. Absolutely idiotic government at work.

There is, however, a different wrinkle here. If a disability medicaid claim has been denied by a department of social services (because the DDS disability examiner did not have an SSD or SSI decision to adopt), then the person who has been denied for MAD can actually pursue a separate medicaid appeal...that has nothing to do with the social security system. Instead, this appeal moves through the state government apparatus (in North Carolina, health and human services).

Is this worth pursuing? It can be. I've seen medicaid appeals filed in this manner get approved independently of an SSD or SSI disability claim.

Why bother? To get access to doctor visits and needed prescription medication.

To answer one of your questions, though, medicaid claims can adopt social security disability or SSI disability decisions; however, it does not work the other way around.





Additional information on Social Security Disability at www.disabilitysecrets.com

Return to the homepage for the Social Security Disability SSI Benefits Blog




Other Posts

Second Social Security Disability Appeal
Doctors at DDS - The Social Security Disability SSI System
DDS Reconsideration
Social Security Disability, Chronic Pain, and the Opinions of Doctors
Appyling for SSD - Disability Application Information

Chronic pain can be debilitating but lifestyle changes may help

Chronic pain can be debilitating. More people seek medical help for chronic and acute-onset pain that any other health issue. While acute-onset pain requires immediate medical attention and can be due to an emergency situation, chronic pain is something that patients have to live with and find ways to manage. Taking pain relievers and anti-depressants are both very successful ways to manage pain, as well as the depression and anxiety that can accompany chronic pain, though neither are sustainable ways to live and can cause side effects over long periods of use.

If you suffer from chronic pain there are many ways that you can help yourself, in addition to seeking conventional medical help. Getting enough sleep, exercising regularly, eating healthy, and using complementary and alternative medical help such as Qigong, Tai Chi, and acupuncture, can help to manage pain symptoms and provide relief (For my own back and neck issues, I've found that chiropractic has been helpful and I may also try acupuncture at some point since this seems to be the only aspect of traditional chinese medicine that recent scientific data has indicated may actually provide more than placebo effect. As for chiropractic, I was NOT a believer in any sense until I found that adjustments did seem to alleviate my neck pain. To each his own, of course).

Establishing a sleep routine, keeping a food journal to determine food sensitivities, and exercising at least 30 minutes a day have all been shown to increase mood and reduce pain (walking does wonders for my own mood and general health). Tai Chi is thought to relieve muscle cramping, while acupuncture is alleged to stimulate pressure points that can reduce pain, elevate endorphin levels and elevate cerebral spinal fluid. Qigong, apparently, has been shown to reduce pain through relaxation techniques.

Although it may seem easier to keep up an unhealthy lifestyle, taking control of your daily routine can do wonders for pain. In addition to conventional pain killers (which, if you read the news, seem increasingly to be the cause behind other problems), complementary and alternative medicine "may" have the potential to help manage pain symptoms and improve quality of life.

Having said that, though, it's my own personal belief that new problems and symptoms, and old problems that seem to be changing in some respect, should always be given a "run through" with a family physician. Better safe than sorry, particularly when its so true that, with certain illnesses, early diagnosis seems to be at least half the battle.


Return to the homepage for the Social Security Disability SSI Benefits Blog




Other Posts

Qualifying for Disability - How difficult are the Qualifications ?
How to Qualify for Disability - social security disability or SSI
Will I Qualify for Social Security Disability?
Disability Benefits based on back problems - degenerative disc disease
Denial of Disability, Pain, and Medical Records
Chronic Pain Increases Suicide
Chronic Pain Management for Veterans
Complex Region Pain Syndrome and Changes in the Brain

If you get Denied, File Your Social Security Disability Appeal Quickly

If you apply for disability benefits from the social security administration, either SSD (social security disability) or SSI, and you get denied as roughly thirty percent of all claimants do, what should you do? The answer is not hard. You should, in the vast majority of cases, file an appeal. But you should also do something else. You should get your appeal filed as fast as humanly possible.

Why? Because even though SSA will give you two months time to get your appeal submitted, actually utilizing that two month period is not only pointless, but potentially financially injurious (the sooner you get through the process, the sooner you can draw benefits).

Amazingly, however, there are a great many claimants who will do exactly that. They will wait or procrastinate until their appeal period has nearly lapsed before either sending in their appeal themselves, or finding a disability representative to do it for them.

Why does this happen? I can only speculate. However, it is my opinion that, in many instances, getting denied for disability can be so disappointing and depressing to a claimant that the mere thought of pursuing their case further along simply seems oppressive---particularly if they heard horror stories regarding how long a disability claim can potentially take.

Here's what any claimant who has been denied should do. Immediately set in motion what needs to be done to appeal. Claimants who do not feel the need for representation should immediately contact their local social security office and request an appeal. And claimants who believe representation is something they would like should immediately set about the task of procuring representation.

And here are some pointers, albeit obvious, for each scenario.

An unrepresented claimant should contact social security regarding an appeal the very day they receive their notice of denial. And upon receiving their disability appeal paperwork, they should immediately complete it and return it, being mindful to keep a copy of the appeal for their own records. Not more than one week later, the unrepresented claimant who has sent in appeal paperwork should make a followup call to their social security office to verify whether or not the appeal has been received. If it hasn't, the claimant may wish to check again in several days.

A claimant who has decided that representation would be best should immediately begin to look for a prospective representative. Once a representative has been found and a new client interview has been conducted (typically by the disability lawyer or non-attorney rep's office staff), the claimant should work on getting their new client paperwork returned to their representative's office immediately.

Of course, if the interview was actually conducted at the representative's office, this won't be a concern. However, for claimants who were interviewed over the phone, receiving the new client paperwork in the mail may take several days and, thus, returning it to the representative's office should be a matter of high priority.

If you consider the fact that most applicants for disability will typically have to file two appeals (the request for reconsideration and the request for hearing) and that claimants are given 2 month deadlines to submit each appeal, its very easy to see that the potential exists for...wasting up to four months of time on a disability case. Therefore, to minimize the financial fallout of subsisting during the long wait for disability benefits, claimants should in all cases file their disability appeals...as fast as possible.





Additional information on Social Security Disability at www.disabilitysecrets.com

Return to the homepage for the Social Security Disability SSI Benefits Blog




Other Posts

Social Security Disability, SSI, Degenerative Disc Disease and Back pain
How Long does it Take to Hear from Social Security About When my Benefits will Take Effect?
Social Security disability reviews
Qualify for Social Security Disability
Can a Younger Person Qualify for Disability Benefits?
Have you worked enough years to qualify for SSD?
Is it Difficult to Win Social Security Disability if you have Mental Illness?