SSI Appeal

[Pinkie39]

Hoping Janke will see this and reply. My brother is still at the nursing facility, nearly a year since his stroke last March. He's been in and out of the hospital for various ailments, along with hospitalization for a major psychotic episodes. Still wheelchair bound, with virtually no use of his right arm. He's being moved to another facility this week, his 3rd in a year.

I called the SSA again today to check on the status of his SSI application. The rep told me his application is being processed by our state's disability determination services unit, and it'll be another 1-3 months before they make a determination on his application.

So, my question is, is that routine for SSI applications to be processed at the state level? Can I or should I call the state to find out if there's anything additional they need to make a decision? Would the state be able to give me any additional information about his application status?

My urgency is from concern that Medicaid is going stop paying for my brother's care in a long term care facility at some point, and he'll have no where else to go. The current facility he's in has already told us that.

No one in our family has a handicapped accessible home with space available to take him in, nor are we equipped to deal with his mental health issues with him residing with us. And the programs we've found that could provide appropriate housing for him, that are rent subsidized, all require applicants to be receiving SSI or SSDI.

Thanks in advance for any help.

 

[NeilTheCop]

No one in our family has a handicapped accessible home with space available to take him in, nor are we equipped to deal with his mental health issues with him residing with us. And the programs we've found that could provide appropriate housing for him, that are rent subsidized, all require applicants to be receiving SSI or SSDI.

Thanks in advance for any help.

You may be able to get a grant to make your, or one of your family members homes handicapped accessible.
https://cfmf.org/grants/

 

[commentator]

How has he been paying for his care since his stroke?

 

[Pinkie39]

How has he been paying for his care since his stroke?

He's on long term care Medicaid.

 

[doucar]

Hoping Janke will see this and reply. My brother is still at the nursing facility, nearly a year since his stroke last March. He's been in and out of the hospital for various ailments, along with hospitalization for a major psychotic episodes. Still wheelchair bound, with virtually no use of his right arm. He's being moved to another facility this week, his 3rd in a year.

I called the SSA again today to check on the status of his SSI application. The rep told me his application is being processed by our state's disability determination services unit, and it'll be another 1-3 months before they make a determination on his application.

So, my question is, is that routine for SSI applications to be processed at the state level? Can I or should I call the state to find out if there's anything additional they need to make a decision? Would the state be able to give me any additional information about his application status?

My urgency is from concern that Medicaid is going stop paying for my brother's care in a long term care facility at some point, and he'll have no where else to go. The current facility he's in has already told us that.

No one in our family has a handicapped accessible home with space available to take him in, nor are we equipped to deal with his mental health issues with him residing with us. And the programs we've found that could provide appropriate housing for him, that are rent subsidized, all require applicants to be receiving SSI or SSDI.

Thanks in advance for any help.

All SSI claims are reviewed by the state disability determination services.

 

[Pinkie39]

All SSI claims are reviewed by the state disability determination services.

Thank you. I wasn't aware of that.

 

[Janke]

You should be able to obtain the name and telephone number of the disability analyst at the state who is handling your brother's claim. You may need to have your brother sitting next to you when you make the phone call unless every component has you listed as an authorized rep. That doesn't always happen. Perhaps they can make a presumptive finding of disability based on the fact that he is still wheelchair bound etc. and that it is a dire need situation. That would only help if you could find him a bed in a facility that would take SSI as payment. Seems odd, though, that Medicaid is going to stop soon; or maybe you are just concerned in advance. Many facilities accept Medicaid for as long as the patient is alive and can't be cared for elsewhere. Probably also need to have a long talk with the facility and social workers at the facility.

 

[Pinkie39]

You should be able to obtain the name and telephone number of the disability analyst at the state who is handling your brother's claim. You may need to have your brother sitting next to you when you make the phone call unless every component has you listed as an authorized rep. That doesn't always happen. Perhaps they can make a presumptive finding of disability based on the fact that he is still wheelchair bound etc. and that it is a dire need situation. That would only help if you could find him a bed in a facility that would take SSI as payment. Seems odd, though, that Medicaid is going to stop soon; or maybe you are just concerned in advance. Many facilities accept Medicaid for as long as the patient is alive and can't be cared for elsewhere. Probably also need to have a long talk with the facility and social workers at the facility.

Thank you Janke, I appreciate the response. I had a lot of issues with the SSA and those darn authorized rep forms. One customer service rep would tell me they didn't have them on file and wouldn't give me info. Then another would say they did have them. I had my brother sign a new set of forms and sent them in about a month ago.

I will try to call the state disability determination services department next week for sure.

My older sister has been the main liaison with the nursing facility, for our brother. The social worker told my sister that our brother no longer meets a skilled level of care, and so Medicaid won't continue to pay for his stay there.

They found another facility that can take him, that Medicaid will cover. It looks to be more of an assisted living type facility, that also offers services for mental health patients. He's supposed to be moved very soon.

Unfortunately it's several counties away, quite a distance from our family, making visitations difficult, particularly for me. I don't drive, and my husband can no longer drive long distances due to health issues.

I'll report back when or if I can get ahold of someone from the state .

 

[Janke]

I can't remember if you said he had both an SSDI and an SSI claim pending. I hope so. Trying to make a decision for the SSDI was going to be a problem, but it is POSSIBLE for DDS to make a presumptive finding of SSI disability beginning with right now, which will pay him SSI for the next six months while they are deciding the SSDI. Presumptive disability is not used often, but it is available. You should talk to both the SSI Claims
Specialist or Technical Expert in your local office as well as the DDS analyst and maybe their supervisor. It seems to me that your brother is so obviously disabled that a presumptive decision could be made as a temporary way of getting him paid some money now. Hope it works. You may need to be persistent.

 

[Pinkie39]

I can't remember if you said he had both an SSDI and an SSI claim pending. I hope so. Trying to make a decision for the SSDI was going to be a problem, but it is POSSIBLE for DDS to make a presumptive finding of SSI disability beginning with right now, which will pay him SSI for the next six months while they are deciding the SSDI. Presumptive disability is not used often, but it is available. You should talk to both the SSI Claims
Specialist or Technical Expert in your local office as well as the DDS analyst and maybe their supervisor. It seems to me that your brother is so obviously disabled that a presumptive decision could be made as a temporary way of getting him paid some money now. Hope it works. You may need to be persistent.

Thank you Janke. I'm going to give them a call this week.

Yes, his SSDI application was denied. The SSA has his date last insured as in 2013. They said they could not find any medical proof that he was disabled prior to that date. He's been unemployed since 2008 due to his schizophrenia, and had one doctor's visit and an brief involuntary hospitalization due to it. He refused to seek treatment for it once he relapsed, so there's no extensive medical records.

I will ask about a presumptive disability finding when I get a hold of someone at the DDS.

As far as SSI...I know that it's normally reduced to $30 a month when a person is in a nursing facility. Does that apply to back pay as well?

 

[Janke]

SSI payment are based on the living arrangement in the effective month. Any month in which someone was in a medical facility throughout a calendar month and Medicaid paid more than 50% is subject to the $30 cap. Other months are not. Payment for past months are based on living arrangements and other income sources for past months.

 

[Pinkie39]

SSI payment are based on the living arrangement in the effective month. Any month in which someone was in a medical facility throughout a calendar month and Medicaid paid more than 50% is subject to the $30 cap. Other months are not. Payment for past months are based on living arrangements and other income sources for past months.

Thank you. That's what I thought. I appreciate your help.

 

[Pinkie39]

Just wanted to add an update: My brother found out this week that he's approved for SSI. Finally! Over a year after his stroke.

 

[commentator]

Great, thanks for the update!