Financial and Health Care Benefits

Few of the programs or services you may need for your child with emotional or behavioral disorders are free. So unless your private funds are unlimited or you have a very good insurance policy, other financial resources must be found. Because each person's financial situation, insurance policy, and treatment program eligibility are different, so no single answer will suffice for everyone. Information on monetary benefits and health care benefits are listed here to inform you of some options that may be available to you.

Monetary Benefits

Social Security Disability Insurance (SSDI) Social Security Disability Insurance (SSDI) benefits provide monthly income when earnings are lost due to disability. This program of the federal government defines disability as a serious physical or mental impairment that (1) prevents you from doing substantial work based on age, education, and work experience; (2) is expected to last or has lasted for at least 12 months; and/or (3) is expected to result in death.

Supplemental Security Income (SSI) Disabled persons of any age with a limited amount of income and resources may be eligible for SSI benefits. The same disability test is used for SSI as SSDI: Is the person able to perform "substantial gainful activity" given his/her age and educational and work experience?

• Regulation require that in the case of a child (under age 18) who resides in the home of his/her parents, the income and resources of the parents be deemed (considered available) to meet the needs of the child. If the parent is receiving public assistance, such as Temporary Assistance for Needy Families (TANF), the child who is disabled is eligible for SSI or TANF, whichever is more favorable to them.

SSI, another federal program, is meant to provide a minimum standard of living for people who have little income and resources. Because of this, it is a "means-tested" program - only those in financial need can qualify. Benefit amounts are periodically adjusted by the federal government. In addition, SSI recipients in Pennsylvania are usually eligible for Medicaid and food stamps too.

• Children and adults who live in public institutions, however, usually cannot receive SSI. An institution is defined as a facility that provides room and board and some services or treatment to four or more individuals who are unrelated to the owner.
• Examples include a hospital, skilled nursing facility, nursing home, intermediate care facility, halfway house, jail, prison, or a public emergency shelter.
• Generally, if you child is in a public institution, he or she is not eligible for SSI, except for the following situations:
  • If he or she is in a public or private health care facility that is receiving substantial Medicaid payments for his or her care, he or she may be eligible for reduced SSI payments ($30/Month) for incidental personal needs not met by the institution.
  • If your child is living in a publicly operated community residence that serves no more than 16 people, he or she may be eligible for full benefits.
  • If your child is a resident of a public institution primarily to attend approved educational or vocational training, he or she may be eligible.
  • If you and/or your child are temporary residents of a public emergency shelter for the homeless, you may be eligible for SSI payments.
  • If your child lives in a private institution, he or she may be eligible for SSI checks, but the payments may be reduced, depending on who is paying for the care.
• The Social Security Administration must be notified when your child enters or leaves a public or private institution.
• If possible, you should make application or reapplication for SSI at least 30 days before leaving the institution. Some public institutions notify Social Security in advance so that an application can be completed before your child leaves. A Social Security representative may be sent to the institution so that any benefits that a person is entitled to will be available by the time or soon after he or she is discharged. Ask the institution's social worker to arrange this.

For more information about Social Security benefits contact:

Social Security Administration
Teleservice Center
800-772-1213 (7 a.m. to 7 p.m.)
800-325-0778 (TTY)
www.ssa.gov - One helpful brochure to ask for (or download from the Internet) is "Social Security: Benefits for Children with Disabilities."

To apply for SSDI and/or SSI contact:

Social Security Administration
Teleservice Office
800-772-1213 (7 a.m. to 7 p.m.)
800-325-0778 (TTY)
www.ssa.gov

Denial of Benefits - How To Appeal

If Social Security Administration decides that you are not eligible or you are no longer eligible for benefits, you should ask Social Security to reconsider its denial by asking for a hearing. You have 60 days to appeal a decision.

On the form, it is better to check the box for a "disability hearing" because then you can actually meet with someone to explain how your child's condition limits what he or she can do.

If you can't get to your Social Security office, then call and have an appeal form (Form 789-US) sent to you. If you had been receiving benefits, be sure to get the form, complete it, and return it within 10 days so your child's benefits will continue.

With the reconsideration form you can provide new reports or information about changes in your child's condition. You can also ask the hearing officer to collect more information about your child.

The Social Security Administration also publishes a brochure entitled "The Appeals Process" which offers additional insight.

Other Public Assistance Benefits

Temporary Assistance for Needy Families (TANF)

TANF is a state - administered, federal block grant-funded program that provides cash assistance to eligible families. Applications for TANF may be made at the County Assistance Office serving the area in which you reside.

If you are having trouble getting the appropriate services contact: Income Maintenance Helpline, Department of Welfare, Harrisburg (800) 692-7462

Medicaid or Medical Assistance

Medicaid is an assistance program that pays medical bills for eligible people. This federal-state Medical Assistance program is probably the most important legal entitlement that people with mental illness have for both mental health care and medical services. Apply at your County Assistance Office.

Children's Health Insurance Program (CHIP)

The state Children's Health Insurance Program (CHIP) insures children from working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. The program covers prescription drugs, vision, hearing, and mental health services.

For information on applying and eligibility requirements contact:

CHIP Program, PA Department of Insurance
1300 Strawberry Square, Harrisburg, PA 17120
800-986-KIDS
http://www.insurance.state.pa.us/html/chip.html

What To Do When You Have Problems Obtaining Benefits

The following agencies may be of assistance to you if you are having trouble obtaining benefits or information:

Pennsylvania Health Law Project: PHLP advocates for access to consumer-directed health services for persons with disabilities. It provides assistance about the Medical Assistance (MA) process. www.phlp.org; 800-274-3258

Philadelphia
924 Cherry Street
Suite 300
Philadelphia PA 19107
215-625-3663
fax: 215-625-3879

Harrisburg
101 South Second Street
Suite 4
Harrisburg PA 17101
717-236-6310
fax: 717-236-6311

Pittsburgh
650 Smithfield Street
Suite 2130
Pittsburgh PA 15222
412-434-5779
412-434-0128

Department of Public Welfare: Welfare Helpline - 800-692-7462

The helpline responds to inquiries about all income-maintenance programs, including cash assistance, medical assistance, food stamps, and energy assistance.

Office of the Inspector General Claim Settlement Hotline - (800) 932-0935

101 South 2nd Street, 3rd Floor; Harrisburg PA 17101
The hotline responds to questions dealing with reimbursement or restitution of cash assistance or food.

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