Aug 27, 2019

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Coalition Makes Major Strides with Disability Benefits Reform

by | Aug 27, 2019

Editor’s note: This vignette originally appeared in Colorado Center on Law and Policy’s 2018-19 Annual Report

Federal cash assistance programs, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) provide a monthly income to people living with disabilities. The programs provide about $730 per month– or potentially more for people that qualify for SSDI. Recipients use the benefit to obtain stable housing, get enough food to eat, and cover other critical basics while they are unable to work.

Unfortunately, for many disabled individuals, the income can be long-delayed or simply unobtainable. Due to the complexity of the application process, only 25 percent of people that apply are approved on their initial application and that number is only 10 percent for applicants experiencing homelessness. Most applicants that get denied at the initial level are ultimately approved, but many give up; and those who appeal wait an average of 18 months for resolution of their cases.

Recognizing the delay, several states, including Colorado, established interim assistance programs that provide some support while individuals wait for SSI or SSDI benefits. These state programs provide resources that help people get some extra food and afford transportation. But what happens when the state program also fails to work for the people that need it most? Until recently, that was the case for Colorado’s interim assistance program – Aid to the Needy Disabled (AND).

AND provides just $217 per month to people that have a mental or physical disability that prevents them from working. Until recently, the requirements to qualify for AND were set almost impossibly high. Case in point: applicants were required to get a medical professional to sign a form (commonly known as the “Med 9” form) attesting that the individual is “totally and permanently disabled” and incapable of working – and submit the form within 10 days after receiving it.

“It’s hard for anybody to get a doctor’s appointment within 10 days,” said CCLP Health Care Attorney Allison Neswood. “AND is supposed to be available for a people that have no income and that are dealing with significant disabilities. That timeline was just impossible for too many.”

A similarly impossible rule required AND applicants to verify that they had applied for SSI within 10 days of applying for AND. It can take months to complete these applications properly, even when a person has the help of an expert.

To further complicate matters, in order to meet the disability standard for the program, health care providers had to mark on an applicant’s form that the applicant had a “total and permanent disability.” Mental health professionals were especially reluctant to characterize their patients that way. So, even when patients had a serious mental illness, providers would mark that the patient had a temporary disability. When this happened, the applicant would not be considered disabled unless a county worker — not trained in disability — determined the applicant faced functional limitations that, in combination with social factors, prevented them from working.

Furthermore, the list of providers who could sign the Med 9 was unnecessarily restrictive. For example, Licensed Clinical Social Workers (LCSWs), psychologists and Licensed Professional Counselors were unable to verify that their patients couldn’t work due to a disability. Such mental health professionals are often are often more aware of their clients’ physical and mental limitations than doctors or psychiatrists, and are more accessible.

Working on solutions
With frustrations around the Med 9 process and restrictions reaching a fevered pitch, a work group consisting of CCLP, Colorado Cross-Disability Coalition, Bayaud Industries, Easter Seals, the Colorado Coalition for the Homeless and the Denver Chapter of the National Alliance of Mental Illness came together in late 2014 to tackle some of the barriers that stood between people with severe disabilities and their benefits.

“Our approach was multi-pronged,” Allison said. “We knew there were some things that could start to alleviate the problems that didn’t require regulatory or statutory change.”

As a first step, the group reached out to mental health professionals to understand their issues with the Med-9 and worked with CDHS to develop a simple one-page cover letter that accompanied the Med 9 form. The letter was designed to inform the providers why they are being asked to sign the form and to clear up some misunderstandings, regarding liability and the definition of “totally and permanently disabled” that gave many professionals pause. The easy-to-read letter is now standard with every Med 9 form.

Next, the work group took aim at regulatory changes, including the disability assessment completed by county workers, the AND timelines. They worked with employees the Colorado Department of Human Services on several rules to bring to the State Human Services Board. The rules gave clients more time to prove that they have a qualifying disability, expanding the timeline from 10 days to 30 days.

The changes also give clients 60 days to complete their SSI application and, while the old rules required an SSI application be completed before a person could begin receiving AND, the new rules allow AND applicants to begin receiving AND while they work on their SSI application so they can take advantage of that full 60-day timeline. The new rules also took county administrators out of the business of determining a client’s ability to work. Finally, the rules expanded the list of providers who can verify that an AND client has a qualifying disability as a result of a statutory change in 2018 that we worked on concurrently.

The Human Services Board was very receptive to the proposed rules and unanimously approved them during a September 2018 meeting in Durango. They were implemented in November, 2018.

Legislation assists applicants
With the rule changes regarding the AND application process already in the works, CCLP and its coalition partners turned their attention toward legislation that would provide services to help people successfully apply for SSI/SSDI.

Among other things, the services would assist applicants with getting a documentation of their medical and employment history, schedule and honor appointments, facilitate communication with government agencies, review and submit application forms, and appeal if the application is denied. A similar pilot program was tested due to legislation passed in 2014, with encouraging results.

The legislation, House Bill 1223, was introduced in the 2019 legislative session, but there were concerns that a $3.8 million fiscal note made it a tough sell to legislators.

“It didn’t look like it was going to go through,” Allison said. “We thought there was no chance of getting money because of too many competing priorities.”

Thanks to strong testimony from partners during a hearing, and the persuasive point that investing in assistance services would actually save the state $3 million a year through federal reimbursements from SSI/SSDI and reducing the wait times and AND payments, the bill passed through its first committee by a vote of 8-1.

“Our coalition did a good job identifying, rallying and bringing their strong voice and perspective to the Capitol,” Allison said.

The program secured $1.5 million from marijuana revenue in its first year, which will become a $3.8 million line-item in subsequent years. The bill was approved in both chambers with bipartisan support and signed by the governor. Now that the legislation is law, CCLP is working on implementation by identifying recommendations for CDHS and working on a formula for allocating the money to the counties.

The difference we make
These comprehensive reforms will make a difference for Coloradans seeking income assistance for a physical or mental disability. CCLP deeply appreciates the support, passion and expertise its advocacy partners contributed in making the changes happen and it appears that they value our role as well.Looking back, Allison said this successful effort is a great example of how systems change works at CCLP and in the advocacy world in general.

“You have to look at multiple types of advocacy, use multiple skills sets and approach things from multiple directions,” she said. “In order to make the system work better, we had to look at administrative process forms and procedures, regulations and state statute. That systemic view of the problem is what helped us identify the appropriate solution. In the end, this is about getting people who aren’t working into the most stable income program in the country: SSI/SSDI. It’s step one for the financial security of this population.”  

 

Recent articles

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.