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SSDI, SSI or Medicaid for early on-set Alzheimer’s Disease

SSDI, SSI or Medicaid for early on-set Alzheimer’s Disease

Social Security pays benefits to people who are disabled/impaired and unable to work. Federal law follows a strict definition of disability and the SSA has a list of rules for every type of impairment that has to be met in order to be eligible for Social Security Disability Insurance. Under this condition, a person is considered disabled if:

  • He/she is unable to continue performing work that they did earlier;
  • The SSA decided that the disabled person cannot find any new work which works with their disability condition;
  • The disability has lasted or is expected to last for one year or more or may result in death;
  • The disabled person is unable to perform any kind of substantial gainful activity, SGA to earn a sufficient amount of income;

In addition to meeting the definition of disabled and other non-medical requirements, the disabled person must have worked long enough, and within a recent timeframe under Social Security to qualify for disability benefits. There are two main programs that provide benefits under the Federal rules in monthly disability benefit checks:

  • I. Social Security Disability Insurance, SSDI

The SSDI is a disability insurance program under the Federal Rule that provides benefits to the disabled person (who has met all eligibility criteria for SSDI benefits program) – the SSDI may also cover certain members of the family if the disabled person is eligible and 'insured'; One main criteria for disability insurance is that the person with a disability condition must have worked 35 years with filed taxes on income payrolls in Social Security taxes.

  • II. Supplemental Security Income, SSI

The Supplemental Security Income, SSI is a need-based benefits program and is not provided for people with disability. The SSI payments are based on financial needs for those who are aged 65 or above, are blind or disabled and have documentation/records to prove that they do not have an income source above the minimum threshold determined each year by the SSA for SSI programs.

While the programs are different, the SSA uses the same non-medical eligibility criteria to determine if an applicant is disabled due to early on-set (sometimes referred to as younger-onset). Alzheimer's disease or other dementia, which is considered early on-set if the person suffers from the condition before the official retirement age i.e., age 65.

SSDI for Alzheimer patients

Alzheimer's is a now very common among elderly people with initial symptoms of dementia. Although not a completely physical disorder, the Alzheimer's is one of the most claimed disability among the SSA's Blue Book of disability/ impairments in Neurological diseases. While some people with extreme cases of Alzheimer's may win disability insurance, the early onset Alzheimer patients are often deferred since they do not meet the minimum work requirements for SSDI benefits.

This is the reason the SSA has put Alzheimer's into its list of compassionate allowances, CAL. The CAL gives those with the disease an expedited access to Social Security Disability Insurance, SSDI and Supplemental Security Income, SSI.

Alzheimer's disease is a form of extreme dementia that may possibly affect different areas of the brain (such as hypothalamus, frontal cortex) causing problems with thinking, memory, coordination loss and behavioral problems. Although the majority of those who suffer from Alzheimer's disease are over 65, but early-onset Alzheimer's can develop in people as young as 40. Experts suggest that around 5.1 million Americans may currently have AD.

It is well known that many people having Alzheimer's disease are unable to work. If they're ineligible for Social Security retirement benefits (due to early onset), then they may apply for the more rigorous Social Security Disability benefits. This means that even the patients with an early on-set diagnosis are made eligible for the expedited processing of their disability claims. There are also some other diseases covered by the Compassionate Allowances, CAL. These include:

  1. Adult-onset Huntington'sdisease
  2. Creutzfeldt-Jakobdisease (CJD)
  3. Early-onset Alzheimer's disease
  4. PrimaryProgressive Aphasia (PPA)
  5. Progressive SupranuclearPalsy(PSP)
  6. The ALSParkinsonismDementia Complex
  7. Lewy bodydementia
  8. Frontotemporaldementia(FTD),Pick's disease-Type A
  9. Mixeddementia

Coming back to Alzheimer's, it is both a good thing and a bad thing that it progresses slowly. Good because the patient does not become disabled at once and normally have many years to put together a good asset management plan, trusts, medical wills etc in case of medical emergencies. Bad because due to the prolonged nature of the disease and its slow spread, the SSA may not consider the patient 'disabled enough' until much later in the disease. Although symptoms can be managed to some degree through the use of medications, therapy, and lifestyle changes, AD is the sixth-leading cause of death in the United States, killing around 100,000 people each year.

If you or a loved one has Alzheimer's and needs to file for income benefits, here are a few tips that might come handy:

  • i. You need to have medical records to prove that your condition is disabling enough to prevent you from working, such as,neurosurgeon or physician's statements, CT scans, MRI reports, employer's statements, caretaker's testimonials etc.

  • ii.Although not always the case, the general rule for eligibility for SSDI by SSA is you need to have worked for atleast five years in the last ten years, with ofcourse, income tax files for Social Security taxes.

  • iii. If you are not eligible for SSDI, you may be eligible for SSI – fortunately, there are no work requirements for SSI but you do need to meet the strict income and asset limits to qualify for SSI.

  • iv. You should keep your medical records in an early on-set diagnosis even if you think that the situation was not deteriorating enough. In order to qualify for Compassionate Allowances, it's important to make the SSA aware of the earliest date of your early on-set diagnosis and how it affected your work and daily lifestyle.

  • v. If there is no early on-set diagnosis and you don't qualify for any of the three benefits programs i.e., SSDI, SSI and CAL, you might still qualify for Medicaid. This would require providing medical records that prove that your condition adequately hinders your ability to perform essentially any job duties on a full-time basis. The SSA will want to see evidence of symptoms such as memory loss, speech and behavioral problems, and impairments in things like problem-solving ability and recognition.

  • vi. The SSDI benefit process can be very long due to the long volume of claimant's applications. Unless the compassionate allowance criteria are met, it is a very common sight to see Alzheimer's patients with benefits claims waiting up to two years for benefits approval. Hence, it is very important that you file for benefits as soon as possible.

*Note: Due to the Coronavirus situation many of the SSA staff is working remotely from their homes. The SSA has made it possible to file for benefits claims online through your SSA ID, which you can sign up for here. The limited number of staff in your local office and due to the large volume of applications you should expect a delay in the call for analysis for your disability eligibility by the SSA's disability examiner after you file your claim.

Remember, in addition to meeting the eligibility requirements by the SSA, it is very important that you fill in the documentation and compile all the files properly when filing for a benefits claim. Having Alzheimer's yourself or taking care of a loved one with the condition might be traumatic enough both physically and emotionally. Hence, we suggest you seek professional help in making sure every action you take while filing your claim gets you closer to winning the benefits at first attempt. This could include receiving statements from your physicians or doctors, providing the SSA will all follow up medical records, obtaining statements from employers and caretakers etc.

It is also vitally important in how you present your case in your application or in front of an ALJ if you are filing for a disability appeal. Hence, you can seek the counsel of our disability attorneys who have years of experience knowing what the SSA might expect from your application and make sure that you win the disability benefits that you very well deserve.

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Thursday, 01 October 2020