Work Incentives Protecting Health Coverage for PWD

Standard

The author of the article smiling

By: Lesly Lopez

Extended Medicare Coverage

For Working People with Disabilities

As long as your disabling condition still meets our rules, you can keep your Medicare coverage for at least 8 ½ years after you return to work. The 8 ½ years includes your nine month trial work Period.

Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage will also continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted monthly from your check.

Continued Medicaid Eligibility (Section 1619(B))

For beneficiaries receiving SSI

One of the biggest concerns SSI beneficiaries have about going to work is the possibility of losing Medicaid coverage. Section 1619(b) of the Social Security Act provides some protection for these beneficiaries. To qualify for continuing Medicaid coverage, a person must:

  • Have been eligible for an SSI cash payment for at least 1 month;
  • Still meet the disability requirement; and
  • Still meet all other non-disability SSI requirements; and
  • Need Medicaid benefits to continue to work; and
  • Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.

This means that SSI beneficiaries who have earnings too high for an SSI cash payment may be eligible for Medicaid if they meet the above requirements. SSA uses a threshold amount to measure whether a person’s earnings are high enough to replace his/her SSI and Medicaid benefits. This threshold is based on the:

  • amount of earnings which would cause SSI cash payments to stop in the person’s state; and
  • Average Medicaid expenses in that state.

If an SSI beneficiary has gross earnings higher than the threshold amount for his/her state, SSA can figure an individual threshold amount if that person has:

The state of Florida 2016 annual threshold amounts for disabled and blind beneficiaries is $30,566.

 Other Health Insurance Options for People with Disabilities

Medicaid Share of Cost or medically needy from Department of Children and Families(DCF)

In Florida, the Medicaid Share of Cost program is a type of health insurance for the medically needy. These are people who make too much money to qualify for regular Medicaid, but not enough money to pay for their healthcare needs. They meet all of the standard Medicaid eligibility requirements except the income requirement.

The day your healthcare expenses for the month exceed your share of cost, your Medicaid coverage begins. From that day until the end of the month, you have full Medicaid coverage.  You don’t actually have to pay the healthcare expenses used to reach your share of cost. You just have to owe that much. When Medicaid coverage begins, not only does Medicaid pay for your healthcare expenses for the rest of that month, it also pays for the expenses used to meet your share of cost that month. If you choose to pay those expenses yourself, they’ll still count toward meeting your share of cost, but you won’t be reimbursed by Medicaid for what you’ve paid.  To apply or for more information visit www.myflorida.com/accessflorida.

Affordable Care Act (ObamaCare) through? the Market Place

The Affordable Care Act (ACA) was signed into law on March 23, 2010. Beginning Jan. 1, 2014, the law requires all Americans to obtain health care coverage through an employer, an individual health plan or programs such as Medicare, Medicaid, or Children’s Health Insurance Program (Florida KidCare) unless they meet an exemption. Individuals who do not meet an exemption and fail to obtain coverage may be subject to a tax assessment.

On Oct. 1, 2013, the federal government opened the Marketplace where individuals can compare and shop for health care coverage. Each year an open enrollment period will take place for individuals who are seeking Marketplace coverage. Medicaid and Florida KidCare enrollment takes place year-round. If a person applies at the Marketplace and is found potentially eligible for Medicaid or Florida KidCare, their application will be sent to the appropriate agency for processing. The ACA also provides cost sharing and tax credits to assist low-income qualified individuals in purchasing health insurance through the Marketplace.

 

  • Individuals seeking more information about services offered through the Marketplace may contact the Federal Call Center at 1-800-318-2596, Deaf and Hard of Hearing TTY 1-855-889-4325, or go to gov.

 

Community Health Centers like CHI (Community Health of South Florida Inc.)

CHI is a nonprofit health care organization providing affordable quality primary and behavioral health care services to the residents of rapidly-growing South Florida. CHI operates 11 state-of-the-art primary care centers and 31 school-based programs. All centers offer quality comprehensive primary and behavioral health care services. Our physicians are board certified or board eligible. Additionally, CHI is accredited by the Joint Commission and is accredited as a Level 3 Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). CHI offers a “one-stop-shop” model where the organization and delivery of quality services are seamless, affordable, accessible and culturally sensitive.  For more information visit their website: http://www.chisouthfl.org/about-us/.

If you are an SSI or SSDI beneficiary and need an individualized analysis of your situation please contact the Community Work Incentives Coordinator or benefits planner in your area.  Please check the SSA Website for more details: http://choosework.net.

Air Travel with a Disability

Standard

By: Aaron Carter Bates, Esq.
Speaking from personal experience, one of the most difficult situations I regularly encounter, as both an attorney and an individual with a disability, is air travel. Unbeknownst to most, air travel is one of the least accessible day-to-day accommodations encountered by individuals with disabilities. As such, one of the most common questions I get asked in my practice is: Why does it seem like airlines are so far behind other public accommodations in terms of accessibility? This article hopes to briefly address that question while also giving disabled air travelers some critical tips for reducing the inconvenience of flying as much as possible.

There are several reasons that, in terms of accessibility, air travel is not on par with other modes of transportation. One, airplanes are in no way designed for, or accessible to, air travelers with disabilities. Prior to boarding a plane, an individual with a disability must leave their chair for an “aisle chair” (an ineffective assistive mobility device for most disabilities) or be assisted by untrained airline personnel onto the plane. Further, the chair (or power chair) is then taken by baggage handlers who, more often than not, damage the chair during loading and unloading in the cargo hold of the plane. This is especially problematic if the chair is a custom, power wheelchair, as service and repairs are especially expensive. Additionally, if a service or support animal is involved, an additional layer of obstacles must be overcome to ensure that an individual can make the trip with their assistance animal.1

All of these reasons, however, stem from the fact that domestic air carriers are largely exempt from the enforcement provisions of federal civil rights laws, including, importantly, the Americans with Disabilities Act (“ADA”). The Air Carrier Access Act, 49 U.S.C. § 41705 (“ACAA”),2 is the primary law setting forth the obligations of air carriers as it relates to disabled travelers. The ACAA was passed in 1986 and is enforced by the United States Department of Transportation. The DOT issues implementing regulations from time to time, and those regulations provide the meat on the bones of the ACAA.

At first glance, many aspects of the ACAA appear to be taken directly from the ADA.  For example, issues like the definition of “disability” are identical to the ADA. The main difference between the ACAA and ADA, however, is that under the ACAA, disabled travelers do not have a private right of action against an air carrier that discriminates against the customer.3 Unfortunately, the most effective means for effectuating change when dealing with large venues or companies is the legal process. However, if an individual is discriminated against while on an airplane, there is no recourse through the courts for the most part. Any complaints or allegations of discrimination are handled in concert between the customer, the airline’s customer service, and the DOT. Aside from potential reimbursement of repair costs or fines levied by the government against the airline, there is no real incentive preventing air carriers from repeating bad conduct. At the end of the day, the degree of effort required to remedy, and the consequences for, misconduct is more trouble than it is worth for the average disabled air traveler to pursue.

With all of that in mind, here are some important tips for individuals with disabilities to follow prior to their next flight:

A. Know your rights. The sad reality is that most airline employees are poorly trained when it comes to providing services to disabled air travelers. I can’t stress enough how important it is to carry a copy of the DOT’s rules as it relates to air travel for persons with disabilities. Entitled “Nondiscrimination on the Basis of Disability in Air Travel”, these rules address 95% of the questions that might arise while traveling by air.4

B. Don’t take the first no for an answer. In the event questions or issues arise, always ask to speak to the airline’s complaints resolution official (”CRO”). Each airline is required to designate and make available to customers a CRO, 24 hours a day, 7 days a week. Generally, CROs are the airline employees with the most knowledge concerning disabled air travelers and associated accommodations. Additionally, the DOT maintains a customer assistance line for these types of issues.5 If the CRO is not being as helpful as they should, contacting the DOT may assist in expediting the process.

C. Contact the airline prior to your date of travel. A lot of the issues commonly encountered by disabled air travelers can be resolved ahead of time through the carrier’s reservation and/or customer service departments. At a minimum, contact your airline 48 hours prior to your departure to inform them of the specifics related to your disability and accompanying needs. This includes advising them of what type of assistive device you’ll be traveling with (i.e. chair, power, type of battery, etc.), whether or not you need assistance enplaning or deplaning, or seat assignment (i.e. the need to be reassigned to seating near the bulkhead of the plane to reduce the amount of distance you’ll need to traverse from the door of the plane to your seat, etc.).6

D. Become very familiar with the complaint resolution process. As mentioned previously, in the event you believe an airline has discriminated against you
on the basis of disability, the designated means for recourse is a complaint filed with the DOT. The DOT’s air consumer department provides a bevy of information on both the rules airlines are required to follow, and the forms and steps necessary to pursue a remedy through the DOT’s administrative process. Having an understanding of these rules prior to traveling will assist a disabled traveler in making sure that the full scope of remedies available through the DOT’s grievance process are in play in the unfortunate event that further steps are necessary. In summary, traveling with a disability already presents certain obstacles and concerns that are just inherent to being disabled. However, the very limited range of available options to a disabled passenger that is discriminated against makes it very important that such travelers are well-versed in their rights and their legal options.

References:

1. Additional guidance on traveling with an assistance animal can be found here: http://airconsumer.ost.dot.gov/rules/20030509.pdf

2. See also Title 14 CFR Part 382; 70 FR 41482; http://airconsumer.ost.dot.gov/ACAAcomplaint.htm

3. In other words, generally, a disabled air traveler does not have the right to file a lawsuit for discrimination against an air carrier. This rule is not set in stone or uniform. While most circuits have found that a private right of action by an aggrieved, disabled traveler does not exist – see, e.g., Love v. Delta Air Lines, 310 F.3d 1347 (11th Cir. 2002) – circuits, such as the 9th, do recognize such a right under the ACAA. See Newman v. Am. Airlines, Inc., 176 F.3d 1128 (9th Cir. 1999).

4. The most recent version can be found here: http://airconsumer.ost.dot.gov/rules/382short.pdf.

5. The DOT Aviation Consumer Protection Division: 800.778.4838 (voice) or 800.455.9880 (TTY), hours of operation: 9 AM to 5 PM EST, Monday through Friday.

6. Up until the day of departure, airlines block out certain bulkhead seating (i.e. close to the door) to accommodate the travel schedules of employees, travelers with disabilities, or any other passenger with special needs.