What do you need to win your Disability Claim?

All Claimants are required to provide medical documentation to support their disability. You cannot obtain benefits, based in disability without a diagnosis and medical documentation of your symptoms.

In Virginia, the Social Security Administration  designates the Disability Determination Services (DDS), a Division of The Commonwealth of Virginia, Department of Vocational Rehabilitation, to evaluate your medical records to determine if you meet the criteria for disability. DDS will request all medical records from medical care providers that you list on your application or that you add to your record; they will analyze those records received and make a written Determination of Disability status based on the information in those records and your responses to forms DDS sends to you.

If medical care providers do not send the records or you do not return forms, you may be denied for lack of information or cooperation.

You do not pay for the medical records obtained by DDS. You should not need to get records from your medical care providers unless they fail to send them to DDS.

If you want copies of your medical records from your medical care providers to compare to what they sent to DDS then you MAY have to pay your medical care providers for copies of medical records to the limits set by the Code of Virginia, Section 8.01-413; check the statutes in your state for the same information. Hospitals are allowed to charge more than medical offices. The medical care provider MUST respond to your request within 21 days of the written request. “Respond” does not mean they have to provide the records in 21 days, only respond and tell you how much you owe for the copies. They cannot withhold your records because you owe treatment care money. Arrange to pay for your records on the day you PICK THEM UP.

If you are told that your records will not be released because you owe treatment costs, explain, nicely, that under Section 8.01-413 Code of Virginia, these are your records and that if they do not provide them to you, you may hire an attorney obtain them by subpoena and their practice may end up paying for the attorney. Usually, the medical care provider either is acting out of ignorance or their employee is uninformed as to the Statutes and placing the practice at jeopardy for the expense for violating this Statute.

If you have a Medicaid Application pending, you might explain to the medical care provider that when you win your Disability case, your Medicaid will be re-evaluted and those medical bills just might get paid by Medicaid,  Medicare, or both.

When should a SSA Disability Claimant Apply for Medicaid?

           You should apply immedicately either before you Apply for SSI/DIB or immediately after. That was a quick and easy answer; getting the benefits may not be!

It is not easy and it does require that you follow-up, do everything on time, and file Medicaid Appeals when deadline dates are not met by the Department of Social Services.

To begin, if you attempted to apply for Medicaid at the Department of Social Services (DSS) and the following happened:

•  DSS (Department of Social Services) told you that you could not be eligible for Medicaid unless you had already won your Disability status with the Social Security Administration;
• DSS denied your Medicaid based on a Denial by Social Security while you were in the SSA Appeal process;
• DSS denied your Medicaid Application without making an independent determination of disability by MDU;
• Someone at the DSS discouraged you from applying, such as telling you that you would not be eligible if you Apply;

YOU NEED TO FILE A MEDICAID APPEAL IMMEDIATELY! 

HOW TO FILE A MEDICIAD APPEAL:

Call your local DSS and tell them to mail you an Appeal form or go online to your DSS and get a form there. You do not have to explain why you need an Appeal form. If they do not send it in 5 business days … GO THERE AND GET ONE!

On the Medicaid Appeal form you are asked when did the violation of your Rights occur (they ask you when did you get Notice from DSS of the Appeal Issue); they will say you should have Appealed within 30 days, however IF YOU RELIED UPON THE REQUIRED SUPERIOR KNOWLEDGE OF THE DEPARTMENT OF SOCIAL SERVICES PERSONNEL, you have the Right to Appeal, based on not knowing your true Rights until you found out this information from us. On the Hearing day, there may be a “pre-Hearing” discussion on the issue of “good cause” for filing the Medicaid Appeal after 30days. We have never lost a case when the Applicant was able to clearly state that they had relied upon the statements made by DSS employees and the DSS employees were wrong.

Once you have an effective date of Application established, either by filing the Application or by the Hearing Officer determining what you Application date was, your Medicaid eligibility must be determined for a period of 90 days prior to that Application date unless you have been declared Disabled by Social Security, then they only have 45 days.

You may get a letter telling you that they are not going to meet the 90 day limit because (whatever they say); IMMEDIATELY file a Medicaid Appeal stating that they have failed to determine your eligibility within the time limit set by the Federal Regulations. There are no exceptions to the 90 day determination of disability by MDU allowed under the Regulations…. NONE!

When you do win your SSA BENEFITS, DSS will reopen this Application and reevulate your eligibility for Medicaid, or a Spend Down Medicaid. Any months you get at least $1.00 of SSI you will have Medicaid eligibility IF YOU FILED THE MEDICAID APPLICATION.