The 24 Month Medicare Gap

From the Associated Press:

Disabled by chronic back pain and unable to afford medical insurance, Lea Walker hoped President Barack Obama's health care overhaul would close a coverage gap that has trapped her and millions of other workers.

It won't.

Although disabled workers can expect improvements, the legislation moving toward final passage in Congress doesn't deliver the clean fix that advocates for people with serious medical conditions hoped for. Some of the neediest could find themselves still in limbo. ...

She started receiving monthly disability checks from Social Security, but found she would face a 24-month wait for Medicare. Insurance available through her husband's job was out of reach at $800 a month.

At any given time, an estimated 1.8 million disabled workers languish in the Medicare coverage gap, a cost saver instituted nearly 40 years ago. Many, like Walker, are uninsured. Lawmakers had hoped to eliminate the gap as part of health care overhaul, but concluded it would be too expensive. ...

"I think everyone needs to realize this is going to be a first, very major step toward health care reform and then there will be a need to come back in the next several years and make midcourse adjustments," said Sen. Jeff Bingaman, D-N.M., who pushed unsuccessfully to phase out the waiting period.

While I wish that Congress would deal fully with the problem now, this article makes the problem out to be worse than it is. Many, perhaps most, of the people in the 24 month waiting period will be eligible for Medicaid under the health care reform bills pending in Congress. Because Medicare lacks an adequate prescription drug benefit, Medicaid may be better for low income families anyway. These bills would also give Medicaid coverage to many of those who are stuck in the lengthy process of appealing Social Security disability denials.

By the way, I will make a prediction now. If some combination of the plans pending in Congress come into effect, a higher percentage of Social Security disability claims will be approved because of better documentation of illness. I think we can also hope that eventually the rate of disability in this country will decrease because of better access to medical care.

Newspaper Tries To Blame Social Security For Murder?

From the Boston Globe:

Two decades ago, Congress was abuzz over scandals involving indigent parents who fabricated behavioral problems in their children to get disability payments for mental disorders. Stunned by news of these so-called “crazy checks,’’ US lawmakers in 1996 enacted tougher standards for children to qualify for such benefits.

But in a highly unusual criminal trial set to start on Tuesday, prosecutors are expected to allege that stricter eligibility rules did not stop a financially strapped Hull couple, Carolyn and Michael Riley, from concocting an elaborate scheme involving powerful psychotropic drugs. By 2006, everyone in the family was on the federal disability rolls, except for the youngest child, 4-year-old Rebecca, whose application had been denied. As the parents were appealing that decision, Rebecca died in December 2006 of an alleged overdose of psychiatric drugs that she had been prescribed for bipolar and hyperactivity disorders.

The parents now face first-degree murder charges.

As I read this, I have to wonder whether the newspaper is accurately describing the case. First degree murder is normally something intended. Nothing about the story presented suggests that these parents were deliberately trying to kill their child. Felony murder is a death that may have been unintended but which happens during the commission of a felony. Are prosecutors saying the parents were trying to commit fraud on Social Security and their daughter died as a result of this fraud? That sounds like a stretch. How would you prove fraudulent intent by the parents? This sounds like a highly disordered family. It is not implausible to me that severe mental illness was rampant in the family. There is a significant genetic component to bipolar disorder.

I expect this newspaper is trying to make a political case using only a caricature of a criminal case. It makes me wonder about the validity of the political argument they are making.

By the way, I have a ready explanation for the increase in the number of children receiving SSI benefits on account of mental illness. Previously, it was believed that bipolar disorder was either rare or non-existent in children. Now child psychiatrists believe that bipolar disorder is not uncommon in children. This belief is bolstered by a National Institute of Mental Health study. Putting the label of such a severe disease on children leads to more of them receiving disability benefits. More children are being diagnosed with bipolar disorder not because of something to do with Social Security but because of research. If you want to blame a government agency for this, blame the National Institute of Mental Health but be prepared to argue with their rigorous scientific study.

GAO Report On ALJs

From Results-Oriented Cultures: Office of Personnel Management Should Review Administrative Law Judge Program to Improve Hiring and Performance Management, a report by the Government Accountability Office (GAO):

SSA [Social Security Administration] and HHS [Department of Health and Human Services] officials responsible for hiring new ALJs reported they were satisfied with the quality of the judges hired from OPM’s [Office of Personnel Management's] ALJ [Administrative Law Judge] register of qualified candidates in 2008. Despite their satisfaction with these ALJ candidates, agency officials raised several issues regarding ALJ hiring and offered suggestions to improve the process, including (1) opening the OPM registry to accept new candidates more frequently, (2) giving greater consideration to agency-specific knowledge and experience, and (3) providing additional agency flexibility in meeting the procedural requirements associated with selecting from the three best qualified candidates and awarding veterans’ preference. OPM officials reported they are working to address these issues and develop new approaches, where appropriate. ...

To safeguard the independence of ALJ decisionmaking, ALJ agencies are prohibited from rating or tying an ALJ’s compensation to their performance. Nevertheless, SSA and HHS officials reported using numerous other practices to manage ALJ performance. ALJ association officials were concerned some SSA performance management practices could affect ALJs’ decisional independence.

SSI Recipients Eligible For VA Benefits

From a recent report by Social Security's Office of Inspector General (OIG):

To perform our review, we identified 2,390 SSI [Supplemental Security Income] recipients as of March 2009 (from 1 of 20 Social Security number segments) with military earnings during certain wartime periods who appeared to meet VA’s [Department of Veterans Affairs'] requirements for benefits. [This would have to be non-service connected VA disability benefits, a point that the report should have made clear. Some of these veterans would also qualify for service connected disability benefits from VA.] We randomly selected 100 cases from this population for detailed analysis. (See Appendix B for more details on our scope, methodology, and sample results.)

RESULTS OF REVIEW

We found that some SSI recipients appeared potentially eligible for VA benefits instead of SSI payments. Based on our review, we estimate SSA paid about $1.3 billion to approximately 22,000 SSI recipients who appeared to meet VA requirements for benefits. In addition, we estimate that SSA will continue to pay about $126 million in SSI payments over the next 12 months to individuals who appeared eligible for VA benefits instead of SSI payments.

Of the 100 cases in our sample,
• 45 appeared potentially eligible for VA benefits;
• 45 did not appear eligible for VA benefits; and
• 10 had military earnings, but we were unable to determine potential VA benefit eligibility.

Award To Medicare Rights Center

The Medicare Rights Center has received an award from the Social Security Administration for its outreach efforts on Extra Help, a program which helps low income Americans pay deductibles and co-payments for the Medicare prescription drug benefit.

Surprising E-Verify Problem

All federal agencies are supposed to use the E-Verify system to determine that new hires are eligible to work in the U.S. E-Verify is a Department of Homeland Security operation, in theory, but the data comes from the Social Security Administration.

It turns out that in the first six months of fiscal year 2009, 19% of Social Security's new hires were not cleared through E-Verify according to a report from Social Security's Office of Inspector General(OIG). Forty-four of those new hires would not have been cleared by E-Verify. (The report does not go into this point but probably in most cases, maybe even all cases, the problems preventing the individual from being cleared by E-Verify would have been technical and could have been corrected.) Of those new hires who were verified, 49% were not verified on a timely basis, which is within three days of being hired.

Social Security agreed with OIG that the agency needs to do better.

Federal Computer Week is running a story on this.

Bomb Threat In Pennsylvania

A man has been arrested for yelling "If I don't get my check, I'm going to blow this building sky high" as he left the Easton, Pennsylvania Social Security field office.

Chubby Checker And Social Security

From Social Security's E-News:

Michael J. Astrue, Commissioner of Social Security, and Chubby Checker, the Grammy Award winning rock and roll legend, today launched a new public service campaign to inform millions of Americans about a new "twist" in the law that will make it easier to qualify for Extra Help with Medicare prescription drug costs. To learn more, click here.

Health Care Reform And Medicare

The Coalition to End the Two-Year Wait for Medicare has sent a letter to the Speaker of the House of Representatives and the Senate Majority Leader giving their views on the pending health care reform legislation. The two year wait that the Coalition's name refers to is the waiting period for Medicare after a person becomes eligible for disability benefits under Title II of the Social Security Act. The waiting period is actually two and a half years since it is on top of a five month waiting period before cash benefits begin that is usually six months because it is five full calendar months.

The letter is a good summary of the possible effects of the bills going into conference between the House and the Senate. Eliminating the two year waiting period is out of the question at the moment. The main issue is how many of these people will qualify for Medicaid. Here is an excerpt from the letter:

While both bills have a Medicaid expansion as an essential element in providing coverage to the uninsured, the House bill extends eligibility to people not eligible for Medicare with incomes up to 150 percent of the federal poverty level. The Senate bill’s ceiling on eligibility is set at 133 percent of the federal poverty level. Expanding eligibility for Medicaid will provide people with disabilities living near the poverty level access to comprehensive health coverage with limited cost sharing. Compared to providing coverage through an exchange, expanding Medicaid is both cost-effective and provides a level of benefits that helps eliminate cost as a barrier to care. We urge you to adopt the House bill’s directive to set eligibility for Medicaid at 150 percent of the federal poverty level.

The House and Senate bills also differ considerably in the help they provide with premiums and cost-sharing for individuals with limited incomes but above the Medicaid eligibility threshold. For example, under the Senate bill, individuals at 200 percent of the federal poverty level pay a higher share of income in premiums for plans that pay a smaller percentage of health care costs (lower actuarial value) than under the House bill. As a result, people with disabilities and limited incomes could face a combination of high premiums and large deductibles that make cost, even under the new coverage options available through the exchange, a continuing barrier to care. The Senate bill does provide valuable protections worth maintaining in the final bill, including overall caps on out-of-pocket spending and more generous premium subsidies for individuals between 250 percent and 400 percent of the federal poverty level. However, it is essential that the final bill provide affordable coverage to people with disabilities on limited incomes. We urge you to adopt the actuarial values for exchange plans and the premium subsidies for people with limited incomes from the House bill.

Number Of Employees At Social Security Continues To Climb

Below are the September 2009 figures for the number of employees at Social Security, recently released by the Office of Personnel Management (OPM), along with earlier figures for comparison purposes.

• September 2009 67,632
  
• June 2009 66,614
  
• March 2009 63,229
  
• December 2008 63,733
  
• September 2008 63,990
  
• June 2008 63,622
  
• March 2008 60,465
  
• December 2007 61,822
• September 2007 62,407
• September 2006 63,647
• September 2005 66,147
• September 2004 65,258
• September 2003 64,903
• September 2002 64,648
• September 2001 65,377
• September 2000 64,521
• September 1999 63,957
• September 1998 65,629