Expanded Access Coalition Minutes

Oregon Health Action Campaign, Salem

November 16, 2004

Attending:

            Michele Wallace, DHS-CAF                                        Jeff Stell, DHS-CAF

            Karen Berkowitz, Oregon Law Center              Jeanne Campos, CHC-Lane County

            Eowyn Oreck, Safe & Sound                                      Nancy Talbot, DHS-SPD

            Erika Miller, DHS-SPD                                         Carol Simila, OR Insurance Div.

            Jerae Bjelland, Marion Cnty. Health Dept.                 Jo St.Clair, OHSU

            Marcy Sugarman, Multnomah Cnty. Health Dept.    Stacy Hall, Outside In

            Kristen Saxton, Outside In                                            Yuleni Rodriguez, OHAP

            Jennie Hamilton, OPCA                                     Kristi Jamison, Central City Concern

            Patty Day, OHSU/CDRC                                      Gary Cobb, Recovery Assn. Projecyt

            Peggy LaCombe, NARA NW

I.          DHS – CAFS, Jeff Stell; TANF Policy Analyst:

Provided short TANF/extended medical program overview.

TANF is federal block grant title 4-A from Social Security Act. Spent in a number of ways through TANF. Example, Family of 3 amount max. is $503 a month.

18,000 approx. TANF families in Oregon.

Other programs funded through TANF funding, i.e. child welfare, temp asst for domestic violence (can receive up to $1,200 in temporary funding to get out of DV situation.)

Amount is very little someone receives from TANF, want to get family into employment. Work with JOBS program, helps to remove barriers (i.e. dv, alcohol, drug/mh issues) stabilize and get person able to achieve employment.

TANF programs and how they interact with DHS medical programs. They are different programs. Almost everyone who gets TANF also gets OHP PLUS. There are TANF requirements that aren’t in OHP Plus, i.e. JOBS requirement in TANF. You can be eligible for TANF, turn it away, and still get OHP PLUS medical. Must be Oregon resident, have social security card, be income eligible for TANF.

MAA: get when on TANF program. Medical Assistance Assumed (OHP Plus category)

MAF: medical assistance for families (available to families before 1996)

When TANF family that rec’s MAA gets a job, and they go over income… they can get medical for an add’l 12 months.

Once eligible for TANF, and you go over income, you are eligible for extended medical Plus. Income guidelines depend on # of family.

Accountable income test: (for TANF and MAA) standard for family of 3 is $616 a month, if over that amount

Adjusted income test: determines amount of TANF assistance they will get. Must for under $460 for a family of 3.

Once get a job and go over income, they do not have to pass an income test and they can go on medical for 12 months.

No central processing branch for TANF, all processing is done at local branches.

“It would be my hope…” that families coming into local branch offices that are applying for food stamps, that the caseworker is also screening them for other programs, i.e TANF, Plus, domestic violence. (Outside In said this isn’t happening).

If you have family with children under 18 living in the home, with no income… they should be eligible. Can call Jeff Stell, or local branch.

What about a young adult, unemployed with no kids living in the home, are they TANF eligible? No. must be dependent child (through 18 yrs) or pregnant woman living in the home. 

Is Oregon complying with Federal mandate to enroll families coming off of TANF? Yes, Oregon is doing a very good job of doing this, depending on earned income.

Non-needy grant clarification? Have to be living with caretaker.

Uncle has two nephews come live with him, but can apply for them only, doesn’t have to include uncle’s income. If caretaker relative (uncle) loses job, then he can come in and apply as a group with the kids. If they aren’t related, then there isn’t assistance.

For a child to be able to get TANF, they must be living with relative.

Chem dependency help? Contract out to JOBS, will screen and work with them on level of treatment needed. Each SDA (service delivery area) works on this determination.

Q: Underage parents, both under 18, living with family, countable income based on set-up is?? Individuals? Family group?

A: Minor parents are required to live in supervised situation of some sort (lots of flexibility). Based on situation of client. Eligibility will depend on where they live. Ex, single minor mom, living with her mom, minor may be eligible w/ or w/o  her mom’s income. (Jeff agrees to come back to further discuss this BIG issue)

TANF vs. food stamps: In TANF it REALLY matter where you live and with who. Actual case scenarios help to give concrete case eligibility examples. (January EAC meeting prepare examples).

Q: How can we make this seamless for our clients? What is the common barrier/complaint that you get through hearing process?

A: Find out locally who is managing local branch and put in your speed dial! If problems arise then call this person, they will be able to help the most.

A: Delay in benefits or unfair treatment are two biggest complaints. Hearing process, still getting over 130 hearing requests a month (Michele will check on this and report back in Jan.)

Q: How does disability interact with TANF? Does disability with kids give special benefits? Do they have to qualify for SS qualification?

A: If family has disabled child, depending on the disability, what it is, what impact it has on the parent to work… determined by JOBS contractor. If kid is receiving SSI, this is not counted against them, regular SS benefits are counted against them. Never hurts a family to go in and find out if they are eligible.

Documented Legal citizens are TANF eligible, they do not need to meet 5 year/40 quarter requirement, is NOT requirement for TANF as it is for medical/Medicaid.

Get your specific questions/case studies written up and sent to Jeff: jeff.stell@state.or.us

II.        DHS, Seniors & People with Disabilities (SPD), Office of Federal Resource Reporting and Financial Eligibility, Presumptive Medicaid Disability Determination Team

Nancy Talbot and Erika Miller

People with disability have right to apply for medical.

If client is applying for Medicaid and they are claiming a disability, then there claim is sent to this office. If client has submitted SS claim and it is pending, then they coordinate this too. However, this office must determine disability within 90 days for medical.

Two ways for client to come to this process:

1. OHP disability question on application marked YES.

2. Client goes directly to county disability office and applies for it.

Big increase in requests since OHP was split and Standard went away.

360 a month last 7 months (big increase since Std went away),

290 average requests when OHP was split Feb 03.

Prior to 2003 OHP split requests were 23 request a month.

50% approval rating

6,011 – requests received

2,385 – approved

2,381 -- denied

888 – pending

69 Days: average processing time for decisions, continues to increase.

How do you decide disability?

Requirements are same as Social Security screening process. Will get release, get records and if they need an exam, they will schedule and pay for this.

Higher approval rating that SSI screening process. Clients aren’t required to pursue SSI to get medical.

When client requests Medicaid due to disability, we’re req’ed to make decision w/in 90 days. If SSI makes decision before the 90 days, then this SSI decision is binding.

Client always has right to request hearing. If SPD approves client and 90 days passes, then SSI denies their claim, then client can STILL receive benefits.

Other option, if denied, if client has NEW condition. Client can re-apply ANYTIME.

Suggestion: Go to local disability office and request form to have in your office to have info on hand for client.

If client has applied for SSI and should be rec’ing notice… they also apply through SPD, and they are denied by SSI. When can they reapply and restart the process?

12 months after they’ve been denied, if condition has worsened OR

If they have new condition they can reapply immediately

Is it beneficial for a client to apply only for SPD than SSI? i.e. HIV clients are immediately denied SSI, then they must go through appeals process.

If client is applying for GA (general assistance, approx $300 for one a month) then they must apply for SSI.

Should a person who is waiting for SSI (or SSD) determination, should they apply for GA?

GA provides $314 cash grant a month, and supplies OHP PLUS.

Local SPD disability office or Seniors office: to apply for GA (different than CAFS branch office). If there SSI is approved, first check comes to state and GA funds are withdrawn and caseworker puts client on long-term disability.

If denied SSI, you can remain on GA through hearing process, appeal immediately! Appeal second time. Has condition worsened?

RE-Application Packets ARE NOT being Sent To:  Pregnant woman who has delivered, gets OHP notice that her Plus is ending. She has 60 days Plus coverage after delivery, and NEEDS to re-enroll submit APPLICATION into Standard. Karen Burkowitz sited case federal law that State is REQUIRED to look for programs before client is disenrolled. This isn’t happening.

Nervous at to what the local branch offices are doing around Pregnant Women who have delivered babies and MUST reapply to enroll into Standard!!!!

Email Erika for a list of disabilities and link to website with this info:

Erika.e.miller@state.or.us

www.severe.net  (great advocate site, with SS regulations, lists, etc.)

Listing of Impairments: is social security book, 14 body systems over 200 listings. You can meet a listing, meeting requirements. Equaling a listing, means you have an impairment that’s not listed but has same lab results. Evidence depends on impairment, i.e. x-rays, MRI, doctor’s testing, 3^rd party ADLs/questionnaires.

Nurse Practitioner and therapist info is “supportive” evidence. Need diagnosis by either PhD or MD for “direct” evidence, very important to have this signed off on.

HOURS of DHS Training for:

40 hrs for Food Stamp training

120 hrs for OHP central process training

120 + 80 + 40 – for TANF training

Write Jeff or Erika questions and they will get back to you.

Nancy Talbot was very impressed with the level of knowledge in this room!

Next EAC meeting is Dec.14, 10am to noon at OHAC offices.

Recorded by Jennie Hamilton, OPCA