Entitlements in the Public Mental Health System

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Income Supports - Federal Programs

Income Supports - State Programs

Health Insurance - Medicare / Medicaid

Health Insurance - The Maryland Children Health Program (CHIP)

Federal Programs -

1. Supplemental Security Income (SSI-Title XVI)
   This federal government income supplement is for those who meet the Social Security Administration's requirements for financial need due to disability, blindness, or age, and have no substantial history of employment. In 1998 the maximum monthly benefit available was $552. If you are found eligible for SSI, you are automatically eligible for Medical Assistance.
   
   
2. Social Security Disability Insurance (SSDI-Title II)
   This federal government income support is also for those who have met eligibility requirements for disability, but is based on the amount and recency of one's past earnings. If the amount of the SSDI benefit is below $504 per month, it is possible to receive SSI as well. Benefits from a spouse's record can be granted to a disabled widow over age 50, even if the widow has never been employed. Individuals who are disabled prior to age 18 may be able to draw on a disabled, deceased or retired parent's claim indefinitely.
   
   For both of these entitlements there is a complicated application process and several eligibility requirements that must be met. The application process begins by contacting the local Social Security Office located at 828 Airpax Road, Cambridge, MD 21613; 410-228-8811; 410-822-8821 to request full information as well as forms to be mailed to you, and to schedule an appointment.
   
   Information that you will need to submit:

• Original social security card and proof-of-age documents (no copies accepted).
• Full medical information including name, address and phone numbers of all physicians, hospitals, clinics, etc., that have provided treatment. This is needed to document your disability.
• Summary of employers and type of work performed during the previous 15 years.
• Copy of the previous year's W-2 form from any employment.

• Proof of marriage, if the spouse is applying.

  It is recommended that the completed application and all accompanying and subsequent documentation be HAND DELIVERED to the Social Security office rather than mailed. You should request a receipt or some documentation from SSA.

  If you are applying for SSI, you will also need full information regarding financial assets (bank accounts, stocks, bonds, trust accounts, and burial accounts or trusts, etc.). If you are living with family who helps to support you, the monetary award will be less. Families are often contacted regarding how much support they provide. If a recipient of SSI obtains employment, Social Security must be notified immediately.

  Social Security considers many factors in making awards, including ability to work and diagnosis. Some diagnoses qualify a person automatically; others require substantial documentation and may require a physical examination by a physician under contract to the Social Security Administration.

  The process of determining your disability is the same for SSI and SSDI. The process takes approximately 120 days and will include consideration of your ability to work in jobs other than the kind you may have done prior to becoming disabled. For medical determination, Social Security uses the Disability Determination Services agency in Towson, Maryland. If benefits are denied, there is an appeal process available.

  Both SSI and SSDI programs have a variety of work incentives to encourage individuals with disabilities to re-enter the work force while maintaining their benefits. Information about these programs can be obtained from the local Social Security office or from a vocational counselor in an approved vocational program.

State -

Medicare - An individual becomes eligible for Medicare after receiving SSDI for 24 months or if over 65 years of age. Part A provides hospitalization coverage at no cost to the recipient. Part B is optional and covers other medical expenses on a co-payment schedule of 80/20 percent. The cost of Part B ($43.60) is deducted from the monthly Social Security check.

Medicaid (Medical Assistance) - This health insurance is a joint federal and state entitlement available to those who meet requirements of income and documented expenses. It is provided automatically for recipients of SSI by the state and to TEMHA recipients on a temporary basis. In some cases, it is available to those with very high medical expenses on a spend-down basis. If the individual receives Medical Assistance as the primary insurance, he/she would access services in the public mental health system when treatment exceeds the ability of the primary care physician to provide, or when the individual needs rehabilitation services funded only by the public mental health system.

Since July 1997, somatic health care under Medicaid has been administered through a program called HealthChoice. If you receive Medicaid, you will need to select a primary care physician to address your medical needs. The change does not apply to those in nursing homes or who receive Medicare and Medicaid.

Generally, the important features of the system are:

• All recipients will have to choose one of the HealthChoice approved Managed Care Organizations (MCO).

On April 28, 1998, Governor Glendening signed a law that created the Maryland Children Health Program which provides health insurance coverage for average to low income children and pregnant women. Those eligible will be included in the HealthChoice program. The new program began on July 1, 1998. Children under the age of 19 and pregnant women of any age are eligible for the program if they have a family income that is at or below $22,422 for a family of two, $28,231 for a family of three, or $34,040 for a family of four.

The following medical services are covered under the program:

MCHP Premium: Effective July 2001, Governor Glendening authorized the expansion of the MCHP program. The expansion program is titled "MCHP Premium." MCHP Premium allows families to purchase the same services covered under MCHP for $40 to $50 per month for all children within the family. Monthly premiums are based on family income. Income limits for MCHP Premium are $36,360 for a family of two, $45,780 for a family of three, and $55,200 for a family of four.

You may obtain an application from your Local Health Departments or Departments of Social Services.

For further information, call 1-800-456-8900.

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