Trying to be an advocate for a friend, but it's so complicated!!!

[OneGrassRoot]

Ugh. I hope some of you brilliant people can help or point me in the right direction.

I typed up a two-page summary of the situation -- it's really complex! -- but here are the highlights:

- 54-year-old living in NC, on disability since 2002 for two psychiatric diagnoses, including VERY severe OCD which is a huge hindrance in him now being willing to interact with SSI, along with a physical condition which I describe next, rendering him homebound.

- He definitely has not worked at all, that's not a concern re: re-evaluation. His diagnoses have not improved, and in addition he has developed a very severe and complex photophobia (extreme light sensitivity) condition which renders him not only homebound, but he is very limited, including can't look at a computer screen, phone screen, etc. It has also resulted in severe sleep disturbance. This developed in 2012 and he did seek treatment through several specialists but no diagnosis could be rendered. But there would be a trail showing him seeking treatment.

- He has NOT seen a psychiatrist nor has he been on medication since probably 2010. No medical documentation of his ongoing illness for which he first received disability.

- Over the last several years his 87-year-old mother, who lives in a different state, has evidently claimed him as a dependent. She has helped him with equipment for the photophobia, for example, and probably does help to some degree with basic living expenses not covered by SSI. His mother evidently did consult with someone (tax attorney, I think) about claiming him as a dependent and was told it was fine.

- In 2014 my friend heard something to the effect that if he gets any help at all, even from a family member, that makes him ineligible to receive SSI. He absolutely refuses to lie or fudge the truth or anything (which is obviously good), and when he heard this he asked to be removed from SSI. (I know, I know...it's so hard to get on it in the first place that that is almost unheard of.) It was more of an OCD reaction and developed into this huge fear of SSI. I mean, really. He's terrified of this entire situation now.

All of his attention quickly turned to a very traumatic situation for him given the above limitations: He was forced to move out of his apartment (they were renovating and raising rates tremendously). He had about eight months advance notice and they let him literally be the last resident to move out, but those eight months were full of so much drama I can't even tell you. The move itself finally happened in July of 2015, and that's when he got his first notice from SSI, in response to his 2014 request to cancel coverage.

- Long story short, SSI acknowledged his cancellation but never stopped sending checks. They did reduce his payment to cover overpayment. He has been simply frozen about what to do. He didn't even notify them of his move, which he fears will cause them to put him in jail. (Seriously paranoid about the whole process and has received less-than-helpful counsel over the years, with no attorney being willing to take him on as a client so that he can receive step-by-step guidance, not only about the SSI situation but what may happen if he comes off SSI...more on that below.)

- He received his first re-evaluation notification earlier this month, which has triggered having to make a decision about how to move forward. He is TERRIFIED of interacting with SSI. He knows that he will need an evaluation of sorts -- and they will surely do it in-home -- but is more inclined to disregard the re-evaluation notification and just let SSI lapse and discontinue benefits. He's an emotional mess about this, to say the least, and no one can do this for him. He is the one who has to undergo an evaluation. (His eye condition is painful and he literally can't look at anything, including human faces, for long. Very odd.)


IF HE SHOULD GO OFF SSI, and we assume that means Medicaid will be discontinued, here are his other huge concerns:


If he does get off of SSI and thus loses Medicaid, he will need to apply for coverage under the Affordable Care Act, which he believes (and was told) he could do because evidently his mother has listed him as a dependent for at least a few years (again, he has fear about how that may impact SSI and if they may come after him to repay something), so he could apply for coverage under her or something. I just don't know anything about how ACA works for adults who live in a state with no Medicaid expansion (NC) but who may be eligible for coverage under their parents' policy even if they live in a different state (WV).

HOWEVER, not knowing the legalities of any of these things makes him fear that if he applies to get on Obamacare, will that trigger red flags involved with his mom claiming him as a dependent over the last couple of years and him having been on SSI.


I told you, it's a hot mess. I continue to try to receive guidance by breaking down these various elements via Avvo.com, but it is like pulling teeth to get an SSI attorney to actually consult about this matter, even when offering to pay! I guess guidance isn't part of counsel; they only take on clients when there is a case against SSI in some way?

*sigh* Like I said, there's a two-page doc with more details but the long summary above hits the high points, I do believe.

Thanks for reading.

[Ed Suspicious]

1. I hope you can find the help you need. I'm not quite

sure of what it is, precisely, that you're looking for, and I'm not really in a position to be of any help anyway. But I just want to thank you for advocating for your friend. It sounds to me like you're his lifeline. I wish there were more people out there like you. Your friend is lucky to have you. Mental illness is so hard. Best of luck. I hope it all works out.

[OneGrassRoot]

4. I truly appreciate that...

thank you kindly.

[COLGATE4]

2. You might try Law Schools in your area. Most have

public interest projects where Law students work under the supervision and guidance of Law Professors. Perhaps one of those groups deals with Elder Law or Benefits and they would probably be delighted to take on as challenging a case as your friends'. In those instances there are no charges to the client, at least for legal fees. PS - These groups do an excellent job, often better than many practicing attorneys.

[OneGrassRoot]

3. What a brilliant idea!

Thank you so much!

[COLGATE4]

5. Hope it works out. Good luck!

[happyslug]

6. First he is 54 years of age

Which is a factor is any consideration that he is NOT disabled. As a person ages, it gets easier to win SSI benefits. Now given this person's main problems are psychological those regulations are not a big factor in this case (the regulations, unless they are jobs the claimant has done in the last 15 years, eliminate Sedentary jobs at age 50, light jobs at age 55 and Medium Jobs at age 60, thus geared more to people with Physical problems not Psychological problems).

Second, SSA to find him NOT disabled MUST produce new evidence AND that the evidence shows Medical improvement. SSA can not just say they reviewed the old evidence and now finds the claimant disabled, some new evidence must be produced.

Please remember, the burden is on the claimant that he is still disabled and thus MUST go to any exam SSI schedule him to go to, if possible.

Given the requirement for new evidence, SSA makes it their practice to request people ruled to be disabled to be re-evaluated every so often (Congress says every five years, if SSA has the money, tends to be every five years for people under age 50, but almost never above that age, thus you comment that the Claimant made a request to be removed probably is what kicked in this reevaluation). The fact he has NOT seen a doctor since 2010 only shows that his mental condition is severe, so severe he can NOT even go see a doctor for treatment let alone work.

I tell my client to go to the re-evaluations, see what happens and if they decide to terminate his SSI, AND file an appeal if benefits are terminated (If one appeals within 10 days, the SSI benefits continue during the appeal process, if done within the 60 day appeal period but outside that 10 day period, no benefits till the hearing).

This being a SSI case, you have the re-evaluation and if ruled no longer disabled, file a request for reconsideration (just go to the SSA and get a copy of that form and have him sign it unless you are on records as his Representative, then you can sign it for him). When the Reconsideration is denied (and it almost always is if the original determination denies benefits), file for a Request for a Hearing and call the local Legal Aid agency for representation. File the appeal FIRST, then contact Legal Aid, Legal Aid may NOT get him in within the 10 day appeal period, thus file the appeal then call Legal Aid.

This NOT being a initial request for SSI, most private attorneys will NOT take the case for there is no way for them to get paid. In an initial SSI Case, Attorneys can request up to 1/4 of any arrears as their fee. In a re-evaluation case there are NO arrears to collect that 25% out of.

AS to his mother claiming him as a dependent, that has NO AFFECT ON HIS SSI. That is for Income Tax purposes only. Now SSI, is reduced by any "In kind" assistance he is receiving, but it has to be actual assistance, such as paying his rent, as opposed to giving things that he would want. It is a fine line, but I do NOT see his mother stepping over that line.

Remember as long as he is on SSI, even during the appeal process (which is one of the reasons you file the appeal within the 10 day appeal period), he remains on Medicaid, for his Medicaid is 100% federally funded and the states have no reason to cut it (unlike Welfare Medicaid which is a 50-50 Federal State share, the Federal Government will pay equal to the amount the State says it will pay, but not more but that is ONLY if he is no longer getting SSI).

That SSA is still sending him checks implies to me that SSA has not ruled him ineligible for SSI. I suspect SSA may have ruled him NOT competent to manage his own affairs and if that is the case SSA will NOT take his word that he is no longer disabled. Thuis he continues to get checks.

Please also note, there is a two months delay in SSI checks and eligibility. Thus what you tell SSA about as to income in January affects one's March's SSI. Just a comment about the reevaluation, get him to go to the consultative exam (if and when one is scheduled) and if benefits are denied, file the appeal immediately, so you can get the appeal in within the 10 day period to appeal AND CONTINUE TO GET BENEFITS.

[OneGrassRoot]

7. Oh my goodness, you're wonderful...

THIS IS SO HELPFUL. THANK YOU!!!!