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Specialist: Reimbursement opportunity being missed
Disability program has 'untapped potential'
Something that puzzles Patti Thrailkill, who spent more than 20 years working with the federal disability program, is why there isn't more energy at hospitals spent trying to get disability benefits for patients.
Several misconceptions about the program are preventing access managers and other personnel from taking advantage of "the untapped potential of Medicaid" in obtaining coverage, suggests Thrailkill, now director of governmental affairs for MedAssist, an eligibility services vendor.
The self-pay population is particularly well served by the federal disability program, she points out, because Medicaid is one of the benefits that comes with it.
"There are misunderstandings about [the federal disability program] and it is detailed, but accessing it is not that difficult," she says. "Either the eligibility services vendor, if you outsource, will pick up the load, or the Social Security Administration [SSA] will take over once you get [the application] in motion."
While the federal government controls Medicaid and contributes most of the money, states vary in their funding, she notes. "As Medicaid programs grow, the number of those that [states] can afford to fund shrinks.
"Medicaid dollars are spread across fewer and fewer categories," Thrailkill says, "but one category that is always funded is federal disability." It is one of five or six mandatory Medicaid programs, she adds.
An area that states can fund or not, on the other hand, is retroactivity, she says. "The date of the application is used to start Medicaid, so if you don't make application at the day of admission, it won't cover the first day, which is the most expensive but if it's retroactive, it is covered."
It is important, Thrailkill says, to make sure that staff understand the distinctions between the Supplemental Security Income (SSI) program and the Social Security Disability (SSD) program, both of which are administered by the SSA. She explains those differences as follows.
SSI benefits, she explains, are targeted to low-income aged, blind, disabled adults and some children and provide monthly income for eligible individuals. The money for SSI programs comes from general taxes, a combination of federal and state dollars. Medicaid is the health insurance program associated with SSI disability benefits. This insurance typically is available as of the date of application/service.
SSD benefit programs are for people who have worked and paid enough FICA withholding taxes to qualify. These tax dollars are collected and managed by the federal government. They are not based on financial limitations, but strictly on having accumulated benefits through paying taxes and confirmation of disability. Medicare is the health insurance program associated with SSD disability benefits, which are typically available two years after the onset of a medical condition.
Thrailkill, who frequently speaks to hospital groups that include access managers, says the extent to which her listeners comprehend the programs varies widely. "I watch the audience to see if I get a [reaction indicating] they don't understand."
Five common misconceptions, along with Thrailkill's clarifications, are listed below.
Thrailkill urges access managers to pursue disability coverage for patients who might qualify. "In order to initiate a claim, all you have to do is make a phone call, so there is no reason not to apply.
"The more you help the patient, the quicker the process will move along," she says, advising that access staff take these steps to facilitate the claim:
"Get a process in place to target these people at admission," Thrailkill advises. "It is worth it in terms of dollars."
(Editor's note: Patti Thrailkill can be reached at firstname.lastname@example.org.)