Data from the U.S. Census is used to assign congressional seats to states, and it directly affects how more than $400 billion per year in federal funding is distributed to state, local and tribal governments. Accurate counts impact several important programs and services that are critical to the disabled community.

Here is what the census means for people with a disability:

* Helps state and county agencies plan for eligible recipients under the Medicare, Medicaid,and Supplemental Security Income (SSI) programs.

* Distributes funds and develops programs for people with disabilities and the elderly under the Rehabilitation Act.

* Distributes funds for housing for people with disabilities under the Housing and Urban Development Act.

* Allocates funds for mass transit systems to provide facilities for people with disabilities under the Federal Transit Act.

* Awards federal grants, under the Older Americans Act, based on the number of elderly people with physical and mental disabilities.

* Allocates funds to states and local areas for employment and job training programs for veterans and disabled veterans under the Job Training Partnership Act, Disabled Veterans Outreach Program.

* Ensures that comparable public transportation services are available for all segments of the population under the Americans with Disabilities Act.

Michael J. Astrue, Commissioner of Social Security, and Chubby Checker, Grammy Award winner and rock and roll legend, have launched a new campaign to inform millions of Americans about a new “twist” in the law that makes it easier to qualify for extra help with Medicare prescription drug costs. The extra help program currently provides assistance to more than nine million older adults and people with disabilities — saving them an average of almost $4,000 a year on their Medicare prescription drug plan costs. To apply for extra help, there is an easy-to-use online application available at www.socialsecurity.gov.

To qualify for extra help, people must meet certain resource and income limits. The new Medicare law eases those requirements in two ways. First, it eliminates the cash value of life insurance from counting as a resource. Second, it eliminates the assistance people receive from others to pay for household expenses, such as food, rent, mortgage or utilities, from counting as income. There also is another important “twist” in the law. The application for extra help can now start the application process for Medicare Savings Programs — state programs that provide help with other Medicare costs. These programs help pay Medicare Part B (medical insurance) premiums. For some people, the Medicare Savings Programs also pay Medicare Part A (hospital insurance) premiums, if any, and Part A and B deductibles and co-payments.

To learn more about the extra help program and to view the new TV spot featuring Chubby Checker, go to www.socialsecurity.gov/extrahelp.

The Associated Press reports that millions of older people and the disabled face shrinking Social Security checks next year, the first time in a generation that payments would not rise.

The trustees who oversee Social Security are projecting there won’t be a cost of living adjustment (COLA) for the next two years. That hasn’t happened since automatic increases were adopted in 1975.By law, Social Security benefits cannot go down.

Nevertheless, monthly payments would drop for millions of people in the Medicare prescription drug program because the premiums, which often are deducted from Social Security payments, are scheduled to go up slightly.

“I will promise you, they count on that COLA,” said Barbara Kennelly, a former Democratic congresswoman from Connecticut who now heads the National Committee to Preserve Social Security and Medicare. “To some people, it might not be a big deal. But to seniors, especially with their health care costs, it is a big deal.”

Cost of living adjustments are pegged to inflation, which has been negative this year, largely because energy prices are below 2008 levels.

Advocates say older people and the disabled still face higher prices because they spend a disproportionate amount of their income on health care, where costs rise faster than inflation. Many also have suffered from declining home values and shrinking stock portfolios just as they are relying on those assets for income.

“For many elderly, they don’t feel that inflation is low because their expenses are still going up,” said David Certner, legislative policy director for AARP. “Anyone who has savings and investments has seen some serious losses.”

About 50 million retired and disabled Americans receive Social Security benefits. The average monthly benefit for retirees is $1,153 this year. All beneficiaries received a 5.8 percent increase in January, the largest since 1982.

More than 32 million people are in the Medicare prescription drug program. Average monthly premiums are set to go from $28 this year to $30 next year, though they vary by plan. About 6 million people in the program have premiums deducted from their monthly Social Security payments, according to the Social Security Administration.

Millions of people with Medicare Part B coverage for doctors’ visits also have their premiums deducted from Social Security payments. Part B premiums are expected to rise as well. But under the law, the increase cannot be larger than the increase in Social Security benefits for most recipients.

There is no such hold-harmless provision for drug premiums.

Kennelly’s group wants Congress to increase Social Security benefits next year, even though the formula doesn’t call for it. She would like to see either a 1 percent increase in monthly payments or a one-time payment of $150.

The cost of a one-time payment, a little less than $8 billion, could be covered by increasing the amount of income subjected to Social Security taxes, Kennelly said. Workers only pay Social Security taxes on the first $106,800 of income, a limit that rises each year with the average national wage.

But the limit only increases if monthly benefits increase.

Critics argue that Social Security recipients shouldn’t get an increase when inflation is negative. They note that recipients got a big increase in January – after energy prices had started to fall. They also note that Social Security recipients received one-time $250 payments in the spring as part of the government’s economic stimulus package.

Consumer prices are down from 2008 levels, giving Social Security recipients more purchasing power, even if their benefits stay the same, said Andrew G. Biggs, a resident scholar at the American Enterprise Institute, a Washington think tank.

“Seniors may perceive that they are being hurt because there is no COLA, but they are in fact not getting hurt,” Biggs said. “Congress has to be able to tell people they are not getting everything they want.”

Social Security is also facing long-term financial problems. The retirement program is projected to start paying out more money than it receives in 2016. Without changes, the retirement fund will be depleted in 2037, according to the Social Security trustees’ annual report this year.

President Barack Obama has said he would like tackle Social Security next year, after Congress finishes work on health care, climate change and new financial regulations.

Lawmakers are preoccupied by health care, making it difficult to address other tough issues. Advocates for older people hope their efforts will get a boost in October, when the Social Security Administration officially announces that there will not be an increase in benefits next year.

“I think a lot of seniors do not know what’s coming down the pike, and I believe that when they hear that, they’re going to be upset,” said Sen. Bernie Sanders, an independent from Vermont who is working on a proposal for one-time payments for Social Security recipients.

“It is my view that seniors are going to need help this year, and it would not be acceptable for Congress to simply turn its back,” he said.

Because of its size and cost, Medicaid has been called the “workhorse” of the U.S. health system. Now it’s front and center in the debate on overhauling the U.S health system and expanding coverage to the uninsured.

With 60 million enrollees, Medicaid dwarfs other insurance programs, including its cousin, Medicare, which covers 44 million elderly and disabled people.Medicaid is a joint federal-state program, with the federal government picking up about 57 percent of the overall Medicaid tab. But the federal contribution varies by state, ranging from 50 percent to 73 percent, with poorer states getting a bigger matching rate.

Medicaid isn’t a one-size-fits-all program; after meeting certain federal requirements, each state has the flexibility to shape coverage and benefits. As a result, the Medicaid program in Pennsylvania bears little resemblance to the one in Louisiana. For example, non-working parents in Pennsylvania qualify for Medicaid if their incomes are below twice the federal poverty level ($44,100 for a family of four). But in Louisiana, non-working parents qualify only if their incomes are below 11percent of the poverty level ($2,426 for a family of four). States frequently experiment with new concepts in benefit design, eligibility and delivery systems.

In general, Medicaid covers about 45 percent of poor Americans, defined as those with incomes below the federal poverty level (about $22,000 for a family of four). To be eligible for coverage, individuals must fall below certain income thresholds, which vary by state, and belong to certain categories, such as having dependent children, or being pregnant or disabled. In 20 states, a parent in a family of four who gets paid the federal minimum wage makes too much to qualify. Only 18 states cover adults without dependent children.

Medicaid benefits include mental health services, transportation-to-health services, and comprehensive screenings and treatment for children. In addition, Medicaid enrollees have much lower out-of-pocket costs than people with private coverage. There are typically no monthly premiums and no, or very low, co-payments

However, in many states, specialists and dentists don’t see Medicaid patients. Providers typically blame low reimbursement rates as the main reason for not accepting Medicaid patients. In Kentucky, Medicaid pays doctors $210for a colonoscopy; Medicare pays $333. Private insurers usually pay more. In Pennsylvania, Medicaid pays doctors $300 for an appendectomy, while Medicare pays $575.

About 76 percent of all enrollees are children and their parents. And 65 percent of people on Medicaid come from working families. About three quarters of Medicaid spending is for the elderly and disabled, even though the two groups make up only about one quarter of the program’s enrollees. Medicare provides little coverage for long-term care, so many elderly, after depleting their savings, rely on Medicaid to pay their costly nursing home bills.

Administrative costs of Medicaid are less than 7 percent, or half the rate that’s typically seen in the private sector. Medicaid holds down costs in part by paying providers lower fees and doing little marketing.

Adults covered by Medicare who have limited income and resources may be eligible for extra help – available through Social Security – to pay part of their monthly premiums, annual deductibles, and prescription co-payments.  The extra help is worth an average of $3,900 per year.

To figure out whether a Medicare recipient is eligible, Social Security needs to know the individual’s income and the value of her/his savings, investments, and real estate (other than the home lived in).   To qualify for the extra help, the individual must be receiving Medicare and also have income limited to $16,245 for an individual or $21,855 for spouses living together.  Even if the annual income is higher, one still may be able to get some help with monthly premiums, annual deductibles and prescription co-payments. Some examples where income may be higher include if either spouse:

** Supports other family members who live with them;
** Have earnings from work; or
** Live in Alaska or Hawaii; and
** Resources limited to $12,510 for an individual or $25,010 for a married couple living together (i.e. resources include such things as bank accounts, stocks and bonds. Social Security does not count a house
or car as resources).

Social Security has an online application. You can find it at www.socialsecurity.gov/prescriptionhelp. To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Help with Medicare Prescription Drug Plan Costs (SSA-1020).  Or go to your local Social Security office.

Although the typical Social Security Disability Insurance (SSDI) recipient has worked for a fairly long time before the onset of his/her disabling condition, an adult who became disabled before turning 22 can also qualify for SSDI if she/he has a parent who meets certain qualifications.

SSDI is a federal program primarily designed to aid people who have become disabled after having worked for a certain amount of time. Unlike Supplemental Security Income (SSI), SSDI is not a needs-based program, which means that there are no income and asset restrictions. Instead, a beneficiary typically has to have paid into the Social Security system for at least 10 years prior to his disability. An SSDI benefit depends on the beneficiary’s income before he/she became disabled, the size of his/her family, and the amount he/she paid into the Social Security system. Finally, SSDI recipients can receive Medicare two years after qualifying for SSDI.

Most people who have a serious disability before turning 22 are not able to assemble the necessary work record to qualify for SSDI on their own. But people in this situation may instead be able to qualify for SSDI on their parents’ work record, in certain situations.

First, the “adult disabled child” (the Social Security Administration’s (SSA) term for a person with a disability that manifested itself before age 22) must be completely disabled according to the SSA’s adult disability standards. Second, the disability must have occurred before the potential beneficiary turned 22. Third, the potential beneficiary’s parent must have paid into the Social Security system for the required number of quarters. Finally, and most importantly, the potential beneficiary’s parent must be either dead, permanently disabled, or receiving Social Security retirement benefits.

If an adult disabled child and her parent meets all of these qualifications, then the “child” should be able to receive a substantial benefit, often greater than an SSI award. On top of the monetary gain, the child does not have to worry about her/his own unearned income or assets, since SSDI does not take these into account. However, if a child earns enough income through employment, the SSA may determine that she is no longer disabled and cancel her SSDI benefits. The parent’s own retirement benefits are not affected by their child’s receipt of SSDI, and the child can still qualify for SSI benefits if her SSDI payments, which count as unearned income for SSI purposes, do not disqualify her/him.

Parents who have not begun to receive their own Social Security income but who think that their child may qualify for SSDI in the future may want to have their child screened by the Social Security system for his disability before he reaches age 22. If this is not possible, it pays to have the child’s physician clearly document all of the information surrounding the child’s disability from as early an age as possible. This way, when the parent does retire, the child has a long record showing the presence of the disabling condition before he/she turned 22, making the SSDI application easier.

Attorney Sheri Abrams can explain the rules for applying for SSDI and can give your family guidance if you think your child may qualify in the future.

Once you become eligible for Medicare, you will be inundated with offers from insurance companies for Medigap (supplemental insurance) policies.  Sorting through these offers can be confusing.  Not only are there 12 standardized plans, but there can be huge differences in premiums between companies.

Medicare plans A and B cover only a portion of medical costs.  Medigap policies are designed to fill in the “gaps” in coverage. The first step is to figure out what coverage you will need. The government created 12 standardized plans (Plans A through L).  Plans in Massachusetts, Minnesota, and Wisconsin have some extra options, so if you live in those states, check with the state department of insurance to find out the differences.
If you regularly see doctors who charge above what Medicare pays, Plans F, G, I, or J which cover excess charges, may be the right plan for you.
If you regularly travel outside the United States, Plans C, D, E, F, G, H, I, and J include coverage for this.
If you have a chronic condition with high medical bills, Plan K or L may work best. Both pay only a portion of covered expenses, but have a yearly out-of-pocket cap on medical expenses. Once you reach the cap, the policy pays 100 percent of all further medical services.

Once you’ve decided what type of coverage you need, the next step is to decide which company to buy from. Each plan covers the same medical services, but premiums can vary significantly from company to company. The companies use three different methods to set premiums: attained age, issue age, or community.

Attained-age policies set the premium based on your age, so the premium automatically increases as you get older. Before buying an attained age policy, check with the insurance company to get the premium costs for the next age increments, so you’ll know the level of increases to expect each year.
Issue-age policies set the premium at the age you first buy the policy. The premium will never be higher than the amount the company is charging new buyers at the same age. For example, suppose you buy the policy at age 65. In five years, the premium will be the amount the company is charging new 65-year-old buyers. While your premiums may increase, the increases may not be large because the company will keep premiums lower to attract new buyers.
Community policies charge the same price to everyone in your area regardless of your age. The premiums go up only when the insurance company raises premiums on all policies of the same type. These increases are regulated by state insurance departments.

While the premiums on an attained-age policy may be lower at first, it is generally better to buy an issue-age or community policy, which may be more expensive at first but doesn’t increase as much over time.

Following are some other things to keep in mind when choosing a policy:

Look for a company that has arranged to file Medigap claims automatically. Companies that offer automatic filing of claims with Medicare can save time and effort.
It is a good idea to purchase from a financially sound company. Make certain that the insurer is rated in the top two categories by one of the services that rates insurance companies, such as A.M. Best or Weiss.
Contact your state insurance department to find out if the insurance company has any complaints filed against it.

The American Recovery and Reinvestment Act of 2009 (known as the Stimulus Bill) provides a premium reduction to certain qualified individuals.  Individuals eligible for COBRA coverage who were involuntarily terminated by their employer on or after September 1, 2008 through December 31, 2009 who are eligible for COBRA and elect COBRA may be eligible to pay a reduced premium amount that is only 35 percent of the premium costs for the COBRA coverage.
The premium reduction for an individual ends upon eligibility for other group coverage (or Medicare), after 9 months from the beginning of the reduction, or when the maximum period of COBRA coverage ends, whichever occurs first.  The premium reduction provisions relate only to premiums for coverage periods beginning after the law was enacted –February 17, 2009.

If a person was terminated between September 1, 2008 and December 31, 2009 and was covered by an employer’s plan on their day of employment, the plan administrator should provide a notice of eligibility to elect COBRA and to receive a premium reduction.  Individuals involuntarily terminated during this period have the right to elect COBRA coverage even if they did not elect coverage when it was first offered; they may also do so if they did elect COBRA, but are no longer enrolled (for example, because they were unable to continue paying the premium). This election period begins February 17, 2009 and ends 60 days after the plan provides the required notice.

For more information the employer should be contacted directly to ask about getting the premium reduction, and how to reconcile any amounts that might have been overpaid after February 17, 2009.

Bills have been introduced in the House of Representatives and the Senate to phase out, over the next ten years, the Medicare 24-month waiting period. S. 700, introduced by Sen. Jeff Bingaman (D-NM), and H.R.1708introduced by Rep. Gene Green (D-TX), also would, upon enactment, eliminate the waiting periodfor those individuals with “life-threatening conditions.”

Sheri Abrams, Attorney at Law, know all too well the hardships faced by clients if they are caught in the 24-month waiting period once cash benefits are awarded. Those individuals found eligible most quickly usually have the most serious medical conditions, yet they will need to wait for Medicare coverage at the time when they need it the most. There have been indications that the waiting period will be an issue in the expected debate over health care reform. Nevertheless, Sen. Bingaman and Rep. Green, longtime advocates for elimination of the waiting period, decided to reintroduce their legislation.

The bills would phase out the 24-month waiting period over the next 10 years. In 2010, it would be reduced to 18 months and then reduced by 2 months each year until January 2019, when it would be totally eliminated.
Under current law, the Medicare waiting period does not apply to only two conditions: (1) end-stage renal disease and (2) amyotrophic lateral sclerosis, (ALS or “Lou Gehrig’s disease”). The bills would extend the exception to all “life-threatening conditions.” These are not delineated in the bills, but are defined as conditions that are “fatal without medical treatment.” The Secretary of Health and Humans Services would be responsible for compiling a list of such conditions, with regular updates. To compile the list, the Secretary would be required to consult with various federal health agencies and to annually review the SSA “compassionate allowances” list.

For the first time in eight years, Medicare’s monthly premium will remain unchanged for most of the program’s44 million beneficiaries. The Centers for Medicare and Medicaid Services (CMS) announced that the Part B premium will remain at its 2008 level of $96.40 for 2009 for individuals earning $85,000 or less or couples earning $170,000 or less. The premium will go up for higher earners (see list below). The Part B deductible will remain at its 2008 level as well.

The monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

This is only the sixth time since Medicare was created in 1965 that the Part B premium stayed the same for two consecutive years. The premium will hold steady in part because Medicare’s reserves have increased, however, monthly rates are likely to go up in 2010 as health costs continue to rise.

While the Part B premium and deductible will not rise, other Medicare deductibles and co-payments will. Here are all the new Medicare figures for 2009:

Basic Part B premium: $96.40/month (unchanged)
Part B deductible: $135 (unchanged)
Part A deductible: $1,068 (was $1,024)
Co-payment for hospital stay days 61-90: $267/day (was $256)
Co-payment for hospital stay days 91 and beyond: $534/day (was $512)
Skilled nursing facility co-payment, days 21-100: $133.50/day (was $128)As directed by the 2003 Medicare law, higher-income beneficiaries will pay higher Part B premiums. About 5 percent of current Part B enrollees are expected to be subject to the higher premium amounts. Following are those amounts for 2009:

Individuals with annual incomes between $85,000 and $107,000 and married couples with annual incomes between $170,000 and $214,000 in 2009 will pay a monthly premium of $134.90.

Individuals with annual incomes between $107,000 and $160,000 and married couples with annual incomes between $214,000 and $320,000 in 2009 will pay a monthly premium of $192.70.

Individuals with annual incomes between $160,000 and $213,000 and married couples with annual incomes between $320,000 and $426,000 in 2009 will pay a monthly premium of $250.50.

Individuals with annual incomes of $213,000 or more and married couples with annual incomes of $426,000 or more in 2009 will pay a monthly premium of $308.30.

Rates differ for beneficiaries who are married but file a separate tax return from their spouse:

Those with incomes between $85,000 and $128,000 will pay a monthly premium of $250.50.

Those with incomes between $85,000 and $128,000 will pay a monthly premium of $250.50.