Thursday, April 4, 2013

Proposed Changes for SSI

There have recently been some proposed changes to the way the government determines if someone with cystic fibrosis is eligible to receive SSI. This would obviously affect many in the community, and if you feel that the changes would negatively impact your own situation, I highly recommend having your voice heard. 3 of the most talked about changes are....


1.       FEV1 values based on age/height/gender.  Basically, from what I gather they are lowering the FEV1 value to meet criteria, making it harder to qualify based on lung function. Some people may be “sicker” with even moderate lung function, but they would no longer meet the more strict criteria.

2.       “Episodes of Illness”- currently you have to have 6 “episodes” in a 12 month period, and a hospital stay counts for 2 of those. But they propose to no longer count doctors visits, ER or other outpatient interventions as episodes. We almost always try to treat oral/output first to avoid an inpatient say, and for our “healthier” patients this generally works. Exposes less to hospital environment/cross infections and IV abx which builds resistant bugs. Even an “outpatient” intervention could be home IVs. Even when we are treating outpt, we ask that pts go from 2 to 4 treatments a day including ACT. This has a significant impact on if someone could attend work or school.

3.       If you have chronic infections of bugs like PA, Cepacia, etc that require ongoing nebulized “antimicrobial” therapy IE, TOBI or Cayston or Colistin. I didn’t see anything in there about those criteria.

As one CF social worker who I greatly respect put it,  "I think the biggest changes proposed are lowering FEV and also not counting outpatient physician interventions anymore BAD !!!!". (Also, big thanks to her for providing the three bullet points above)

If you would like to have your voice heard on this matter and/or read the proposed legislation, click here.

Comments (12)

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Do you know if this will also affect those currently on SSI? Or will this affect only those that have not applied yet? Either way, not good for those who need this.
1 reply · active 626 weeks ago
This is the answer I got from the social worker.

"The criteria are how you qualify for either program

SSI is for children, or adults who have not worked enough quarters to qualify for SSDI.

I do not know about people who are currently on disability, but I do know that periodically people are reviewed for continuation of coverage, and my guess is there would be a risk if the criteria was changed that people may no longer satisfy the criteria."
I read the link...I am curious as to what exactly are the FEV1 requirements, it never states- just that they are going to change the requirements for children and adults (acknowledging there is a difference).
Never mind I didn't read far enough....FEV1 requirements are below 70% after a treatment.
2 replies · active 626 weeks ago
Maybe I missed that. I thought it was a volume prediction based on height, weight, age and gender.
yes I made a mistake. please ignore this comment from me. I am sorry to everyone. I read the wrong thing.
How long ago were these changes made?
1 reply · active 626 weeks ago
It's proposed changes. Have not taken place.
Well, trying to find the positive here, I'm sure you can always appeal. It's a longer process with more hoops ( speaking from experience) but as soon as an independent doctor sits down with your "chart" aka a massive BINDER full of everything that is wrong with you, 9 times out of 10 I'd bet the judge would pay the case. Happened to me. I was nowhere near criteria but certainly can not work full time or even manage school full time so I jumped through hoops. Sat down for 3 minutes in front of a judge. Just long enough for a doctor to say, I believe her condition will limit her ability to work. And bam. SSDI, was awarded.

Also, if the fev1 requirement is below 70%, that's a significant increase from 6 or so years ago. When I was applying you had to be on transplant list or blow less than 40%. I was around 60 % when I was rejected.

In summary, I think having any requirements is silly. Every case of CF is different and that should be recognized. Unfortunately, the government does not have the manpower to attend to each case separately so requirements are made. At least we should be grateful that we have the ability to challenge a rejection and plead our case. Imagine if the healthcare system decided to remove CF as a qualifying disease, so in retrospect we're still pretty lucky.
1 reply · active 626 weeks ago
I agree. Great points!!
Hi, I've been following your blog for awhile now.

I am a nurse (LVN) and used to work on a Pulmonary/Adolescent unit many years ago...

The requirements are obviously written by someone who has no idea the reality of living with CF. I also disagree with the exclusion of outpatient interventions. Consider this scenario:

Person with CF gets mildly sick, enough for outpatient intervention. How is this person feeling? Probably tired, feverish, increased cough, decreased appetite. Maybe they spent the night in the ER... The average non-CF person would probably be in bed, taking days off form work for this. If you have CF and have to do this a couple of times per year or more, that could get tricky work-wise.
1 reply · active 624 weeks ago
This will make an even greater divide between health and career for sure.

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