ACA disabled friend in TX

[XanaDUer2]

Turned down first ssdi apply. No Healthcare providers will fill out paperwork. COBRA running out. Told me shes not elible for ACA premium subsidies bc TX didn't expand Medicaid. I got my ACA free for 6 mos in NC. I'm totally confused. She's mentally and physically disabled and needs ssdi. She's worked for yrs.

I don't know what to tell her. I thought these subsidies were federal.

[rsdsharp]

1. I my experience, SSDI is almost always denied on the first application. They denied benefits to my mother

on the first try, and she was paralyzed from the waist down. She should contact a lawyer. Contact the local bar association, or Legal Aid.

[XanaDUer2]

2. I told her that

Many times. My lawyer did everything 4 me all i did was wait my drs filled out everything took 14 mos beginning to end. She's mentally ill and I'm not sure she's hearing things right. I guess she'll have to go back to work for health benefits

[haele]

5. A lot depends on the judge; if they run a quota or are skeptical.

SSDI first application denials can run up to 90% depending on the judge.
My SIL works for a disability lawyer in Alabama. She deals with a judge who has an attitude: doctors will lie for patients; if there's no VA, police or EMT report to back up an injury or condition, and if you're really disabled, you'll apply again with a report from one of the trusted doctors on his list and a lawyer.

But even in lenient disability courts, 50% of first time claims are denied typically straight up, especially where there's no disability lawyer involved, simply due to the onerous paperwork requirements and errors in the submission.

Haele

[obamanut2012]

3. She needs to get an attorney who specializes in this

They will take a chunk of the "backpay" settlement, but it is worth it.

My aunt was turned down THRICE, even though she has Parkinson's and MS, and has been in Michael J. Fox studies. Three times over several years. She had to take medical retirement almost ten years earlier, so her pension was low. I got her an attorney, and within six months she had a huge back payment and future payments. Her attorney took 45% of the settlement, but without the guy, she would ahve gotten ZERO.

[XanaDUer2]

4. I think i need to step back

Bc I've said the word lawyer about 100 times. She has mental illness. She's 48. She says the lawyer keeps asking how old she is that's a bad sign. She does weird things. She didn't take LTD insurance from her job tho it was a benefit. I told her I don't understand y she did that.

She's smart but stupid.

[haele]

6. 48 years old might be considered in a grey area for SSDI.

Social Security Disability judges often consider applications for a chronic disability by people between 40 and 55 who might be looking for an early retirement. Not saying all, but some do. Especially for people who claim PTSD or a very late mental diagnosis, conditions medical laypeople might consider subjective.

At Laz's second SSDI hearing that we came in early for, the morning judge told her last applicant who suffered from debilitating migraines and neuropathy " I have bad headaches, too - I just take Excedrin and a cup of coffee and go on with my work. You have to convince me there's something medical behind them."

Lucky for Laz, the judge after lunch was different.

Haele

[XanaDUer2]

7. Her dr said her agonizing arthritis is not debilitating

And I don't know about the bipolar. Still unclear on her paying 800 a month for aca w no income. I had support from drs and lawyers

[haele]

9. Her arthritis doctor probably doesn't work with any other doctor.

That doctor probably assumes the mental issue can be managed with meds, and your friend can still work, but at a desk job or some career or something.
Laz's first rheumatologist said that to his face -"You have arthritis, and yeah, it's going to hurt some -but just go get some psych meds, get your cortisone shots, Tylenol, and methotrexate and you can work a desk job for the next 10/15 years. You're smart enough."
Like she thought he was fishing for disability and painkillers.

Dropped that idiot.

Haele

[dsc]

10. Age does matter

the older one is the easier it is to get disability. Once a person gets to retirement age the disability reverts to retirement (usually a lower amount)

[XanaDUer2]

11. Yes I know

But she's so disabled she thought she'd go for it. Anyway looks like she's screwed

[dsc]

12. Both my brother and sister are on disability

my sister isn't 48 yet and my brother got it around then maybe a bit earlier. I admit to being afraid of getting disabled myself. I was actually the physically weakest of the three of us growing up and had my own mental issues coming to terms with being gay and alcohol addiction. But, so far, I seem to be keeping on keeping on so to speak.

[XanaDUer2]

13. Good

She's really b not getting help like I did. My dr was friends with the lawyer. Filled oyt reams of forms. Told me he knew how to. Lawyer got it on forst appl. Even he was shocked. Added in my physical probs

[totodeinhere]

8. She might want to talk to a social worker.

She should try to find out if there is some way to get low cost or free access to a social worker, perhaps at a community health center.