Friday, October 30, 2009

Work and Social Security Programs—Impact on AD/HD

My 19-year-old son is in a post-high school program that offers trial work assignments, independent living skills, and social skills, combined with some community college. We are hopeful that he will develop work skills. Social challenges are his most immediate challenge. The prospect of no health insurance because of a lack of full-time employment with a large employer is a longer-term concern (and thus our support for national health care reform). With time and support, work should be a realistic goal.

At CHADD’s 21st annual international conference two weeks ago in Cleveland, we had two sessions on work, economic crisis, and Social Security programs. Rick Tully with the Ohio Department of Mental Health presented an overview of government programs to assist in times of economic hardship. These included the Social Security Administration (SSA) income assistance programs—Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). To qualify for SSI and SSDI, one must not be able to “engage” in “substantial gainful activity” and one must have a documentable medically determinable disability.

Tom Gloss of the Social Security Administration conducted a session on the Ticket-to-Work—Work Incentives Program. Ticket to Work is a program for persons already on SSI or SSDI who want to work.

AD/HD is a qualifying medical disability for SSI for children. One has to have substantial limitations, but it is a qualifying disability. There are 194,026 children (under age 18) on SSI with a primary or secondary diagnosis of AD/HD.

Currently, there are no SSA medical disability criteria for AD/HD in adults. The law requires that there be a medically determinable impairment and that there be substantial functional limitations. Adults who meet the Diagnostic and Statistical Manual (DSM) criteria for AD/HD would meet the medically determinable impairment criteria. Then, SSA would determine the severity of disability and its relation to work. Failure to precisely list AD/HD in adults will be a major roadblock to some individuals becoming eligible for SSDI or SSI. There are no SSA regulations preventing an adult with AD/HD from becoming eligible.

For any of the mental disorders, one must have substantial limitations in specific areas such as activities of daily living, concentration, social interaction, and ability to adapt to changes in the environment.

The challenge: Many people with AD/HD and related disorders don’t have the severity of limitations to meet the SSI and SSDI test. But they also may not have the ability to sustain permanent and consistent full-time work. Finding a social policy that encourages work, reduces disability, and provides health insurance—while keeping the social safety net of SSI and SSDI—is a very difficult challenge. CHADD continues to work with national public policy makers to address these difficult issues.


You can read this blog and others like it at the HealthCentral website.