The ABC’s of OCD, Disability, and TreatmentBy Shana Doronn, LCSW, Psy.D
So you have been diagnosed with a severe anxiety disorder and require more than one to two hours of therapy a week…What do you do? What if you have no financial resources and need to apply for public benefits? As a clinical social worker and doctor of psychology, many of my clients come to me with questions about insurance, disability benefits, income and proper treatment. I don’t always know all of the answers but I can most always put someone in the right direction. I would like to take some time to address “going out” on disability whether it be temporary or permanent. I call this process “Navigating the System.”
When “Navigating the System” of work or public benefits, disability, and insurance, one must be prepared to have patience and perseverance, as managing one’s care takes time. NOTHING HAPPENS QUICKLY!
It is a difficult decision to leave work due to disabling anxiety. If someone decides to take a leave, this typically indicates that they are going to receive a level of treatment that tends to the severity of the diagnosis, such as a residential or partial hospitalization program. The guiding reasons for taking a leave are severity of illness, financial concerns, and if one’s insurance will cover the cost of a specialized treatment program. In an ideal world, anyone whose diagnosis precludes them from functioning on a day-to-day basis would receive appropriate treatment, but this is not always the case.
Many people who take a short term leave for OCD and other anxiety disorders are planning to go into some kind of intensive treatment, such as partial or intensive out-patient program or a residential program. If you are considering taking a short-term leave of absence from work and would like to be paid for the leave, you must talk with your human resources person to determine what kind of short-term disability you have (or not). If you have disability insurance, you will then need your psychiatrist to put you on leave so you can attend a treatment program. Many people are in intensive treatment and/or residential programs for about 6 weeks or longer. Of course, this depends on whether or not insurance will cover that length of treatment. The goal is to get the necessary treatment and return to work and have the least amount of financial burden possible.
In conjunction with a short-term leave, the Family and Medical Leave Act (FMLA) may be able to provide protection for your job…Visit http://www.employer-employee.com/fmla.html#bytopic for more information. Not everyone is covered by FMLA! If you are covered by FMLA, most people will be able to take 12 weeks off work but this does not mean the leave comes with a financial benefit. Of importance is the opportunity to have your job to return to once treatment is completed. It is very important to work with the human resources department at your place of employment.
If one is not able to return to work and is considered disabled on a long-term basis, it is then important to look to long-term disability and Social Security Disability. If you are employed, discuss your benefits with your human resources department. If you are unemployed, you will need to consider Social Security to determine the appropriate course of action (1-800-772-1213).
Social Security Administration (SSA)
The SSA oversees two different long-term disability programs:
- Social Security Disability Insurance (SSDI, Title 2), and
- Supplemental Security Income (SSI, Title 16).
What Social Security Means by Disability
The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
"Disability" under Social Security is based on your inability to work. Social Security considers you disabled under Social Security rules if:
- You cannot do work that you did before;
- You cannot adjust to other work because of your medical condition(s); and
- Your disability has lasted or is expected to last for at least one year or to result in death. This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers compensation, insurance, savings and investments (http://www.socialsecurity.gov).
Requirements for Social Security Disability Insurance
The qualifications for Social Security Disability Insurance (SSDI) are more rigorous than those for SSI. To qualify for SSDI benefits, you must meet all of the following criteria: (1) Worked in a job covered by Social Security. (2) Worked in that job for 5 of the past 10 years. (3) Have a medical condition that prevents you from working and renders you disabled (according to SSA’s definition of “disabled”).
The most common factor that disqualifies SSDI applicants is not having worked five of the last ten years. However, even if you do not meet the Social Security’s requirements for SSDI benefits, you may still be eligible to receive Supplemental Security Income (SSI) (http://www.ssa.gov/dibplan/dqualify.htm).
The above information seems so simple, yet being approved of disability is very difficult and the process is lengthy and difficult. Many people I know have worked with attorneys to have a higher success rate of being approved for Social Security Disability. With that being said, it is up to the individual as to whether or not an attorney should be involved.
Social Security Disability Insurance (SSDI) - Medicare
SSDI is federal long-term disability insurance. It is an entitlement program; you must have paid into Social Security through F.I.C.A. payroll taxes in order to collect your Social Security Disability. Awards vary from $1 to about $2,300 (as of 2010) per month, and are based on work history and the amount of F.I.C.A. paid. To qualify, you must meet Social Security's definition of "disabled," meaning your disability will keep you from doing any kind of work at all for up to one year. There is a five-month waiting period before payment begins. You may backdate your claim as far back as your medical records substantiate disability. You may collect SSDI and State Disability together. After two years on SSDI payments you will receive Medicare automatically (Medicare coverage is considered good health insurance. (http://www.socialsecurity.gov).
Supplemental Security Income (SSI) - Medicaid
SSI is the Social Security program that guarantees a standard of income to people who are age 65 or older, blind or disabled with limited income and resources. Medicaid is a state-run medical program that is federally funded and pays for medical assistance for certain low-income people. Some of the people covered by Medicaid are certain children, the aged, the blind, the disabled and others with limited financial means. Usually, a person receiving SSI is eligible for Medicaid. In 32 states and the District of Columbia, Social Security makes Medicaid eligibility decisions for people receiving SSI or federally administered state supplementary payments.
In seven other states and the Commonwealth of the Northern Mariana Islands, people receiving SSI have to file a separate application with their Medicaid agency. In those states, the agency will use the SSI rules to decide Medicaid eligibility for the aged, blind and disabled receiving federally administered cash assistance. The seven states are: Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah.
The remaining eleven states require a separate application with the Medicaid agency and use their own Medicaid eligibility rules. Each of these states uses at least one Medicaid eligibility requirement more restrictive than the SSI program uses. The eleven states are: Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio and Virginia (http://www.socialsecurity.gov).
As you may have figured out by now having a disabling anxiety disorder and dealing with the financial and insurance aspects is by no means an easy task. Even with the best resources, it is not always easy to find care that is close in proximity or a therapist who will take insurance. The trend is that many OCD/Anxiety therapists no longer will accept insurance.
The sad reality is that there is a cost to care and not everyone can afford the care. Some might think it better to have a system like in Canada, but it is difficult to find appropriate care in Canada and many Canadians who can afford care comes to the US for treatment of OCD and other anxiety disorders.
The key to both “Navigating the System” and success in treating OCD/Anxiety is perseverance. Despite their complexity, Leave and Disability programs exist to help those in need, so if you and your therapist feel these programs are a viable option for allowing the delivery of treatment you need, make it your mission to understand the programs so, when it comes to choosing or qualifying for any of them, you’re well-informed.
Shana Doronn, LCSW Psy.D is in private practice in Barrington, IL and specializes in the treatment of OCD and other anxiety disorders. She is a member of the Scientific Advisory Board of Beyond OCD . Dr. Shana can also been seen on the show “Obsessed,” and seasons 1 and 2 can be viewed on Netflix. Email: Shanadoronn@msn.com; phone 310-903-7115.