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This week the A&E channel  highlights Atlanta in a series of Intervention episodes focused on the “Heroin Triangle.”  Intervention documents individuals addicted to drugs and alcohol.  “The Heroin Triangle” consists of areas just outside of Atlanta, mainly in Cobb County.  Cobb County officials report a growing opioid and heroin epidemic.  Examples of opioids are morphine, hydromorphone, methadone, fentanyl, hydrocodone, codeine, tramadol and burprenorphine.  Heroin is an opioid drug made from morphine.  Research indicates that 80% of Americans using heroin first misused prescription opioids. 

The National Institute of Drug Abuse reports over 30,000 deaths last year from opioid overdose.  There were 20,000 overdose deaths from heroin and illicit opioids.  Drug overdose deaths in 2016 totaled approximately 64,000 people, making it the leading cause of death of individuals under 60 – exceeding car accidents.  Opioid death rates are highest for white males.

What is the cause of this opioid epidemic?  The New England Journal of Medicine (“TNEJM”) reports that the “widespread use of opioid analgesics has resulted in a national epidemic of opioid overdose deaths and addictions.”  Opioid analgesics are the most commonly prescribed class of medications.  Thirty percent of adults and forty percent of older adults suffer from chronic pain.  However, research suggests that opioids soon become the problem.  As TNEJM explains:  For a patient in chronic pain,  even mild levels of pain can trigger the learned associations between pain and drug relief, which are manifested as an urge for relief.  Such a conditioned urge for relief from even mild pain can lead to the early inappropriate use of an opioid outside of prescribed scheduling.  Given the current overdose and addiction epidemic, doctors and medical associations are starting to question the practice of prescribing opioids for chronic pain.    The Center for Disease Control reports that over 2 million Americans are estimated to be dependent on opioids and an additional 95 million are dependent on prescription painkillers.

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Last night Congress agreed to fund the government through December 22, 2017 and just hours ago the President signed that bill.  One of Congress’ constitutional obligations is to approve government funding.  The federal government’s fiscal year runs through October 1st to September 30th.   Because Congress cannot agree on spending priorities, particular the defense department, immigration and healthcare, annual funding has been delayed.  With the approaching holidays and more work to be done, another possible shutdown, days before Christmas, is a possibility.  According to Reuters, “the White House and lawmakers say the bill will give them more time to negotiate several end-of-year agenda items, including the budget, a children’s health program and hurricane aid.”   

For those of you who rely on SSDI or SSI monthly disability benefits, these will not be affected by a government shutdown.  However, for those of you who have pending claims before the Social Security Administration, there may be a slowdown in services.  It is hard to imagine that it could be any slower, but apparently that is possible.  If the shutdown lasts between 1-5 days, essential SSA employees will continue to work.  Ninety-seven percent of hearing office employees will report for work.  However, if the shutdown lasts for more than five days, SSA will “re-evaluate its contingency plan.”  We do expect that scheduled hearings will continue.  However, a shutdown that lasts beyond five days will furlough more employees and create more backlog in workloads.



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The Children’s Health Insurance Program (“CHIP”) is at risk of going belly up thanks to Congressional inaction on funding the widely popular children’s health insurance program.  Created in 1997, the program provides federal dollars to states to fund an insurance program for children whose families are low income, but earn too much to qualify for Medicaid.  CHIP benefits 9 million children nationwide.  In Georgia, that program is known as Peachcare.  Peachcare provides low cost (about $35 a month) health insurance coverage for children whose families earn below 200 % of the poverty level (roughly about $40,000 a year for a family of three).

While members of Congress from both parties agreed that the CHIP program should continue, neither the House nor the Senate can agree on how to fund CHIP.  CHIP provides about $13 billion in federal funds annually.  In November, House Republicans voted to fund CHIP by taking money from other public health programs (such as vaccinations).  House Democrats disagreed on that approach.

In Georgia, Medicaid and Peachcare cover over one-half of all the children in Georgia, approximately 1.3 million Georgia children.  Prior to 2018, CHIP had never had a lapse in funding.  State officials predict that Peachcare’s funds will last through Spring of 2018 if Congress does not fund this program over the next two weeks.  Meanwhile, both houses of Congress have passed a massive tax cut for this country.

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At 37 years old, Michelle had stopped working as a teacher due to complications with gastro paresis and rheumatoid arthritis. Gastro paresis is a disease that prevents her stomach from correctly digesting food. Because her stomach muscles did not work properly, she could not digest food. Michelle contacted me in May of 2015. She came into the office with her mother because she needed to file for Social Security Disability. Quickly into the conversation, Michelle and her mother made it clear that her debilitating disease was the gastro paresis from which she had no relief.
She suffered from intractable nausea and vomiting daily. She could not keep food down. Over the course of our two-year representation, she was hospitalized nine times in 2016; six times in 2015 and ten times in 2014. By 2016, she received all of medicine and nutrition through surgically implanted gastric port called a GJ- tube for short. Her days consisted of infusing a specialized high protein prescription formula and medicine into two different ports; cleaning the ports after use; and dealing with some very difficult bathroom issues. If she was not in her bed, she was in the bathroom, resting on the cold tile floor for relief from her nausea.

One would think that Michelle’s case would have easily been approved at application. It was not. In May of 2015, we filed an online application for Michelle and sent in a mountain of medical records. We continually faxed over medical records to SSA and spoke with the adjusters each time Michelle entered the hospital. Despite her ten hospitalizations in 2015 and favorable doctor’s statements, the disability review team at the SSA determined that she could stand and walk and lift and carry as necessitated by her job as a preschool teacher and her claim was denied.
We requested reconsideration of this denial in September of 2015 and that was denied again in March of 2016. In the time period from September of 2015 to March of 2016, Michelle had five additional hospitalizations. Her disability file indicates that the second level of review was denied because during one hospitalization, the treating doctor prescribed Humira (a drug to treat her rheumatoid arthritis) and the reviewing SSA doctor thought that would work and she would improve. Also, the reviewing team ignored her treating doctor’s statements that she met a medical listing. A medical listing is a list from SSA of conditions that are considered to be disabling. Continue reading →

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Women, who suffer from pain as a result of some kind of medical condition or disability, are much more likely to have their reports of pain dismissed. This is even though women may actually be more likely to suffer from pain due to physiological and other causes.

women in pain.jpgDoctors have known for very long now that women and men vary greatly in the way that they respond to certain drugs, and even the way that they feel pain. Women have hormonal cycles that determine their level of tolerance to pain. Their organs are smaller, and their bodies are made up of a much higher body fat composition, which means that drugs affect their bodies differently.

These differences are even more acute for those women who live with chronic pain across the country. As many as 25% of Americans suffer from chronic pain, and a significant proportion of those Americans are believed to be women. There are millions of women who currently live with symptoms of chronic pain, and many of them are on Social Security disability benefits.

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A new estimate indicates that the number of Americans who suffer from Alzheimer’s disease could triple over the next 4 decades, if there is no progress made in treatment soon. Any Social Security disability attorney would also be very concerned about the implications for these patients, considering the slowness with which disability claims are currently processed by the Social Security Administration.

Fortunately, The Social Security Administration recently added early onset/younger onset Alzheimer’s disease to its Compassionate Allowances program, which means that people who suffer from these conditions could have their Social Security Disability Insurance claim processed quicker.

The new estimates were reported in the journal Neurology, and researchers say that by the year 2050, there will be at least 40 million Americans who suffer from Alzheimer’s disease. Alzheimer’s is the most common form of dementia, which normally affects senior citizens, and results in symptoms like cognitive deterioration, mental impairment, and a progressive loss of memory.

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Contrary to the picture of a person with mental or psychological disabilities that has been painted by the media in the wake of the recent school shootings in America, the fact remains that people who suffer from mental disabilities are much more likely to be victims of violence, than perpetrators. According to World Report on Disability, violence is the number one cause of morbidity among disabled people.

The researchers analyzed data between 2009 and 2010 in the United Kingdom, and estimated the chances that a person, who suffers from physical or mental disabilities, would experience violence including sexual, domestic, physical and non-domestic violence.

The research found that people who suffer from a mental disability are much more likely to be victims of violence, and not perpetrators of violence. The report also found that persons who suffered from disability, suffered severe psychological impact after suffering violence. These people were deeply traumatized, and not surprisingly, also sustained a much higher economic burden after the violence.

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Multiple Sclerosis is an autoimmune disorder that is characterized by a general progression of symptoms. Over time, symptoms which typically affect the brain, the spinal cord and the central nervous system, will worsen making it impossible to perform even daily routine functions.

multiple_slerosis.jpgIt can be a challenge for a person who has multiple sclerosis to qualify for Social Security disability benefits. To qualify for benefits, it is important that your condition have lasted for 12 months or is expected to last for 12 months.

This can be easier to calculate for other conditions, but when a patient suffers from multiple sclerosis, it can become much more complicated because people who suffer from multiple sclerosis typically have periods during which they have no symptoms of the disorder at all, interspersed with relapses or periods of sickness. Additionally, the periods of sickness differ in intensity and severity.

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The Atlanta Journal-Constitution reported Sunday that Georgia is expected to announce a plan this summer that would dramatically expand the use of for-profit insurance companies in a new approach to managing Medicaid in Georgia.

Georgia’s Medicaid program costs $7.8 billion annually with the federal government covering seventy-five percent of the cost. Georgia pays approximately $2.3 billion dollars in Medicaid coverage. The federal matching dollar rate in Georgia is one of the highest in the country. This matching rate is based upon state poverty rates. Georgia predicts that this year Medicaid will have a $350 billion dollar deficit with projections to double in three years. David Cook of the Georgia Department of Community Health maintains that, “the current Medicaid program cannot be sustained.”

Roughly two out of ten citizens in Georgia receive Medicaid. The aged, blind and disabled make -up twenty-five percent of the two million Georgia residents receiving Medicaid. However, this group accounts for over half of all Medicaid spending. The bulk of costs for the elderly and disabled tend to come from long-term care.

State legislatures report that Medicaid costs are expanding and putting increasing pressure on state budgets. Legislatures attribute the cause to rising health care costs and an increase in enrollment numbers due to the stagnant economy. Medicaid enrollment in Georgia grew 9.5% from 2009 to 2010. Medicaid enrollment grew in every state during the same period. At the same time, the economic downturn means that state budgets are experiencing shortfalls, making it harder to meet Medicaid needs. In other words, as tax revenues dip, Medicaid enrollment swells. Conversely, when state revenue grows due to a strong economy, Medicaid needs diminish.


Persons with disabilities who are receiving Medicaid are doing so through a program called Supplemental Security Income (SSI). The SSI program covers disabled workers whose income and assets meet stringent resource tests. Unlike Social Security Disability Insurance, SSI is not dependent on years of paying into the disability insurance program through FICA taxes to qualify. SSI is a need-based program.

In an effort to restrain rising costs, many states are considering allowing for-profit managed companies to run the Medicaid program. Federal law prohibits states from lowering Medicaid eligibility. However, states can apply for waivers to test new or existing ways to deliver or pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP) programs. Under Section 1115, states can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP services. Under section 1915(b), states can apply for waivers to provide services through managed care systems.

Many health care advocates and medical providers question whether for-profit companies in a Medicaid model can improve care, spend less and earn a profit, particularly when provider payments are at the lowest level already. States that have implemented cost-cutting measures and/or hired for-profit managed care companies to run Medicaid programs instituted reforms such as charging higher co-pays to dissuade recipients from “unnecessary” treatments.

A significant body of research shows that while cost-sharing ideas (co-pays) may reduce Medicaid costs, they also create barriers to treatment for low-income populations. Shifting costs onto the population Medicaid was meant to serve – those who can least afford it – should not be an option. Those with permanent disabilities are often the most affected by Medicaid cuts. A chronic, medically disabling condition means one cannot return the workforce no matter what the state of the national economy.
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