Local ASOs respond to disability proposals

Posted on 07 Oct 2010 at 7:05pm

New guidelines are more specific but would require qualifying for benefits every three years

DAVID TAFFET  |  Staff Writer taffet@dallasvoice.com

Bret Camp
Bret Camp

The Institute of Medicine has published recommendations that would change guidelines for people living with HIV to apply for Social Security disability.

Bret Camp, Resource Center Dallas’ associate executive director for health and medical services, said the recommendations are a starting point for discussions about changing those qualifications.

To qualify, the institute recommended that a person’s T-cell count would have to be less than 50. Currently, a count of 200 or lower is generally needed to qualify.

The other major change is that persons qualifying after new rules take effect would have to requalify every three years. Currently, disability payments are for life.

Certain AIDS-related illnesses would qualify someone for disability payments no matter what the CD4-cell count is. Wasting syndrome, for example, would impair a person’s ability to function, the Institute of Medicine report said. Dementia, AIDS-related cancers, heart disease or hepatitis are other conditions they list that would qualify a person for disability payments.

“These seem fairly reasonable to me,” said AIDS Arms Executive Director Raeline Nobles. “Perhaps I would consider a CD4 of 100 rather than 50 — 50 does seem very low and indicates rather extreme health vulnerability.”

She said that by the time someone has a CD4 cell count of 50, chances are they have already experienced an opportunistic infection.

“However, current treatment, if ongoing and proactive and of high quality, does do miraculous things these days even for people with CD4s who drop well below 50,” she said.

“The Social Security Administration is beginning to revise the listing criteria for every condition starting with HIV,” Camp said. “Reevaluation has always been a goal for SSA.”

He said that because of strides in treatment of HIV over the last 15 years, this was a good place to start.

Current guidelines are not as specific, he said. Camp said he likes the specific enumeration of certain AIDS-related cancers and other infections.

He said he has worked with people who have been denied benefits with a CD4 cell count of 200 and seen people with a higher count receive them.

Nobles worried about compromising access to treatment because disability status impacts Medicare eligibility.

“That would be disastrous,” she said. “Sure, HIV treatment has come a long way — for those who have ongoing access to that treatment administered by specialists in the field. And therein lies the problem.”

Nobles is also worried about unforeseen problems with the changes.

“Often governmental entities seem to forget that a change in one area ripples throughout the entire system of care and support and has ramifications they should have thought about, but didn’t until it’s too late and significant issues/problems emerge,” she said.

Steve Dutton, executive director of Samaritan House in Fort Worth, said the proposed changes don’t surprise him.

“It’s going to be tough,” he said.

Dutton said he likes the addition of certain specific categories that qualify people for disability but worries about those who don’t quite fit into those categories.

“I hope there are still some gray areas,” he said.

Dutton also wondered about the motive.

“They’ll look for every opportunity to minimize the number of people covered,” he said.

He agreed that those who manage their disease well can go back to work without further need for disability payments.

But he worries about those who became ill and are too sick toward the end of the three-year period to go through the bureaucratic paperwork to qualify again.

For more on the report go online to iom.edu/Reports/2010/HIV-and-Disability-Updating-the-Social-Security-Listings.aspx

This article appeared in the Dallas Voice print edition October 08, 2010.

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